NUR 109 Chapter 9

Chronic Illness and Disability

-Chronic diseases are 7th in the 10 leading causes of death and are responsible for more than 2/3 of deaths that occur globally. Include heart and chronic lung diseases, cancers, and diabetes -Chronic disease is rapidly increasing in lower income countries, populations, and communities due lack of a healthly lifestyle. -Lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption are modifiable risk factors for chronic disease and early death

Causes of the increase in number of people with chronic conditions

-Decrease in mortality from infectious diseases -Lifestyle factors - those modifiable risks -Longer lifespans due to better management of chronic disease and improved meds and technology -Improved screening, diagnostic procedures when accessed can lead to early intervention in chronic disease

Nursing Considerations

-Disabled individuals may need assistance when acutely ill but do not automatically assume they need it. Ask first. -May need to rearrange hospital room to accommodate equipment. -May need to make arrangements for service animals during stay. -Pt and/or family are the experts in dealing with their disability so ask them what they want. -If disability is new to patient as a result of this visit pt will need referrals to specialists, rehabilitation, support groups, and information on modifying their living space to better accommodate the needed changes -Many patients who develop a disability will experience grief. May see them expressing emotions as they would if they had lost a loved one.

Gerontologic Considerations

-Increase in number of older adults with chronic illnesses =More have multiple chronic conditions and are at increased risk for poor functional status, unnecessary hospitalizations, adverse drug events, unnecessary and duplicate testing, as well as conflicting medical advice and eventual death.

Chronic Conditions

-Occur in people of every age, socioeconomic level, culture -Medical conditions or health problems with associated symptoms that require long-term (3 months or longer) management -Conditions that do not resolve or for which complete cures are rare -Management: people must learn to live with symptoms or disabilities, carry out lifestyle changes or treatment regimens -Chronic diseases are a global issue. -The number of people dying of chronic disease is projected to reach 52 million annually by 2030 (WHO 2011) twice that of people dying of infectious disease

Nursing Process

5 steps -Identify specific problems, trajectory phase -Establish, prioritize goals -Plan of action to achieve desired outcomes Interventions focus: -Regimens to control symptoms, avoid complications -Psychosocial issues affect quality of life Evaluate outcomes, reassess problems

Challenges of Living With A Chronic Illness

Alleviate, manage symptoms Psychologically adjust to, physically accommodate disabilities Prevent, manage crises, complications Carry out regimens as prescribed Validate individual self-worth, family functioning Manage threats to Identity Normalization of personal and family life Altered time, social isolation, loneliness Establish networks of support, resources that can enhance quality of life Return to satisfactory way of life after acute debilitating episode or reactivation of chronic condition Die with dignity and comfort

Types of Disablilites

Developmental ~Occur at anytime from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care Acquired ~Occur as the result of an acute and sudden injury, acute nontraumatic disorders, or progression of a chronic disorder Age - related. Sensory disabilities affecting hearing or vision, Learning disabilities that affect ability learn, remember, or concentrate Functional disabilities

Managing Chronic Conditions

Importance of prevention -Lifestyle changes, interventions to prevent chronic disease -Health promotion and maintenance Once disease occurs, focus shifts to: -Managing symptoms -Avoiding complications and acute illness -Maintaining functional status

Strategies to Ensure Quality Health Care for People With Disabilities

Know Chart 9-5 Will Be On Test!! Pg. 143

Interacting and Communicating With People Who Have Disabilities

Know Chart 9-6 Will be on Test!! Pg. 145-146

Characteristics of Chronic Conditions

Managing chronic illness involves more than treating medical problems -Usually involves different phases over person's lifetime to which the person must adapt -See factors that affect adjustment to chronic illness p 132 bullet points Persistent adherence to therapeutic regimens necessary One chronic disease can lead to the development of other chronic conditions Chronic illness affects the entire family Day-to-day management of illness is largely the responsibility of people with chronic disorders and their families -Caregiver stress. Role reversals Management of chronic conditions is a process of discovery -Pt education on how to manage disease and noting individual charactersitics and responses Financial burden -out of pocket costs have increased over 30% -Missing work or being unable to work. Ethical issues -allocation of resources Living with chronic illness means living with uncertainty -Each persons course is individual

Models of Disabilities

Medical model ~Problem of person directly related to disease, trauma, or other health care condition. The health care providers and not the person are viewed as the expert Rehabilitation model ~Regards the disability as a deficiency that must be rehabilitated. Biopsychosocial model ~Integrates medical and social models to address disability more holistically Interface model ~The person with the disability defines the problems they are having and seeks or directs the needed solutions

Phases in the Trajectory Model of Chronic Illness

Pretrajectory, Trajectory onset, Stable, Unstable, Acute, Crisis, Comeback, Downward, Dying See Table 9-2 pg. 137

Importance of Language

Use "People first language" Mrs Jones in 434. not "that diabetic lady in 434" The person, not the illness or disability, is most important See "Interacting and Communicating with People who have Disabilities" Chart 9-6 p. 145 -146 for more information in managing patients with disabilities. **Every healthcare facility must have patient access to TTY (teletypewriters for vision and hearing impaired) and interpreters for language barriers. Patient education materials will need to be modified as well.

Definitions of Disabilities

WHO (2001)- International Classification of Functioning, Disability and Health ~A persons functioning or disability is viewed as dynamic between a persons health condition and their environment Americans With Disabilities Act of 1990 ~Physical or mental impairment that substantially limits one or more major life activities ~Record of, or regarded as, having such an impairment

Secondary conditions or disorders

any physical, mental, or social disorders resulting directly or indirectly from an initial disabling condition; a condition to which a person with a disability is more susceptible because of having a primary disabling condition

Impairment

loss or abnormality of psychological, physiologic, or anatomic structure or function at the organ level (e.g., dysphagia, hemiparesis); an abnormality of body structure appearance, and organ or system function resulting from any cause

Chronic disease

medical or health problems with associated symptoms or disabilities that require long-term management; has also been referred to as noncommunicable disease, chronic condition, or chronic disorder

Disability

restriction or lack of ability to perform an activity in a normal manner; the consequences of impairment in terms of an individual's functional performance and activity-disabilities represent disturbances at the level of the person (e.g., bathing, dressing, communication, walking, grooming)

Chronic Illness

the experience of living with a chronic disease or condition; the individual's perception of the experience and the individual's and others' responses to the chronic disease or condition