Chapter 13 Summary Of Serious And Disabling Chronic Health Illnesses PDF
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This document summarizes Chapters 13 on serious and disabling chronic health illnesses, focusing on causes, management, and coping strategies. It details initial reactions to diagnosis, influences on coping with acute versus chronic conditions, and factors relevant to crisis theory.
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1 CHAPTER 13 SERIOUS AND DISABLING CHRONIC HEALTH ILLNESSES: CAUSES, MANAGEMENT, AND COPING CHAPTER OUTLINE I. Adjusting to a Chronic Illness A. Initial reactions to having a chronic condition 1. Sequence of reactions a. shock is u...
1 CHAPTER 13 SERIOUS AND DISABLING CHRONIC HEALTH ILLNESSES: CAUSES, MANAGEMENT, AND COPING CHAPTER OUTLINE I. Adjusting to a Chronic Illness A. Initial reactions to having a chronic condition 1. Sequence of reactions a. shock is usually the first reaction after being diagnosed i. phase characterized by feeling stunned/bewildered, behaving in automatic fashion, and feeling detached from situation ii. more pronounced when little warning b. the next phase is a period of emotion focused coping such as denial or grief c. patients tend to come to the reality of their situation and reach some form of adjustment 2. Use of denial and other avoidance strategies a. allow patient to control emotional responses to stressor i. usefulness has limits and may become maladaptive e.g., they may gain less information about condition. B. Influences on coping with a health crisis 1. Initial reactions to acute versus chronic conditions a. first phases in coping are similar regardless of whether the condition is acute or chronic b. unlike acute conditions, chronic problems require patients and families to make permanent behavioral, social, and emotional adjustment 2. Crisis theory describes factors that combine to influence adjustment during crisis. a. factors contributing to coping process i. illness-related factors ii. background and personal factors iii. physical and social environmental factors 3. Illness-related factors a. some illnesses pose a greater threat than others i. may be more disabling, disfiguring, painful or life-threatening ii. annoying or embarrassing changes to body functioning cause difficulty in coping iii. conditions that drawn attention from others can raise feelings of self-consciousness or of being stigmatized b. aspects of treatment regimen i. may be painful or have medications with severe side effects ii. require treatment schedules or time commitments that 2 interfere with their lifestyle and holding a job 4. Background and personal factors a. people who cope well with chronic health problems have psychological and behavioral resources to deal with them i. often have hardy or resilient personalities b. other factors that influence coping. i. age ii. gender - men more threatened by conditions that decrease vigor and physical capabilities or place them in a more dependent role iii. social class iv. philosophical or religious commitments v. emotional maturity vi. self-esteem c. timing of health problem in life span i. young children - concerned with restrictions on lifestyle, frightening medical procedures, or being separated from parents. ii. adolescents – can understand illness, but the need to be accepted by peers can lead to difficulty coping iii. early adults - resent not having the chance to develop life in desired direction iv. middle-aged adults - concerned with disruptions to established roles and lifestyles v. older adults - resent not being able to enjoy leisure after a lifetime of work d. impact of self-blame i. higher levels of self-blame for condition are related to poor coping and depression 5. Physical and social environmental factors a. physical aspects of environment i. dull or confining atmosphere of hospital may depress morale/mood ii. home environment may interfere with getting around or lack special equipment needed b. social aspects of environment i. presence of social support generally helps patients cope. ii. sometimes the social network can undermine coping with poor examples or advice iii. primary social support comes from immediate family or friends and neighbors iv. support groups exist for many illnesses C. The coping process 1. Section introduction a. stages in coping process according to crisis theory i. coping begins with cognitive appraisal ii. outcome of appraisal leads to developing array of adaptive tasks and applying coping skills to these tasks 3 2. The tasks and skills of coping a. two types of adaptive tasks i. tasks related to illness or treatment 1. coping with symptoms/disability 2. adjusting to hospital environment/medical procedures 3. establishing good relationship with physician ii. tasks related to general psychosocial functioning 1. controlling negative feelings/maintaining positive outlook 2. maintaining self-image and sense of competence 3. preserving good relationships 4. preparing for uncertain future b. tasks can be difficult, especially when health problems may lead to disability, disfigurement, or death c. patients adapt well when family members participate in actively, encourage self-sufficiency, and respond to needs in a caring manner c. coping strategies for chronic health problems i. denying or minimizing seriousness of situation