Midterm Study: Chronic Disease Management, Renal Failure, and More (PDF)

Okay, here is the converted text from the images into a structured markdown format. # CHRONIC DISEASE MANAGEMENT **Illness Trajectory Model** Describes the progression of chronic illness over time * **Crisis Phases** sudden onset or worsening of the condition * **Chronic Phase** long-term mana...

Okay, here is the converted text from the images into a structured markdown format. # CHRONIC DISEASE MANAGEMENT **Illness Trajectory Model** Describes the progression of chronic illness over time * **Crisis Phases** sudden onset or worsening of the condition * **Chronic Phase** long-term management and adaptation * **Terminal Phases** end-of-life care when the disease becomes Life-threatening **(Shifting Perspectives Model)** Emphasizes that people's experiences with chronic illnesses change over time. * Sometimes illness is the focus (dominates their life) * Other times they focus on well-being - adapting to their condition and maintaining a good quality of life **(Expanded Chronic Care Model)** Suggests a more holistic approach to chronic disease care * Healthy Public Policy & government policies supporting health * Supportive Environments & safe housing, strong social networks * Strengthening Community Action & working with local groups to improve health * Self-management Support & teaching patients to take control of their condition * Delivery System Redesign & moving away from short-term treatments to long-term care * Decision Support & using the best available evidence for patient care * Information Systems using data to improve care and monitor progress **(Self-Management Framework)** Highlights 4 key tasks for managing chronic illness 1. Processing Emotions & dealing with the emotional impact of illness 2. Adjusting to Changes & adapting to new limitations & Lifestyle shifts 3. Integrating Illness into Daily Life & Finding ways to live a fulfilling life despite the illness 4. Determining the meaning of illness & understanding how it affects life decisions. Presents a systematic way of understanding healthcare team efforts to the burden of chronic diseases among patients living with the disease + also supporting people + communities to be healthy Successful self-management is related to better overall physical + psychological health outcomes * self-management is the daily activities that individuals take to keep the illness under control # APPROACHES TO IMPROVE CHRONIC ILLNESS MANAGEMENT **(Integrated Palliative Care)** is not just end-of-life care * Helps patients live well despite chronic illness * Supports symptom management & informed decision-making * Encourages seamless collaboration among health care providers * Continues support for families after the patient dies * Emphasizes good communication between patients, families, healthcare teams **(Trauma-Informed Practice (TIP))** Experienced trauma may affect their health care experience Trauma results from experiences that overwhelm a person's capacity to cope * Trauma Awareness & understanding that trauma affects many patients * Safety Trustworthiness & creating a supportive + nonjudgmental health care environment * Choice Collaboration & empowering patients to make their own decisions * Strength-based Approach & focusing on patient resilience + self-efficacy * Cultural Sensitivity & recognizing historical + gender-related trauma **(Theories of Learning)** 1. **Behaviorism** = learning happens through reinforcement & rewards * B.F. Skinner 2. **Cognitivism** = learning is an active, logical process of organizing information 3. **Humanism** = learning is personal & emotional * Carl Rogers 4. **Constructivism** = knowledge is built through experience & reflection 5. **Andragogy** = adults learn best when information is relevant to their lives * Malcolm Knowles # RENAL FAILURE **Pre-Renal** Not the kidney itself blood volume + sepsis * Sudden $\downarrow$ in blood flow (perfusion) to the kidney * Can be reversible if perfusion is restored * Epithelial cells become damaged * Main Function is impaired- often leads to AKI * **Causes** * $\downarrow$ blood volume * $\downarrow$ BP -- HF liver cirrhosis * Renal artery stenosis * Renal vein thrombosis **Intra-Renal** The Kidney itself * Kidney is directly affected ie. Acute Tubular Necrosis (ATN) * Doesn't respond to Fluid resuscitation * **Causes** * Nephrotoxic medications * Infection * Inflammation * Ischemia **Post-Renal** Obstruction in bladder/ureter * Typically caused by an obstruction * Can be reversible if found quickly * **Causes** * BPH * Kidney/bladder stones * Obstructed urinary catheter * Bladder ureteral renal malignancy **ACUTE RENAL FAILURE** * MI * Hemorrhage * Obstruction * Hemolytic syndrome (E. coli) * Medications * Glomerulonephritis Generally shorter duration + reversible **CHRONIC KIDNEY DISEASE** * Diabetic nephropathy * HTN * MAIN CAUSE * Prolonged obstruction * Nephrotic syndrome * Polycystic kidney disease Gradual onset, managed but not reversed * Treatments * $\downarrow$ volume replacement * Treatments * identify cause & treat appropriately NOTE: NSAIDs inhibit prostaglandins AVOID TAKING WITH CKD! * Treatment G identify cause * progressive, irreversible decline in kidney function Cannot stop it but can slow it down GFR $\lt$ 60 for months / longer GFR is a calculation that indicates serum creatinine, age, gender **Stages**$ 1. GFR 90 damage + normal function 2. GFR 60-89 mild CKD 3. A. GFR 45-59 moderate CKD 4. B. GFR 30-44 to moderate CKD 5. GFR 15-29 → severe CKD 6. GFR <15 → ESKD, dialysis/transplant **Causes** * diabetes, HTN, autoimmune diseases, urinary obstruction PKD # DIALYSIS OPTIONS **HEMODIALYSIS (HD)** * blood is removed, filtered through a dialyzer and returned to the body * requires vascular access * performed in dialysis centers or at home * uses diffusion, osmosis, ultrafiltration to remove toxins excess Fluids, lytes * typically done 3-4 times/week for 3-5 hrs / session. * Types of ACCESS: 1. Arteriovenous (AV) Fistula = surgically connects an artery & vein, 6-12 weeks before usage, lowest risk of infection/bleeding PREFERRED 2. Arteriovenous (AV) Graft = synthetic tube to connect an artery & vein, 2-4 weeks before usage, higher risk of infection/clotting. 