Chapter 9: Chronic Illness and Disability

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness?

Chronic illness affects the entire family. Explanation: Chronic illness affects the entire family to the extent that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. One chronic disease can lead to the development of other chronic conditions. Chronic conditions usually involve many different phases over the course of a person's lifetime.

The nurse is working with a client who has difficulty controlling her blood sugar. The overweight client does not adhere to a low-calorie diet and forgets to take medications and check her blood glucose level. The client's glycohemoglobin is 8.5%. When establishing a goal for the client, the nurse first

Collaborates with the client to establish an agreed-upon goal Explanation: When establishing a goal, the nurse should collaborate with the client. The nurse does not dictate to the client what the goal will be. Goals must be consistent with the abilities and motivation of the client. The long-term and short-term goals may not be realistic for this client.

Which disability model is most appropriate for the nurse to use as a guide for planning care?

Interface Model Explanation: Several models of disability have been used to address or explain the issues encountered by people with disabilities (Drum, 2009; Phelan, 2011; Smeltzer, 2007a). These include the medical and rehabilitation models, the social model, the biopsychosocial model, and the interface model. Chart 9-4 briefly describes these models of disability. Of these, the interface model (Goodall, 1995) may be one of the most appropriate for use by nurses to provide care that is empowering rather than care that promotes dependency.

Which is a true statement regarding characteristics of chronic conditions?

Managing chronic conditions must be a collaborative process. Explanation: Managing chronic conditions must be a collaborative process. Many ethical issues arise in the care of people with chronic conditions. Living with chronic illness means living with uncertainty. The management of chronic conditions is becoming more costly.

Spinal cord injury is an example of which type of disability?

Acquired Explanation: Spinal cord injury is an example of an acquired disability. An acute nontraumatic injury is a stroke or myocardial infarction. Age-related disabilities include hearing loss, osteoporosis, and osteoarthritis. Cerebral palsy and muscular dystrophy are examples of developmental disabilities.

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability?

Developmental Explanation: Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.

End-stage renal disease Explanation: Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

An elderly client with chronic osteoarthritis has difficulty ambulating and is seeking a prescription for a walker. How should the nurse categorize the client's disability?

acquired Explanation: Acquired disabilities may be progression of a chronic disorder, such as arthritis. Developmental disabilities are those disabilities that occur any time from birth to 22 years and may result in impairment of physical or mental health, cognition, speech, language, or self-care. Sensory disabilities affect hearing or vision. Age-related disabilities are conditions from age, not a chronic disease.

The nurse is conducting a community education program on chronic illness. The nurse evaluates that additional education is needed when the participants make which statement?

"Out-of-pocket expenses for chronic illness are low." Explanation: The nurse determines that additional education is needed when the participants state that out-of-pocket expenses for chronic illness are low. Although the majority of clients with chronic illness have health insurance, out-of-pocket expenses are high and are increasing. Chronic illness is a leading cause of death and is on the rise in developing countries.

A client from a low socioeconomic background was diagnosed with a chronic health problem. The client states, "Everyone has to die of something." What is the most appropriate response for the nurse?

"You can do some things to minimize the effects of this disease on your health." Explanation: The question is asking about the most appropriate response by the nurse. The nurse should remain positive and empower the client. The statement about the client doing things to minimize effects is the statement that is positive and empowers the client.

A client is diagnosed with type 2 diabetes mellitus. The client takes metformin and exenatide and reports adhering to a diet. The glycohemoglobin is 5.9%. According to the stable phase of the Trajectory Model of Chronic Illness, how should the nurse respond?

Acknowledges that the client is performing satisfactorily Explanation: In the stable phase of the Trajectory Model of Chronic Illness, the nurse reinforces positive behaviors. The glycohemoglobin is at a level of good control for a client with diabetes. No adjustments need to be made to the diet or the medications.

A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have?