ii. seeking information about health problem and treatment procedures iii. learning to provide one’s own medical care iv. setting concrete limited goals v. recruiting instrumental and emotional support vi. considering possible future events vii. gaining a manageable perspective d. some coping skills may be more appropriate for dealing with some tasks than others 3. Long-term adaptation to chronic health problems a. process of adaptation i. defined as making changes to adjust constructively to life’s circumstances and enhance quality of life - quality of life - degree of excellence in one’s life b. effective long-term coping is related to having psychological resources to appropriate coping strategies i. heavy use of avoidance is related to poor adaptation II. Impacts of Different Chronic Conditions A. Asthma 1. What Is asthma? a. clinical characteristics i. a respiratory disorder involving bouts of impaired breathing due to inflamed and obstructed airways 4 b. asthma statistics i. 6% of the population suffers from asthma. ii. prevalence higher in children - 1/4th childhood asthma gone by adulthood iii. about 4,000 asthmatics die due to attacks each year - death rates for children higher in African Americans iv. leading cause of short-term disability in US - 14.5 million lost work days,14 million lost school days, 2 million emergency room visits, and 465,000 hospitalizations 2. The physiology, causes, and effects of asthma a. most asthma attacks begin when immune system is activated in allergic response. i. bronchial tubes release histamine which causes bronchial muscles to become inflamed, spasm, and produce mucus. ii. tissue damage leading to greater likelihood for future attacks can occur. b. causes of attacks i. presence of triggers usually prompts attacks - personal factors - respiratory infections; anger or anxiety - environmental conditions - air pollution, pollen, or cold temperature - physical activities - strenuous exercise ii. individual differences in triggers occur iii. main triggers tend to be allergens c. role of immune processes in asthma i. evidence of bone marrow donors transmitting their allergies and asthma to recipients d. factors that cause asthma to develop i. heredity ii. history of respiratory infection iii. exposure to cigarette smoke 3. Medical regimen for asthma a. three components for treatment i. avoiding known triggers ii. using medications such as bronchodilators and anti- inflammatories iii. exercising b. treatment regimen tend to combine fitness training and medication. i. adherence to regimen is important - many asthmatics don’t take medication to prevent attacks or take it incorrectly during attacks 5 4. Psychosocial factors in asthma a. attacks may be triggered by stress or emotional states b. suggestion may trigger an attack i. evidence - placebo study using graduated strengths of allergen, false feedback of airway obstruction, and placebo asthma medication c. asthma attacks have been related to family maladjustment i. living with asthma may lead to emotional problems in family ii. maladjustment in family may lead to asthmatic episodes B. Epilepsy 1. Section introduction a. clinical characteristics i. recurrent, sudden seizures due to cortical electrical disturbances b. types of epilepsy i. grand mal or tonic clonic attacks begins with a loss of consciousness with progression to muscle spasms. ii. milder forms of seizures involve staring blankly and slight facial twitching c. epilepsy statistics i. prevalence rates are that condition affects 1% of worldwide population - 2.5 million in U.S., 180k new cases a year - many are undiagnosed and untreated ii. 1/3 of epileptics experience first seizure before age 20. iii. risk factors - family history - severe head injury - infections of the central nervous system - stroke d. what to do for a seizure i. prevent injury from falls or flailing ii. do not put anything in the person’s mouth iii. do not restrain the person iv. if the person hasn’t come out of attack within 5 minutes, call ambulance v. when person regains consciousness, describe what happened and see if help is needed 2. Medical regimen for epilepsy a. main medical treatment is anticonvulsant medication i. must be taken regularly to get appropriate serum concentration in blood b. surgical options i. may be used if attacks are frequent and severe and other methods haven’t worked ii. 80% may be symptom-free after surgery 3. Psychosocial factors in epilepsy a. epileptic condition may stigmatize the person among people 6 who don’t understand i. seeing an attack may arouse fear in observers b. having strong seizures may be associated with cognitive and motor impairments that limit eligibility for certain activities or jobs c. how epilepsy is related to other psychosocial factors i. emotional arousal may trigger attacks ii. severe and frequent episodes may result in poor adjustment, anxiety, or depression C. Nervous system injuries 1. The prevalence, causes and physical effects of spinal cord injuries a. clinical characteristics of spinal cord injury i. compression, tear or severing of the spinal cord resulting in loss of motion, control, sensation or reflexes ii. degree of impairment depends on amount of damage and location - quadriplegia/tetraplegia - paralysis resulting from spinal cord damage in the neck region - paraplegia - paralysis in legs when