Sean Whitfield - WK 1-Module 1- NURS 3510 Chronic Illness ALG kjc 11.30.23 - Complete.pdf

Harding University NURS 3510 Module 2 Active Learning Guide Chronic Illness Purpose/Overview Active learning guides help students to focus their study time by...

Harding University NURS 3510 Module 2 Active Learning Guide Chronic Illness Purpose/Overview Active learning guides help students to focus their study time by using knowledge-level information and then focusing on the application and analysis of information to provide context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content and then work to complete the guide during and after to engage with the content. An active learning guide is different from a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. Instructions: Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will give you a preview of the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content prior to responding. The completed learning guide will be turned in one week before the exam. There are a possible 20 points for this learning guide. Reading Focus: In the text, you will see essential boxes, such as Assessment Abnormalities Tables, which discuss abnormal findings in the assessment of adults. Biologic Sex Consideration Boxes, which contain a summary of how the disease affects males and females. Clinical Judgment Model Case Studies at the end of every chapter are available to promote your understanding of the decision-making process. Many other tables and boxes are noted in the text that will bring out the most important information organized in an effective summary. Sean: BLUE Minton: GREEN Harper: PURPLE Clark: RED Boone: ORANGE A Sacred Covenant: The Spiritual Ministry of Nursing: Chapter 1 (pgs. 1-13) Chronic Illness 1. (2.1) Explain the characteristics of chronic illness. How does this differ from an Acute illness? Chronic Illness→ Diseases that are prolonged, do not resolve spontaneously, and are rarely cured completely. Chronic Illness Characteristics  Permanent impairment or deviations from normal.  Irreversible pathologic changes  Residual disability  Special rehabilitation required  Need for long-term medical and/or nursing management Chronic Illnesses Alzheimer’s Disease → 5.4 million. 6 th leading cause of death. Arthritis → 1 in 5 people. One of most common chronic illnesses. Cancer → 2 nd leading cause of death. COPD → 3 rd leading cause of death. Coronary Arterey Disease → 17 million people affected. Diabetes → Over 25.8 million people affected. 7 million do not know they have. 7 th leading cause of death. Obesity → Over 35% of adults are obese. Major contributor to other health problems. Stroke → 7 million people affected. 15 – 30% disabled. 4 th leading cause of death. Acute Illness→ Diseases that have a rapid onset and short duration. Ex., cold, flu or acute gastroenteritis. Acute Illness Characteristics  Usually self-limiting  Responds readily to treatment  Complications infrequent  After illness return to previous level of functioning Acute illness are easier to return to homeostasis or to the state before affected by acute illness. Chronic illnesses are diseases that the client needs to learn how to cope and live with. The ability to perform ADL’s will be impacted. a. Draw a picture that describes what comes to your mind when you think of someone with a chronic illness. Upload a photo to the discussion board and explain what you have drawn. (20 points; due Friday of module 2) Professor Notes: Living with chronic illness has a downward trajectory. A person may be functioning well and, in a short period of time, be physically unstable. Professor Notes: Nursing is important in promoting the health of people with chronic illness by supporting self-management. 2. How does the nurse promote health and manage a chronic illness? Diagnosis and treatment of the acute phase or acute exacerbations of a chronic illness are sometimes done in a hospital. Other phases of chronic illness are managed in an ambulatory care setting, at home, in an assisted living facility, or in a skilled nursing facility. The course of chronic illness is often unpredictable. The management of a chronic illness can profoundly affect the lives of the patient, caregiver and family. a. Hospital: An assessment of health status includes an individual’s level of daily functioning and his or her perception of relative health or illness. This health assessment includes activities of daily living, such as bathing, dressing, eating, toileting and transfer. It also included instrumental ADLs, such as using a phone, shopping, preparing food, housekeeping, doing laundry, arranging transportation, taking medications, and handling finances. Nurses play an important role in the management of individuals with chronic illness. This begins with planning care, teaching the patient and caregiver regarding the treatment plan, implementing strategies for symptom management, and assessing patient outcomes. b. Home: Because the majority of chronic illnesses are treated are in an ambulatory care setting, it is increasingly important for patients and caregivers to understand and manage their own health. The term self-management refers to the individual’s ability to manage his or her sysmptoms, treatment, physical and psychosocial consequences and lifestyle changes in response to livingwith a long term disorder. 