Chronic Illness PDF

CHRONIC ILLNESS Previous Next  CHRONIC ILLNESS Chronic illness is a disease or other human health condition that is persistent or long- lasting in nature. course of the disease lasts more than three months. "chronic" comes from the Greek word chrono...

CHRONIC ILLNESS Previous Next  CHRONIC ILLNESS Chronic illness is a disease or other human health condition that is persistent or long- lasting in nature. course of the disease lasts more than three months. "chronic" comes from the Greek word chronos, which means lasting a long time. Previous Next  CHRONIC ILLNESS is long term or permanent, as opposed to acute. causes much disability in individual lives and needs to be managed well. It costs society and families a great deal of financial stress, loss of employment and is dysfunctional in all aspect. Previous Next  CHRONIC ILLNESS In ancient Greece, Hippocrates- the "father of medicine" distinguished diseases that were acute from those that were chronic. This is still a very useful distinction. Previous Next  CHRONIC ILLNESS  In medicine, the opposite of chronic is acute.  A chronic course is further distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between.  A chronic or long term illness means the person has to adjust to the demands of the illness and the therapy used to treat the condition. There may be additional stresses, since chronic illness might change the way a person lives, sees themselves and relates to others. Previous Next  CHRONIC ILLNESS Examples of chronic illness include: Diabetes Mellitus  Heart Disease Arthritis Previous Next  COPD Cancer * If it affects you for more than a few months, it’s often considered chronic illness Previous Next  CHRONIC ILLNESS NEEDS PRIORITY ON CHRONIC ILLNESS A. Employment B. Financial support C. Health D. Housing E. Self-esteem Previous Next  NEEDS PRIORITY ON CHRONIC ILLNESS A. EMPLOYMENT Difficulties will arise if the chronic illness is physically or psychologically limiting. If unemployed, a person will need to seek welfare payments from the government and this can become emotionally challenging. Previous Next  This can become difficult if primary wage earner in family becomes chronically ill which in turn can change whole dynamics of the family structure. Difficulties will arise if the chronic illness is physically or psychologically limiting. Previous Next NEEDS PRIORITY ON CHRONIC ILLNESS B. FINANCIAL SUPPORT Significant costs are associated with medical costs and treatment and in many cases a person may have multiple illnesses adding to these costs When a chronic illness impacts on employment opportunities there will be considerable financial strain Previous Next NEEDS PRIORITY ON CHRONIC ILLNESS C. HEALTH Chronically ill have significant health care needs such as: a. visits to a general practitioner b. followed by diagnostic tests c. pharmaceutical prescriptions Previous Next  d. consultations with specialists e. visits the hospital f. possible surgery Previous Next NEEDS PRIORITY ON CHRONIC ILLNESS D. HOUSING Modifications to a house may be required if a person has physical limitations such as ramps, handrails, and modified toilet and bathing facilities In some cases patients cannot stay in their homes as it is too far away from medical services Previous Next  NEEDS PRIORITY ON CHRONIC ILLNESS E. SELF-ESTEEM A person with a serious medical illness is at risk of developing associated emotional problems. They must take good care of their bodies and accept limitations as well as celebrating their strengths. Previous Next  FACTORS AFFECTING ACCESS TO RESOURCES: 1. Socio-economic status 2. Age 3. Disability Previous Next  FACTORS AFFECTING ACCESS TO RESOURCES:  A. Socio-economic status Many sufferers cannot work and have no income as their illness is that bad. They rely on the public health system.  Previous Next  They also have limited housing options which may not suit their needs. Physical wellbeing affected as they cannot afford nutritious foods Economic wellbeing affected as they cannot afford to pay bills Previous Next  FACTORS AFFECTING ACCESS TO RESOURCES: B. AGE ❑Youth do not have as much knowledge about what they could be doing to help prevent or maintain their illness, however they have greater skills in finding resources Older people are less mobile and usually have more than one chronic illness making all of their conditions worse Previous Next  FACTORS AFFECTING ACCESS TO RESOURCES: C. DISABILITY Those who are suffering from a chronic illness and also have a disability can find it hard to understand what is going on and do not know how to maintain their illness. One of the biggest fears is the uncertainty associated with a chronic illness. The condition may be sporadic ( IRREGULAR, INTERMITTENT, lasting only a short while.) Previous Next  POTENTIALLY STRESSFUL LIFESTYLE CHANGES IN CHRONIC ILLNESS 1. Giving up cherished activities 2. Adapting to new physical limitations and special needs 3. Paying for what can be expensive medications and treatment services. Previous Next  4. Diminished performance in their jobs and social functioning 5. Feelings of anxiety and sadness, often leading to depression. Previous Next  WAYS TO COPE WITH CHRONIC ILLNESS 1. Finding information - this can help if the person feels helpless or out of control. 2.Emotional support from others - family and friends, can be a source of great help. Previous Next WAYS TO COPE WITH CHRONIC ILLNESS 3.Setting concrete, short term goals - to restore certainty, power and control. Thinking about possible outcomes and discussing them with the doctor. This can help the person to face them before they become a reality. 