spinal cord damage is lower in spinal column b. spinal cord injury statistics i. 250,000 persons have spinal cord injuries with 11,000 new cases each year ii. majority of cases are males under 30 years of age iii. common causes of spinal cord injuries - automobile and motorcycle accidents - falls - sporting activities - wounds c. physical effects of spinal cord injuries i. long-term effects - full extent of recovery difficult to predict for six months - if spinal cord not severed, considerable recovery may occur over a long time - if spinal cord is severed, autonomic functions may recover, but other functions not d. progress of care i. initial care is directed toward medical needs ii. once condition is stabilized, rehabilitation begins iii. major goal for psychologists during rehabilitation is to help patient adjust to demands and limitations of rehabilitation 2. Physical rehabilitation a. goals of rehabilitation i. regaining as much physical functioning as damage will allow ii. becoming as independent in functioning as possible b. phases of rehabilitation i. initial phase - developing bladder/bowel control and maintaining range of motion 7 ii. intermediate phase - improve function in muscles over which person has control iii. last phase - extend therapy to include activities of daily living 3. Psychosocial aspects of spinal cord injury a. main challenges after spinal cord injury i. average years of life for quadriplegics is 38, 45 for paraplegics ii. need to learn to make most of remaining abilities and lead a full life b. family and friends may influence adjustment i. providing the opportunity for patient to redefine self- concept ii. providing social support without being overprotective c. role changes in wage earning and family responsibilities may occur d. concerns with sexual functioning and fertility vary with gender. i. serious barriers to sexual functioning are psychosocial in nature ii. counseling and education can reduce these barriers e. other psychosocial experiences i. negative thoughts about themselves, future, and relation to others ii. physical barriers in the environment iii. being treated strangely by others may reduce self- esteem, contribute to depression and substance use D. Diabetes 1. Section introduction a. clinical characteristics of diabetes mellitus i. too much glucose in the blood, or hyperglycemia, occurs because of insufficient insulin produced by the pancreas b. prevalence i. prevalent illness worldwide ii. 13 million diagnosed and 5 million undiagnosed cases in US iii. prevalence increases with age iv. women of color are at greater risk 2. The types and causes of diabetes a. Type I or insulin-dependent diabetes mellitus i. typically develops in childhood or adolescence ii. accounts for 5-10% of cases iii. autoimmune processes have destroyed cells of pancreas iv. injections of insulin are required to prevent complications - ketoacidosis - high levels of fatty acids that lead to kidney malfunctions allowing waste buildup which poisons the body b. Type II or non-insulin-dependent diabetes mellitus 8 i. most prevalent form of diabetes ii. pancreas produces some insulin iii. treatment involves special diets and medication iv. usually appears after age 40, in the overweight v. in overweight Type II cases, bodies appear resistant to glucose-reducing action of insulin vi. in normal weight Type II cases, pancreas produces less insulin c. causes of diabetes i. genetic factors found in heredity studies ii. Type I cases are linked to viral infection iii. Type II cases are linked to diets high in fat and sugar, stress, and over-production of protein that impairs metabolism of sugars/carbohydrates 3. Health implications of diabetes a. diabetes as a direct cause of death i. 70,000 deaths are caused by diabetes annually due to acute complications - acute complications can be avoided by following recommended medical regimen b. diabetes as an indirect cause of disabling health problems i. health problems associated with diabetes include neuropathy, blindness, kidney disease, gangrene, heart disease, and stroke ii. indirect effects of diabetes are due to impact on the vascular system 4. Medical regimens for diabetes a. main approaches to treating diabetes i. medication, diet, and regular exercise under medical supervision ii. risks associated with diabetes can be markedly reduced if diabetics carefully follow treatment regimens iii. full extent of reduced risk unclear because long term complications don’t appear for many years 5. Do diabetics adhere to their regimens? a. noncompliance is a major problem in managing diabetes. i. diabetics tend to administer wrong dosage of insulin, test glucose incorrectly, do not follow recommended diets b. adherence to regimen i. diabetics try to adhere but base behaviors on inaccurate perceived symptoms ii. many diabetics can make crude estimates of their glucose, but are not usually very accurate iii. diabetics often have more difficulty following dietary and exercise than the medical aspects 6. Self-managing diabetes a. components of self-care activities i. self-monitoring blood glucose - testing blood for presence of glucose - tests may be done once or several times a day 9 ii. taking insulin and oral medication - medications can increase insulin production or decrease glucose production - insulin injections may be used, the dosage