Acquired disability Explanation: Disabilities can be categorized as developmental disabilities, acquired disabilities, and age-associated disabilities. Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury (e.g., traumatic brain injury, spinal cord injury, traumatic amputation), acute nontraumatic disorders (e.g., stroke, myocardial infarction), or progression of a chronic disorder (e.g., arthritis, multiple sclerosis, chronic obstructive pulmonary disease, blindness due to diabetic retinopathy). A chronic disability is one that has a long disease course and is likely incurable. An impairment is a loss or abnormality of psychological physiologic, or anatomic structure or function at the organ level.

The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in?

Acute Explanation: In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life.

A nurse practitioner would be applying the pre-trajectory model of chronic illness when she:

Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. Explanation: The pre-trajectory phase involves the prevention of a chronic illness. For example, the focus of nursing care would be to refer the patient for genetic testing and counseling, if indicated, and provide education about prevention of modifiable risk factors and behaviors.

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply.

Alleviate and manage symptoms Validate individual self-worth Validate family functioning Explanation: The challenges of living with chronic conditions include the need to accomplish the following: alleviate and manage symptoms, validate individual self-worth and family functioning, manage threats to identity, and die with dignity and comfort.

A nurse is assigned to work with a client who has a disability. The nurse believes that all people with disabilities have a poor quality of life and are dependent and nonproductive. What type of barrier will this client experience?

Attitudinal barrier Explanation: Attitudinal barriers are barriers in which bias, mistaken beliefs, and prejudices impose limitations for people with disabilities. This client experienced no barrier to health care, no structural barrier, and no transportation barrier as currently defined.

The nurse provides corrective instruction to the nursing assistant when the assistant refers to the client as the

Blind diabetic patient Explanation: It is important to use "people-first" language, which means referring to the person first. Examples include person who is disabled, man with a stroke, and woman who has multiple sclerosis. Using "blind diabetic patient" conveys that the illness or disability is of greater importance than the person.

The instructor provides corrective information to the nursing student when the student refers to the client as the

COPDer in 216 Explanation: "People-first" language means referring to the person first. Examples include patient who is disabled, man with an MI, and woman who has diabetes. Using "COPDer in 216" conveys that the illness or disability is of greater importance than the person.

Which statement is a misconception about chronic disease?

Chronic illnesses cannot be prevented. Explanation: A misconception regarding chronic disease is that chronic illnesses cannot be prevented. Almost half of chronic illness-related deaths occur prematurely in people younger than 70 years of age. Chronic illness typically does not result in sudden death. The major cause of chronic disease is known.

Which phase of the Trajectory Model does the nurse recognize is present when the patient is in remission, after an exacerbation of illness?

Comeback Explanation: The acute phase is characterized by severe and unrelieved symptoms or the development of illness complications necessitating hospitalization, bed rest, or interruption of the person's usual activities to bring the illness course under control. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The comeback phase is characterized by a gradual recovery after an acute period and learning to live with or overcome disabilities and return to an acceptable way of life within the limitations imposed by the chronic condition or disability. It involves physical healing, limitations stretching through rehabilitative procedures, psychosocial coming-to-terms, and biographical reengagement with adjustments in everyday life activities. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.

This type of disability represents one that occurs any time from birth to 22 years and results in impairment of physical or mental health, cognition, speech, language, or self-care.

Developmental Explanation: Developmental disabilities occur any time from birth to 22 years and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

A client who is legally blind had orthopedic surgery 3 days ago and wants to urinate. She is using a walker for ambulation. It would be best for the nurse to

Guide the client's hand to the armrest on the bedside commode prior to the client sitting on the commode. Explanation: When the nurse offers seating to a client with low vision or blindness, the nurse should place the client's hand on the arm of the chair. This helps to guide the client in sitting. Though placing the bedside commode next to the bed is a good idea, it is not the best choice. The nurse will encourage the client to use the bedside commode, not the bedpan, for better emptying of the urinary bladder.

The client with blindness is hospitalized following a myocardial infarction. Which care measures would the nurse take with this client? Select all that apply.