4. Stay connected - Establish and maintain quality relationships with friends and family. Previous Next  WAYS TO COPE WITH CHRONIC ILLNESS 5. Take care of yourself. Don't allow worries about your illness to get in the way of eating property, getting rest and exercise, and having fun. 6. Maintain a daily routine of work, errands, household chores, and hobbies as much as possible. This will provide you with a feeling of stability amid the chaos and uncertainty of your illness. Previous Next  BEHAVIORAL MANAGEMENT IN CHRONIC ILLNESS Previous Next  BEHAVIORAL MANAGEMENT: similar behavior change or modification less intensive version focus is on changing behavior, while in behavior management the focus is on maintaining order. Previous Next  TWO (2) APPROACHES FOR ADDRESSING BEHAVIOR. 1. B. F. Skinner's approach anyone can manipulate behavior by first identifying what the individual finds rewarding. Once the rewards of an individual are known, then those rewards can be selected that the manager is willing to give in exchange for good behavior. Skinner calls this "Positive Reinforcement Psychology". Previous Next 2. Rogers proposes that in order to effectively address behavior problems, individual must be persuaded to want to behave appropriately. This is done by teaching the individual the difference between right and wrong including why he or she should do what is right believes that the individual must have an internal awareness of right and wrong. Previous Next  1. Chronic Disease management: The Expert Patient Previous Next  Are You an "Expert Patient"? Can your Doctor(s) say the following about you? Previous Next  "My Patient knows more or as much about the disease than I do; and enough about his/her symptoms that it is easy to communicate with him/her." Previous Next  What, you ask, is a "chronic illness". Health concerns are usually classified as either acute or chronic. Acute illnesses usually begin abruptly and last only a short time. Most people with an acute illness can expect to return to normal health. Ex. A strep throat is an example of an acute illness: it is easy to diagnose with a lab test and is cured with antibiotics. Previous Next  Chronic diseases are different. 1. They usually develop slowly, last long periods of time, and often are never cured. 2. In most cases, there is no cure. 3. The long-term effects may be difficult to predict. 4. Some conditions cause few problems. Previous Next  5. Others cause only episodic problems or symptoms that can be controlled with medication. 6. may severely limit a person's ability to work, go to school or take care of routine needs. Previous Next  Ex. of chronic diseases include, but are in no way limited to: diabetes, congestive heart failure, asthma, hypertension, chronic kidney disease, depression, irritable bowel syndrome, arthritis, emphysema, fibromyalgia, parkinsons syndrome, and multiple sclerosis - just to mention a few. Previous Next  Why is "Chronic Disease Self- Management" so important? Previous Next  For the person with a chronic condition, there is no way not to self-manage the disease/illness. If one retires from life and stays at home as a depressed person this is a type of self- management. On the other hand, many people learn to deal with their conditions and remain active, happy participants in life. Previous Next  CHRONIC DISEASE SELF – MANAGEMENT: Covers the ff: 1) knowing how to recognize and respond to changes in a chronic disease 2) dealing with problems and emergencies 3) using medicines and treatments effectively Previous Next  4) finding and using community resources 5) getting enough exercise 6) coping with fatigue, pain and sleep problems 7) maintaining good nutrition Previous Next  8) making decisions about when to seek medical help 9) working with your doctor(s) and other care providers 10) talking about your illness with family and friends 11) managing work, family and social activities Previous Next  It is the learning of the skills necessary for this later type of proactive disease/illness self- management that is the subject of this document. The information about developing the skills is fascinating; and, they (the skills) really are the key to DECIDING, and remaining active, happy participants with a quality of life as full as you can make it. Previous Next  Research and practical experience in North America and Britain are showing that today’s patients with chronic diseases need not be mere recipients of care. Previous Next  They can become key decision-makers in the treatment process. By ensuring that knowledge of their condition is developed to a point where they are empowered to take some responsibility for its management and work in partnership with their health and social care providers, patients can be given greater control over their lives. Previous Next  Self-management programs can be specifically designed (between you and your Doctor(s)) to reduce the severity of symptoms and improve confidence, resourcefulness and self-efficacy (a big word that basically means self reliance). Previous Next  2. WHY BECOME A CHRONIC DISEASE SELF-MANAGER? Previous Next  Why would people with chronic illnesses want to learn how to manage their disease symptoms? Why would their Doctors want them to learn and do these things? What is in it for both patients and Doctors? Previous Next  Little has been done to prepare patients for long-term management of their diseases. They face many challenges in coping with discomfort and disability and carrying out treatment programs on a regular basis. Previous Next  They need to modify behavior to minimize undesirable outcomes, adjusting their social and work lives to accommodate their symptoms and functional limitations and deal with the emotional consequences. Previous Next  For their care to be effective, they must become adept at interpreting and reporting symptoms, judging the trends and tempo of their illness and participating with health professionals in management decisions. The expert patients are "people who have the confidence, skills, information and knowledge to play a central role in the management of life with chronic diseases." Previous Next  WHAT IS CHRONIC DISEASE SELF- MANAGEMENT - Chronic Disease Self-Management; Self-Efficacy; great terms, but what do they really mean, and how does one start to become a Chronic Disease Self- Manager? Previous Next  Consider the following quotations associated with these concepts. 