2. List the seven tasks that people with chronic illness must face in their lifetime. Prevent and manage a crisis.  Carry out prescribed treatment regimen.  Control symptoms.  Reorder time.  Adjust to changes in course of disease.  Prevent social isolation.  Attempt to normalize interactions with others. Professor Notes: Stress plays an important role in the chronic disease trajectory. Your text states the following about stress. “Stress has a powerful effect on the mind and a significant effect on one’s health and well-being. The concept of stress directly relates to multiple other concepts. Chronic stress is a major factor in causing and worsening chronic health conditions. This, in turn, is a major driver of soaring health care costs.” Chronic illness provides physiologic and psychologic stressors. Stress, in turn, worsens our trajectory of chronic illness.  4. Describe the nurse’s role in health promotion and managing the special needs of chronically ill older adults: important to teach health promotion and management to increase personal responsibility for health and independent functioning; use to enhance self-care practices by older adults These listed below are interventions that the nurse may use and teach patients with chronic illness. 1. Create a personal identity that includes the chronic illness and any lifestyle adjustments that may be needed. 2. Prevent social isolation that may occur with chronic illness. 3. Manage symptoms so the patient can function the same or as near to it as a person without a disability. 4. Teach prevention.  a. Primary Prevention b. Secondary Prevention c. Tertiary Prevention 5. Nursing interventions and older adults with chronic illness. Professor Notes: Assessment: For older adults, the stress of an illness may lead to fear and anxiety. They may view healthcare personnel as helpful but perceive institutions as negative and potentially harmful places. Communicate a sense of concern and care using direct and simple statements, appropriate eye contact, direct touch, and gentle humor. These actions help the older adult relax in this stressful situation. Use the SPICES Model to assess geriatric clients: Please define each step. For example: S = assess sleep disorders, etc. S: Sleep disorders P: Problems eating I: Incontinence C: Confusion E: Evidence of Falls S: Skin breakdown Determine primary needs by assessing readiness for assessment, like bathroom, glasses, and hearing aids. Define these functional assessments: ADL, IADL’S: ADL–activity of daily living (walking, feeding, toileting, bathing, dressing) IADL–independent activity of daily living (managing finances, cooking, transportation, managing medication) How does a nurse evaluate mental Status? Mini Mental Status Exam 6. Describe each Care Alternative for the Elderly and Chronically Ill listed below. 1. Acute Ambulatory Care: Acute ambulatory care is outpatient care that provides the patient with the assessment, treatment and management of their illness. 2. Care Transition – Medicare; Medicaid: Because the transition of care from one setting to another can be challenging for patients, they’re given information and support to assist with the transition. Medicare requires nurses or social workers to develop transition plans for their patients in order to ensure the safest and most optimal transfer of care. 3. Rehabilitation: Rehab is designed to help patients recover from disability and adapt back to normal daily functioning. After rehabilitation and, occasionally, additional resources are supplied to the patient, they may be able to live independently.  4. Assistive Devices – How do dentures, glasses, hearing aids, walkers, wheelchairs, adaptive utensils, elevated toilet seats, and skin protective devices increase function? These devices all assist in the return to normal function as much as possible for the patient. Glasses, for example, allow a patient with vision decline to see clearly and perform ADL’s without difficulty. Walkers assist those with decreased mobility to still move around independently and complete ADL’s. 5. Safety – Falls, neglect, maltreatment: Due to sensory changes and a slower reaction time as we age, older adults are at higher risk for injury from falls than other people, most likely occurring in their home. In order to prevent this, review their living situation to assess necessary changes to prevent injury and implement safety measures. Some changes include colored step strips to make it easier for them to see where to step and prevent any falls as well as hallway and stairway handrails to prevent falls and assist ambulation around their home. Older adults are also at higher risk for neglect or maltreatment so performing an elder abuse screening is important as well as assessing their home and living environment for any indications of neglect so this can be reported to a social worker and increase safety. 