Identify self when walking into the client's room. State when the nurse is leaving the room. Orient the client to the room using a clock reference. Explanation: Suggestions when providing care to a client with low vision or blindness include identifying oneself to the client, stating when leaving the room, and orienting the client to the room. The nurse uses a normal tone of voice, not even slightly louder. The nurse does not pat service animals without the owner's prior permission.

A nurse prepares a diabetes prevention health seminar for community residents. Her teaching points should emphasize the most important factor influencing metabolic syndrome (pre-diabetes). What is that factor?

Obesity Explanation: Obesity, caused by an improper diet and physical inactivity, is the major cause of pre-diabetes.

A client who is hearing impaired and communicates through sign language only is scheduled for an endoscopy. She does not read lips. It would be best for the nurse to

Obtain a sign interpreter. Explanation: The facility should provide an interpreter for the client with a disability. Family members should not serve as interpreters due to concern for misinterpretations of information and the need to maintain client privacy and confidentiality. The nurse should face the client when speaking even if the client does not read lips.

A client who is blind is hospitalized for hip surgery. The nurse notices that the containers on the client's lunch tray are unopened, the client is fumbling with items, and food is on the front of the client's gown. The nurse assists the client by

Opening containers and orienting the client to placement of items on the tray Explanation: During hospitalization clients with pre-existing disabilities may require assistance with activities of daily living that they may be able to manage at home. For clients who have impaired vision, it is necessary to orient them to the environment to assist with their independence. The option that best meets these criteria is the nurse opening containers for the client and telling the client where items are found on the tray.

A nurse is talking on the phone with a doctor and states, "I am calling you about Mrs. Nye, my client with cancer in room 213." This is an example of what type of language that is important to all people?

People-first Explanation: It is important to all people, with and without disabilities, to not be equated with an illness or a physical condition. Therefore, it is important for health care providers to refer to all people using "people-first" language.

A client has lost mobility following a stroke. The nurse has established interventions that include providing direct care to the client, teaching, making referrals, and managing the case, to meet the goal. The next step is to

Plan with the client how to incorporate the regimen into the client's activities of daily living. Explanation: The nurse should work with the client and family to identify ways to implement the treatment regimen. The nurse does not tell the client what the client must do. The other options may be appropriate interventions for this client, but these would not be the next step.

The client had a cerebrovascular accident with drooping of the face. Speech is slurred. The nurse is obtaining the admission assessment data. It would be best for the nurse to

Repeat back what the client states. Explanation: When communicating with a client who has speech disabilities or difficulties, the nurse repeats what the nurse understands the client has stated for clarification. The nurse asks questions of the client who is able to provide information, not a family member. The nurse does not chart "unable to obtain the information." The client's situation could have changed since past medical records were written.

A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which element?

Smoking cessation Explanation: Chronic conditions are increasing rapidly in low-income countries because of the adoption of unhealthy lifestyles. Modifiable health behaviors responsible for the high incidence of chronic disease such as cardiac disease include lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. By focusing on smoking cessation programs, the nurse is appropriately addressing a modifiable risk factor of a chronic condition.

The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate?

Stable Explanation: The stable phase indicates that the symptoms and disability are under control or managed. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The comeback phase is the period in the trajectory marked by recovery after an acute period. The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.

The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?

The client gradually returns back to an acceptable way of life within the limits imposed by the illness. Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the client gradually returns back to an acceptable way of life within the limits imposed by the illness. The acute phase has unrelieved symptoms that result in the interruption of the client's everyday life activities. In the stable phase, the illness course and symptoms are under control and the client's everyday life activities are managed. In the trajectory onset phase, the client begins to cope with implications of the illness.

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:

The client stops taking some medications due to side effects that are disturbing to the client. Explanation: Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.

A client with impaired hearing communicates through sign language and has been admitted to the unit before scheduled surgery. The interpreter that the hospital employs is at the bedside. The nurse needs to take what actions into consideration prior to doing preoperative teaching with this client?