1) "Row Your Own Boat" - Chronic Disease Self-Management. 2) “Every bird flies with its own wings." Swahili proverb Previous Next  WHAT DO THE TWO QUOTATIONS HAVE IN COMMON? 1. First of all, the desire, then the knowledge,\ 2. then the action to take back control over your health, and your life. Previous Next  CHRONIC DISEASE SELF-MANAGEMENT READINESS TEST 1) How confident are you that you can keep the fatigue caused by your disease from interfering with the things you want to do? 2) How confident are you that you can keep the physical discomfort or pain of your disease from interfering with the things you want to do? Previous Next  3) How confident are you that you can keep the emotional distress caused by your disease from interfering with the things you want to do? 4) How confident are you that you can keep any other symptoms or health problems you have from interfering with the things you want to do? Previous Next  5) How confident are you that you can do the different tasks and activities needed to manage your health condition so as to reduce your need to see a doctor? 6) How confident are you that you can do things other than just taking medication to reduce how much you illness affects your everyday life? Previous Next DEFINITION OF CHRONIC DISEASE SELF- MANAGEMENT 1.Chronic disease self-management involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes. Previous Next  2. There are a number of key elements to this definition that will enable us to develop a practical concept of self-management. 3. It is important to note that these elements are about the behaviors of the patient, rather than models of self-management for health care systems, service providers or health professionals. Previous Next ELEMENTS OF SELF – MANAGEMENT: Entails engaging in activities that promote health; Involves managing a chronic condition by monitoring signs and symptoms; Entails dealing with the effect of a chronic condition on personal well being and interpersonal relationships; and Previous Next  Involves following a treatment plan prescribed to you by your Doctor(s). The definition of self-management encompasses a range of behaviors, as well as knowledge and attitudes and is an important starting point towards the development of a concept of chronic disease self-management. Previous Next STAGES OF BEHAVIORAL CHANGE: Pre-contemplation [not thinking of change] Contemplation [thinking of change] Determination [ taking preliminary steps to change] Action [ actively engaging behavior change] Maintenance [ sustained behavioral change] Relapse [ can occur at any point.] Previous Next  SOCIAL LEARNING Previous Next  The key principles of these theories as applied to chronic disease self- management are: 1. Disease management skills are learned and behavior is self-directed; 2. Motivation and confidence (including self- efficacy) in managing one's condition dictate an individual's success; Previous Next  3. The social environment (ie. family, workplace & health care system) support or impede self-management; and 4. Monitoring and responding to changes in disease state, symptoms, emotions and functioning improve adaptation to the chronic condition. Previous Next  3. BECOMING TRAINED IN CHRONIC DISEASE SELF-MANAGEMENT How do you become trained in Chronic Disease Self-Management? Previous Next  PRIMARY RESOURCES AVAILABLE: 1) Start with your own health insurance company. Call up the Customer Service folks in Plan, and ask if they offer "Chronic Disease Self Management Program" classes. Previous Next  My Internet searches indicate that many of the larger companies are offering such classes for their enrollees. And, in some cases, self-management is becoming a requirement of retaining insurance coverage! Previous Next  2) Go to your State's Home Website, and look up the Department of Health, and of Aging. In some cases they might be the same, in others, different. Call each and see if/when they will be offering classes in your city/county for Chronic Disease Self Management Program. Previous Next  3. Use one of the many Internet search engines to locate this statement: "(your state) Chronic Disease Self-Management Program (CDSMP)". This should help you locate classes in your state. In my state, they located classes by county and city. Some of the "bigger" states even offer classes derived from the original Standford research program. Previous Next  4. Use one of the many Internet search engines to ask locate this statement: "Chronic Disease Self-Management Program (CDSMP)". This should provide you with additional options. Previous Next  5. Finally, and probably the best source, from the original Stanford site where the concept was created, there is a link to each state’s CDSMP sites: http://patienteducation.stanford.edu/progra ms/cdsites.html