3. Central Venous Catheter = immediate dialysis access, jugular/subclavian/femoral vein, highest risk of infection TEMPORARY. | Pros | VS. | Cons | | :----------------------- | :------------------------------- | :------------------------------------- | | efficient waste & fluid removal | requires vascular access surgery | strict dietary & fluid restrictions | | ↓ risk of peritonitis | | frequent trips to dialysis centers | | performed by healthcare professionals | | can cause ↓, BP muscle cramps infection | **PERITONEAL DIALYSIS (PD)** * uses peritoneal membrane in the abdomen to filter waste surgical catheter to allow fluid exchange *dialysate fluid is introduced into the peritoneal cavity → waste | Fluid pass From the blood into the dialysate<br> 1. Continuous Ambulatory = manual exchanges done 4-5 times/day dialysate placed for 4-6 hrs (drained/replaced), no machine. 2. Automated uses a cycle to perform overnight uses machine | Pros | VS. | Cons | | :------------------------------------------------------- | :---------------------------------------------------------- | :----------------------------------------------------------- | | done @home fewer dietary restrictions better BP control | risk for peritonitis requires good manual dexterity& hygiene | ↓ for obese or abdominal adhesions & ↓ efficient waste removal | | no need for access | | | **DIALYSIS TYPES FOR DIFFERENT TYPES OF RENAL FAILURE** *AKI(Acute kindey injury) -> Hemodialysis temporary prefereed* more effective for rapid wastes / toxins / fluid overload & requires in hospital settings * **Types used** 1. Intermittent Hemodialysis (IHD) = 3-4 times / week 2. Continuous Renal Replacement Therapy (CRRT)= in ICU for $\downarrow$ BP can need a slow continous over 2 hrs **CKD(Chronic kidney disease)* Depends on pt health, lifestyle, medical conditions * Avoid for HD for elderly/ frail petent & difficult vascular ccess(d) *AVIOD PD for stable BP , mild CKD symptoms For young pt , no sever heart disease / obes , with poor hygiene with cognitive impairment. ## Comparison Table of Hemodialysis (HD) and Peritoneal Dialysis (PD) | Feature | Hemodialysis (HD) | Peritoneal Dialysis (PD) | | :--------------------- | :--------------------- | :----------------------- | | Location | Dialysis Center/Home | Home-based | | Frequency | 3-4 Times/week | Daily(CAPD 4-5/day; APD=PM) | | Efficiency | More For sever CKD | Less For advanced CKD | | access | AV Fistula, graft or catheter | Abdominal catheter | | Diet Restriction | Strict(Low potassium, Phosphorus) | Less strict | | infection | Bloodstream(Sepsis) | Peritonitis | NOTE: dont want to use PD as if takes longer to remove toxins, ↑ the risk of peritonitis # TRAUMMATIC BRAIN INRURY & ALZHEIMER'S DISEASE **TBl(TRAMMATIC BRAIN INRURY )** Brain dysfunction caused by external source **Types** 1. Concussion(Mild) brief LOC or altered mental statests headache dizziness confusion nausea 2. Diffuse Axonal Injury - severe damage to brain's white + Immediate Unconsionsnes ↑1P,poor Prognsisi, and 5+5 conna- abnormal& Brain Tissu 3. Focal Injuries (local) * Epidural and rapid * Intracerebral : Brain Tissu **Medical Mangemnet for Thi** *ABC's! * Monitor ICP * Medication - osmatic Diuretics, anticonvulsants, pain control NOTE: NEVER GIVE OPIOD - it DePresses RESP(Response) *Alzheimer Dissse- Progessive Degenerative Disorder Causing Bran CEll death # Stages Signs and Symptoms 1. EaRiy 5TaGe = subtic short term Memory loss difficulty Problem So ving-Decision Making, confusion time and Place, anxiety mood changes 2. middie StaGe = memory loss difficulty with language + communiction, Wandering Getting lost, Personality behavior change 3. ate TaGe. Seure COGenitive decline Lost ability for Al, Incontinent, + tal dependence #### TREATMENT **Drug Intractions** * NSAIDS(IbuP rofen) T Rish Stomach (ucers bleeding * BEta B10cKers(metoprolo), HK to much #### 7A of Aizheimer 1. aMNesia - Menng 10 ss 2. apHasia - (2iculty SKesking 3. agNOSIa abuty to Recounize Q6iects People # NEUROLOGICAL DISORDERS **Autism Spectrum Disorder** Neurodevelopmental disorder affecting social interaction, communication, & behavior Characterized by : Difficulty in Scoial 1nteraetions Restric Ted + Retitive Betavious Vaniel Level: **The levels** 1. Requing Support 2. Requiring subtsantial support 3. Requiring Very subtsantial support **ADHD** Neoro deuelopmented order affecting abtentons impulsuity+ Hypor achivity **Types** 1. *Redominantly 1nattentine ADH -1 2. *Redominately typoractue, impulso ADH-t 3. Combind ADHA-C | TYPE | EXAMPLES | PURPOSE | | :------------------- | :--------------------------- | :-------------------------------- | | Rescue (Quick Relief) Meds | abertol, sabutamol | Relaxes aurmay Musce for immediat relef | | Daily [COnrtioller] Meas, | Hicasone, Brdesnnie | 8 a inflammation long term |