The interpreter may lag a few words behind--especially if names or technical terms are to be finger spelled. Explanation: If a nurse is speaking through a sign language interpreter, the interpreter may lag a few words behind-especially if names or technical terms are to be finger spelled. So the nurse should pause occasionally to allow the interpreter time to translate completely and accurately. The facility should provide an interpreter for the client with a disability. Family members should not serve as interpreters due to concern for misinterpretations of information and the need to maintain client privacy and confidentiality. The nurse should talk directly to the person who has hearing loss, not to the interpreter. However, although it may seem awkward, the person with hearing loss will look at the interpreter and may not make eye contact with the nurse during the conversation.

Clients must contend with chronic illness daily. Nurses relate more effectively to clients when they understand the following as characteristics of chronic illness. Choose all that apply.

The management of chronic conditions is a process of discovery. Managing chronic conditions must be a collaborative process. Chronic illness affects the entire family. Explanation: Management of chronic conditions is a process of discovery. Chronic illness affects the entire family to the point that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. Chronic conditions usually involve many different phases over the course of a person's lifetime. Chronic illness involves not only treating the medical problems but may also include the psychological and social problems.

The number of people with disabilities is expected to increase over time. What is a major contributor to this prediction?

The survival of people with severe trauma, chronic disorders, and early-onset disabilities Explanation: The number of people with disabilities is expected to increase over time as people with early-onset disabilities, chronic disorders, and severe trauma survive and have normal or near-normal lifespans. There has not been a decrease in the number of people with early-onset disabilities. Acquired chronic disorders still cannot be cured. Genetic risk factors for early-onset disabilities have not decreased.

Chronic illness can be monitored using the Trajectory Model. In what phase can the nurse's nursing diagnosis help in care planning?

Trajectory Explanation: The pretrajectory phase is characterized by genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. The trajectory onset phase is characterized by the appearance or onset of noticeable symptoms associated with a chronic disorder and includes a period of diagnostic workup and announcement of diagnosis. It may be accompanied by uncertainty as the patient awaits a diagnosis and begins to discover and cope with the implications of the diagnosis. The crisis phase is characterized by a critical or life-threatening situation requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed. The downward phase is characterized by rapid or gradual worsening of a condition, including physical decline accompanied by increasing disability or difficulty in controlling symptoms. It requires biographical adjustment and alterations in everyday life activities with each major downward step.

A nurse cares for a client with a chronic illness who has a diagnostic workup for the illness and announces the diagnosis to friends and family. According to the Trajectory Model of Chronic Illness, what phase is the client displaying?

Trajectory onset Explanation: According to the Trajectory Model of Chronic Illness, the trajectory onset phase includes the period of diagnostic workup and announcement of the illness. While the other answer choices are phases of the Trajectory Model of Chronic Illness, these are not the correct answer choices.

A client has been diagnosed with diabetes and has received instructions about managing the disease. The client has undertaken an activity to improve quality of life and maintain functional status. The nurse recognizes this activity as

Walking at least one mile 5 days each week Explanation: Behaviors, such as exercise or walking, are essential to quality of life and maintaining functional status for a client who has a chronic illness. The other activities, such as ingesting low caloric foods, taking medications, and checking blood glucose level, relate to managing symptoms and avoiding complications.

A cause related to the increasing number of people with chronic conditions is

improved screening and diagnostic procedures. Explanation: The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious diseases has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.

A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states

"You have succeeded in making positive progress." Explanation: In the evaluation stage of the nursing process, the nurse validates even small increments toward goal achievement, as reflected in statement b. This is important for enhancement of client self-esteem and reinforcing client behavior. Change is a slow process, and success may be defined as making some progress. The nurse and client will then need to re-evaluate the goal, as in statement d, and either continue with the current goal, change the goal, or discontinue the goal. Statements a and c are negative criticisms and would diminish client self-esteem.

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic?