If you go to this site, you can click onto your state and see which organizations in your state are licensed to offer the Chronic Disease Self-Management program. Previous Next  4. CONCLUSION Many people with chronic conditions, as well as family members who care for them, also suffer needlessly from the physical and emotional effects of their illness. By helping people change their behaviors and adapt to their conditions, self- management programs often increase people's Previous adherence to medical treatments, Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS Previous Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS Introduction: Aging is a normal progressive process, beginning at conception and ending in death. Aging is not synonymous with diseases but diseases become more common as age progresses. Previous Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS Usually the diseases present with non-specific multiple symptoms that involve many organs. Increasing age in the elderly is associated with the higher morbidity and frequent use of health services. Their illness tends to be chronic with no simple cure. This makes them more dependent on the family, society and health services. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS A. Confusion/Dementia Nursing Interventions: 1. Spend time with the Patient 2. Use touch to convey concern 3. Provide frequent reiteration of orienting data (e.g. time, place) Previous Next  4. Have clocks or calendars in the environment 5. Explain all actions, procedures and routines to the patient 6. Address the patient by his/her name  7. Keep a routine activities Previous Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS B. Constipation Nursing Interventions 1. Increase Fluid Intake 2. Daily Exercise 3. Increase fiber intake (e.g. fruits and vegetables) Previous Next  Complications associated with constipation include hemorrhoids from straining, anal fissures, rectal prolapse, and fecal impaction. Untreated constipation in institutionalized patients can lead to cemented lesions in the colon, megacolon, bowel blockage and perforation, peritonitis, and sepsis. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS C. Osteoporosis Nursing Interventions 1. Have adequate calcium in diet: · Milk/dairy products · Fish · Beans · Orange Juice · Cereal or read that have added calcium · Take calcium supplements Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS C. Osteoporosis 2. Get regular exercise 3. Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass. 4. Avoid large amounts of protein – rich or salty and caffeine foods. They can cause loss of calcium from the body. 5. Make the home safe to avoid accidents. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS C. Osteoporosis 6. Practice good posture. 7. Use good body mechanics when lifting objects (e.g. bend the knees instead of the back). 8. Do back exercises to improve posture. 9. Wear rubber-soled, low-heeled shoes that grip well. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS C. Osteoporosis 11. Avoid using a stool or bending over. 12. Put items frequently used within easy reach. 13. Use handrails when going up and down stairs. 14. Hormonal Replacement Therapy (HRT) for menopausal women as prescribed. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS D. Postural Hypotension (PH) Nursing Interventions 1. Get out of bed slowly and in stages. 2. Sleep with head of bed elevated several inches. 3. Have a daily fluid intake of 2 to 3 liters. Previous Next  4. Avoid hot showers or baths, may cause venous dilatation thereby, venous pooling. 5. Avoid straining at stool. This may cause fall of BP Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS D. Postural Hypotension (PH) ▪ 6. Avoid bending down and suddenly standing up again. ▪ 7. Rest for 60 minutes after meals. ▪ 8. Avoid hyperventilation. This lowers the BP. ▪ 9. Exercise regimen must be recommended. ▪ 10. Use thigh-length elastic stockings to reduce venous pooling. Previous Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS D. Postural Hypotension (PH) 11. Avoid prolonged standing. 12. Heed warning signs of PH (e.g., dizziness, faintness, visual disturbances) 13. Pharmacotherapy: Fludrocortisone (a mineralocorticoid that promotes retention of water and sodium) Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS E. Hypertension Nursing Interventions 1. Encourage stress reduction and relaxation. 2. Encourage exercise such as swimming and walking. 3. Encourage healthy diet (fresh fruits, rice, vegetable). Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS E. Hypertension 4. No weightlifting. 5. Quit smoking, no alcohol, 7. Reduce salt intake to 1 to 6 gm per day. 8. Take prescribed medications at regular basis. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS F. Elder abuse Types of abuse used against the elderly. They include: 1. Psychologic abuse such as instilling fear, threatening or making the elderly perform demanding tasks, 2. Physical abuse such as hitting, slapping, or burning. 3. Financial abuse such as taking their money or forcing them to sign over their assets. Previous Next KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS F. Elder abuse 4. Neglect such as withholding food, medications or basic care. 5. Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions. 6. Sexual abuse Previous Next  KEY PROBLEM AREAS EXPERIENCED BY PATIENTS WITH CHRONIC ILLNESS The perpetrator of abuse is usually the spouse or the children of the victim. Caregivers who abuse their elderly family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse. Previous Next Previous Next