depends upon size, age, food intake, and activity level - insulin pumps may be used to deliver drug continuously - knowing how much insulin to inject is difficult to judge iii. diet and exercise. - recommended diets focus on reducing sugar and carbohydrates, achieving healthy body weight, and maintaining balanced intake of nutrients - physical activity burns glucose so regular exercise complements dietary efforts 7. Psychosocial factors in diabetes care a. compliance to diabetes treatment regimen i. diabetes treatment regimen tend to have all the characteristics that lead to low compliance - complexity - long duration - requiring changes to lifestyle - focus on prevention instead of cure ii. perceived social support and feelings of self-efficacy affect compliance. b. coping processes i. stress affects blood sugar levels. - directly affects levels of epinephrine and cortisol which cause pancreas to decrease insulin production and liver to increase glucose production ii. indirectly affects blood glucose through effects of nonadherence iii. loss of personal control can lead to severe depression, which can effect glucose control c. life circumstances i. testing glucose levels affected by embarrassment, forgetting, sleeping patterns, poor diet judgments ii. temporary weight gain can occur when glucose is controlled, leading some to stop taking insulin to control weight iii. dietary recommendations may be incompatible to food habits in certain ethnic groups iv. feelings of frustration may occur when diet is followed but glucose targets aren’t met v. if patients don’t feel ill they tend not to follow regimen d. differing patient and doctor goals i. research has revealed that children’s blood glucose levels are more strongly associated with parents’ goal of mild/moderate hyperglycemia than doctor’s goal of 10 normal glucose level 8. When the diabetic is a child or adolescent a. presence of a diabetic child in the family may cause stress and readjustment b. factors that affect child’s experience with diabetes i. little knowledge about the disease ii. aspects of the regimen that sets them apart c. responsibility for following regimen i. parents monitor care during childhood ii. children who are given too much responsibility of poorer glucose control iii. when adolescents assume care, compliance is lower and affected by peer pressure - hormonal changes make controlling blood glucose more difficult - those who are socially competent with high levels of self-esteem and strong parent relationships more likely to adhere E. Arthritis 1. Section introduction a. clinical characteristics i. rheumatic diseases consist of over 100 disorders that affect muscles, joints, and connective tissue near the joints and cause pain, stiffness, and inflammation ii. rheumatic diseases that affect the joints are called arthritis 2. The types and causes of rheumatic diseases a. types of rheumatic diseases i. osteoarthritis - a degeneration of joints associated with wear - risk increases with age, body weight, and occupations that stress the joints ii. fibromyalgia - pain and stiffness in muscles and soft tissue iii. gout - excess uric acid leaves crystalline deposits at the joints iv. rheumatoid arthritis - inflammatory disease of the joints, heart, blood vessels, and lungs, apparently due to an immune response b. mechanism involves autoimmune response attacking bone and tissue of the joint i. causes include genetic factors and viral infections c. trends in prevalence rates i. 70 million Americans suffer from rheumatic disease - arthritis afflicts nearly half of Americans over age 65 ii. observations regarding trend data - mild cases probably are not counted - females more likely to experience osteoarthritis, fibromyalgia, and rheumatoid arthritis; male more likely to have gout 11 - nearly 300,000 children suffer arthritis with many having juvenile rheumatoid arthritis 3. The effects and treatment of arthritis a. leading cause of disability in those over age 15, second most cause of work disability b. progress of rheumatoid arthritis i. lubricating fluid leaking out of joints ii. cartilage is destroyed and joint function reduced iii. conversion of organic matter into minerals for bones decreases near joints iv. bone erosion occurs near joints v. joints become deformed c. treatments to manage pain and functional impairment i. medications or surgical procedures - pain relievers such as aspirin and ibuprofen, or prescription - joint replacement. ii. other approaches - maintaining proper body weight - limiting certain foods and alcohol - physical therapy and exercise - use of assistive devices - splints - some alternative medicines/treatments iii. compliance with treatment regimen. - studies show more compliance when using powerful drugs and less for physical therapy compared to medications 4. Psychosocial factors in arthritis a. vicious circle of stress i. arthritis symptoms produces stress ii. stress is linked to flare-ups b. emotional adjustment levels i. research notes link between arthritis severity and depression and feelings of helplessness/hopelessness ii. research on feelings of personal control - patients believe physicians have more control over disease than they do - patients who believe they have control over daily symptoms show less mood disturbance - patients who are active partners in decisions adjust