3 months Explanation: Chronic diseases or conditions are often defined as medical conditions or health problems with associated symptoms or disabilities that require long-term management. Some definitions use a duration of 3 months or longer, whereas others use a year or longer to indicate chronic disease. Definitions of chronic disease or chronic illness share the characteristics of being irreversible, having a prolonged course, and unlikely to resolve spontaneously (Lubkin & Larsen, 2013).

Chronic conditions occur in people of every age group, socioeconomic level, race, and culture. Globally, annual deaths due to chronic disease are expected to increase from 38 million in 2012 to 52 million by 2030. It is predicted that by 2030, what percent of the world's population will have at least one chronic illness?

50 Explanation: By the year 2030, approximately half (50%) of the world's population is predicted to have a chronic illness. One-fifth of those with chronic disease will likely have an activity limitation. The total number of people who die from chronic disease is about twice that of individuals dying from infectious, maternal and perinatal conditions, and nutritional deficiencies combined.

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse

Acknowledges the client's achievement when she walks to the bedside commode with her walker Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.

An elderly male client was in an automobile accident 2 weeks ago and incurred a spinal cord injury with resulting paralysis. The nurse assesses this disability as

Acquired Explanation: An acquired disability results from an acute and sudden injury, such as trauma to the spinal cord. The paralysis may be temporary. It may not be known to be permanent until swelling in the spinal cord has decreased. This may take weeks to months. A developmental disability is one that occurs prior to age 22 years. An age-related disability occurs in the elderly population as a result of the aging process.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Despite various medication regimes, the client's symptoms are gradually increasing. The nurse realizes that this client is which phase of the Trajectory Model of Chronic Illness?

Downward Explanation: The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management. The unstable phase is characterized by development of complications or reactivation of the illness. The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. The dying phase is characterized by gradual or rapid shutting down of life-maintaining functions.

A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as

Downward Explanation: The downward phase of the Trajectory Model of Chronic Illness is characterized by a worsening of the client's condition with alterations in everyday activities. The stable phase is one in which the client's symptoms are under control. The acute phase is characterized as severe and unrelieved symptoms necessitating hospitalization, bedrest, or interruption of the client's usual activities to bring the disease under control. The crisis phase is one in which the situation is critical or life-threatening and requires emergency care.

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause?

Early detection and treatment of diseases Explanation: Improved screening and diagnostic procedures enable early detection and treatment of diseases, resulting in improved outcomes of management of cancer and other disorders. Lifestyle factors, such as smoking, chronic stress, and sedentary lifestyle, increase the risk of chronic health problems such as respiratory disease, hypertension, cardiovascular disease, and obesity. Longer lifespans are because of advances in technology and pharmacology, and a decrease in mortality from infectious diseases.

Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following?

Make referrals for additional care. Explanation: Nursing care of patients with chronic illnesses is varied and occurs in a variety of settings. Care may be direct or supportive. Direct care may be provided in the clinic or health provider's office, the hospital, or the patient's home, depending on the status of the illness.

A patient who is at risk for developing a chronic condition because of genetic factors is said to be in which phase of the Trajectory Model?

Pretrajectory Explanation: The pretrajectory phase is characterized by genetic factors or lifestyle behaviors that place a person or community at risk for a chronic condition. The trajectory onset phase is characterized by the appearance or onset of noticeable symptoms associated with a chronic disorder and includes a period of diagnostic workup and announcement of diagnosis. It may be accompanied by uncertainty as the patient awaits a diagnosis and begins to discover and cope with the implications of the diagnosis. The unstable phase is characterized by an exacerbation of illness symptoms, development of complications, or reactivation of an illness in remission. It is a period of inability to keep symptoms under control or reactivation of illness in which the person has difficulty in carrying out everyday life activities. It may require more diagnostic testing and trial of new treatment regimens or adjustment of the current regimen, with care usually taking place at home. The acute phase is characterized by severe and unrelieved symptoms or the development of illness complications necessitating hospitalization, bed rest, or interruption of the person's usual activities to bring the illness course under control.