6. Medication Use – polypharmacy: Polypharmacy is the use of multiple medications by a person who has more than 1 health problem and is a major cause of illness for older adults because they may not fully understand the purpose of all their medications and can be at risk for drug interactions or overdose. In order to prevent this, regularly having their medications checked at healthcare visits, encouraging them to have all of their medicines filled at one pharmacy, and educating on and implementing medication reminder systems can help them keep their medications organized and prevent misuse. 7. Prevention of Depression: Depression is very prevalent in older adults, especially those that are residing in institutional settings. Preventing depression in older adults is very important and can be done by performing a physical exam and tests to ensure their signs and symptoms are not those of an imbalance as well as assess for depression, encourage treatment and provide information on services to help them. 8. Restraints Use: Restraints can be dehumanizing and should only be used when the patient’s safety or the safety of others is in danger. If restraint use is considered, first try to assess why there’s a need for restraints by performing an assessment and then document. It is important to better understand why the patient may be acting out so an assessment of the patient while using open ended questions can give a more well rounded view of their behavior. Oftentimes, this behavior can be attributed to pain, unmet needs, or the effects of a medication which are all fixable for a patient without the use of restraints which risk causing a worse effect on the patient. 7. Evaluation: What are the discharge/ home care, etc., needs of the chronically ill, and what can nurses provide? They need a full discharge plan of care with appropriate supports and resources in place. Do a complete assessment prior to discharge this includes emotional, physical, and mental. Making sure the patient has the social needs and that they can be met. Checking to ensure that they can manage their illness at home and have the mobility needed to do so. Can they perform ADL’s and IADL’s. Making sure home health is set up if this is a need for the patient. Going over medication management and what that looks like for them. Education on all the medications that they have. Assisting with follow up appointments if necessary and ensuring they have available transportation. Education on nutrition and diet to make sure they are meeting the needs of nutrients for stability. Having assistive devices assessed and available if needed. Being an advocator for the client as they may not be able to understand certain things and help them be able to get the best care possible. Audio Visual Focus: Please watch this video “Multiple Chronic Conditions: A Day in the Life” https://youtu.be/XIG1ZQFxTvs Answer the following questions about the video. 1. What are “Mae’s responsibilities?” She is a wife, mother, cares for her father, husband, and children. She works full time and takes care of her own medical appointments. 2. What does a person with multiple chronic conditions have often? Medical healthcare appointments. 3. The amount of information from different sources can be what three things? Overwhelming, confusing, conflicting and impersonal 4. Multiple conditions may lead to which additional disease? Depression 5. What would be the best way to manage Mae’s healthcare? Having one individualized care plan created just for her treating her as a whole person rather than just from one disease to the next. Having her care plan team and family on the same page that builds a reliable support system. Website Focus Areas: Please view the following websites and follow the instructions listed with each link. www.healthypeople.gov (2.5) Search “older adults” review the first 5 Objectives: OA-02, OA-06, OA-03, IVP-08, OA-05 OA-02: Aimed at the use of inappropriate medication use in older adults due to the risk vs benefit of the medications. Goal of reducing the proportion of inappropriate medication usage. OA-06: Related to hospitalizations of older adults for pneumonia. In older adults pneumonia is the leading cause of death, and the goal of the objective is to reduce the hospitalization rate. OA-03: Goal of this objective is to reduce the number of emergency room visits in older adults as the result of a fall injury. Injuries in older adults have falls as the leading cause. IVP-08: This objective is also related to falls, but the goal of this objective is to reduce the number of deaths related to falls in older adults. The data collected as of 2021 for this objective shows that the trend is moving in the opposite direction of the goal. OA-05: This objective focuses on diabetes hospitalizations for older adults. Older adults with diabetes have a higher chance of hospitalization due to diabetes than other age groups. The goal for this objective is to reduce the number of hospitalizations for diabetes related problems. https://www.jointcommission.org/standards/national-patient-safety-goals/ (2.7) Look left of screen. Click on Hospital: 2023 National Patient Safety Goals. Look to left of screen. Click on simplified version. List the seven broad areas of concern for patients in the hospital setting. Correct identification of patients, improved communication between staff members, safe medication administration, use alarms safely, infection prevention, identification of safety risks for patients, improvement of health care equity, prevention of mistakes in surgery