better - those that believe treatment can help are more likely to follow regimen iii. spouse with higher levels of social support have less depression 12 iv. patients who express negative emotions a lot show poorer adjustment and disease status F. Alzheimer’s disease 1. Characteristics of dementia and Alzheimer’s disease a. dementia is a progressive loss of cognitive functioning associated with old age b. Alzheimer’s disease is a deterioration of attention, memory and personality i. incidence increases with age ii. progression of deterioration includes initial losses of attention and memory with eventual personality changes, decline in self-care and disorientation 2. The causes and treatment of Alzheimer’s disease a. causes i. lesions consisting of tangled nerve and protein fibers linked to genetic defects ii. link between Alzheimer’s and strokes iii. regular physical activity and moderate drinking associated with lower risk b. diagnosis and treatment i. tests of cognitive ability and physiological indicators made at specialized centers are 90% accurate ii. no treatments prevent progression of disease, but some medications slow progression and improve symptoms 3. Psychosocial effects of Alzheimer’s disease a. caregiving to Alzheimer’s patients i. most victims are cared for at home by family members. ii. as disease progresses, patients may experience frustration and high levels of helplessness/depression iii. problematic behavior by patients leads to stress in caregivers iv. caregiver health becomes affected by the stress of providing care - caregivers have compromised immune function, poorer health, higher stress hormones, and higher mortality - stress occurs from watching loved one deteriorate over several years III. Psychosocial Interventions for People with Chronic Conditions A. Section introduction 1. Study on perceptions of chronic illnesses a. parent perception of seriousness of illness is related to whether their child has the illness i. view is less negative when one’s own child had the illness 13 2. Types of adjustment problems in chronic illness a. physical coping with disability or pain b. vocational coping with revised educational or vocational plans c. self-concept adjustments to changed body image, self-esteem d. social adjustment to losing enjoyable activities and coping with changed relationships e. emotional changes in levels of negative emotions f. compliance with rehabilitation regimen 3. Factors influencing adjustment a. nature of illness i. visibility, level of pain, level of disability, whether life- threatening b. patient’s age c. interpersonal aspects i. over-protection from family ii. delayed progress in school due to absences that impairs friendships, self-confidence, and self-esteem iii. changes in roles d. treatment approaches i. interdisciplinary teams that work in integrated manner facilitate adjustment B. Educational, social support, and behavioral methods 1. What patients and families need to improve adjustment a. accurate information about disease prognosis and treatment b. community support such as respite centers for Alzheimer’s c. effective support systems i. support groups that provide information, give emotional support, and allow for sharing of feelings 2. Addressing psychosocial factors that contribute to adherence a. improving physician feedback b. use of behavioral methods i. tailoring the regimen ii. using prompts and reminders iii. incorporating rewards 3. Self-management programs combine information with cognitive behavioral methods a. enhance patient’s ability to carry out regimen b. help adapt to new behaviors/life roles c. provide help for coping with emotions d. teaches problem-solving skills to deal with day-to-day circumstances C. Relaxation and biofeedback 1. Chronic conditions are aggravated by stress and anxiety a. stress management techniques, such as progressive muscle relaxation and biofeedback, have been used with diabetics and epileptics a. used to help diabetics manage stress and blood glucose 14 b. epileptics can be taught to recognize sensations before an attack - no way to determine who will benefit from this approach c. asthma sufferers can learn to control the diameter of the bronchial airways D. Cognitive methods 1. Focus of cognitive approaches a. problem-solving training teaches clients to think through a medical situation and make good choices b. cognitive restructuring helps patient discuss incorrect thoughts/beliefs and learn ways to cope better i. used to alleviate depression in Alzheimer’s or cancer patients and caregivers c. the success of these approaches depend upon how careful and conscientiously they are carried out by the patient E. Interpersonal and family therapy 1. Interpersonal therapy a. designed to change the way patients react to, and interact with, their social environment b. used to help patients gain an understanding of their feelings and behaviors toward others 2. Family therapy a. uses behavioral, cognitive, and insight methods to change patterns of family interactions b. with children, may discuss jealousness of siblings, activities to engage in, how to discuss the illness with friends and relatives and how self-care can be improved F. Collaborative or integrative care approaches 1. Collaborative or integrative care - combines and integrates perspectives of multiple professionals and providers