CHRONIC ILLNESS Acute Illness Produces symptoms soon after exposure to the cause Runs a short course There

ere is usually full recovery or abrupt termination in death Not all acute illnesses are sever nor illnesses at all Chronic illness long term illness A condition w/c lasts over an extended period of time 3 mos. or longer Characteristics Insidious onset, produces symptoms over a variable period of time Runs a long course Non-correctible changes leading to progressive physical change Left over disabilities Partial recovery, permanency Chronic conditions Medical conditions or health problems w/ associated symptoms or disabilities that require long-term management May be due to illnesses, genetic factors or injury Lifestyle changes & regiments that keep signs & symptoms under control & to prevent complications Reasons for an increase in chronic condition Decrease in mortality from infectious disease Longer life spans Improved screening & diagnostic procedures Prompt & aggressive management of acute condition Advancing age Modern lifestyle factors Characteristics Managing chronic illnesses involves more than managing medical problem Chronic condition usually involve many different phases over the course of a persons lifestyle

Control requires strict adherence to therapeutic regimens One chronic illness can lead to another chronic condition Chronic illness affects the whole family The major responsibility for the day-to-day management of illness lies on the chronically ill client & his family Management is a process of discovery A collaborative process Expensive Can raise difficult ethical issues for the patient, health care workers & society Living w/ chronic illness means living w/ uncertainty Periods of remission & exacerbation

Elucidate A. Acute illnesses may become chronic B. Chronic illness may have an acute exacerbation An acute illness may occur from acute exacerbation Difference in care Plan care that goes beyond the period of hospitalization Consider many aspects of the persons life C. An acutely ill person may have an underlying condition An individual may have an acute & chronic at the same time Implications for Nursing Holistic approach Requires knowledge from social sciences, psychology in particular Clients response to therapeutic regimen & health teaching may be different from what you expected Chronic condition have a course & proper illness management strategies may be used by understanding the course Phases 1. Pre-trajectory phase at risk for developing a chronic condition 2. Trajectory phase onset of symptoms or disability associated w/ a chronic condition 3. Stable p symptom & disability are being managed adequately 4. Unstable p exacerbation of symptom development of complication or reactivation of an illness in remission

5. Acute p sudden onset of severe or unrelieved symptom or condition 6. Crisis p critical/life-threatening situation that requires emergency treatment/care 7. Comeback p recover after an acute period 8. Downward p worsening of a condition 9. Dying p gradual/rapid decline in trajectory despite efforts to control Care by phase: Step 1: identifying the trajectory phase 2: establishing goals 3: establishing a plan to achieve desired outcomes 4: identifying factors that facilitate or hinder attainment of goals 5: implementing intervention 6: evaluating the effectiveness of intervention Other forms of long-term care: Sub-acute or transitional care Assisted living facility Adult day care Home Care Hospice TERMINOLOGIES: Invalid Not well & strong by illness/infirmity Disability Lack of physical & mental fitness Maybe permanent/temporary Maybe partial/total Impairment Condition w/c lessens or limits function below normal Handicap Physical/mental condition that renders success more difficult Cripple One who limps across or halts from loss of a limb Partially disabled person Factors influencing patient needs Medical diagnosis Term chronic illness is not a disease entity, such as CVD Each long term patient will automatically fall into a medical classification that will indicate some needs

Age Age & a persons stage of life are important factors in planning the care of a long term illness

Supporting system Makes a great deal of difference in determining the needs w/c nursing need to compensate Prognosis Important when setting goals for the long-term patient Effects A. Physical Physical limitations Invalidism Deformities & contractures B. Psychosocial Social system Financial problems Emotional problems on patient & family Growing concern for chronic illness Such disabling diseases are among the most common causes of death Social & economic problems it imposes upon the family & community Health team must make maximum application of knowledge & resources to reduce the impact of disease on the patient & family Areas to be considered Prevention & Control Health promotion positive health practices & health teaching concerning: a. Nutrition b. Mental hygiene c. Safe & healthful working environment d. Adequate housing e. Well-balanced personal habits a. Sufficient rest b. Appropriate exercise c. Good personal hygiene d. Avoid alcohol & tobacco f. Recreation g. Sense of financial security h. Education i. Useful & productive role in the society j. Periodic physical check-up k. Removal of local forms of infection

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Community resources of health & illness & encourage their use

Specific prevention Immunization Researches Noting health hazards in industries Instituting measures to decrease their danger o Screening programs o Mobile x-ray units o Operation Timbang o Operation BP Early Recognition Multiphasic screening program Awareness of the diagnostic facilities available in the community Prompt & adequate treatment Intelligent care of the patient Rehabilitation Limit disability from disease Prevent complication Enable patient to be self-sufficient Nursing Intervention Important Objectives: Think in long-term goals as well as immediate goals Assist the patient in continuing therapy Work w/ the health team Aid the patient in working through the grief progress Work w/ the family in accepting the patients illness Nursing intervention focused on prevention & reduction of disability Focus on enabling functioning individual in every aspect Principles of care A. Restoration of optimal function capacity Adequate evaluation of the patients physical capacity Use Physical Profile System o Patient is graded considering 6 categories o 1. Physical condition, such as cardiovascular, pulmonary, GI, GU endocrine, cerebrovascular disorder o 2. Upper extremity

3. Lower extremity 4. Sensory components (speech, vision, hearing) o 5. Excretory function o 6. Mental & emotional status In each category, the patient is graded 1-4 o (1) No expected difficulty o (2) Minor difficulty that does not preclude normal activity & may require occasional medical supervision o (3) Difficulty that requires medical and/or nursing supervision. No limited activities o (4) Severe impairment requiring constant & complete care Help the patient accept condition/disability o Patient motivation Proper nutrition o Sufficient proteins & vitamins o Special diets be properly interpreted to patient & family Good personal hygiene o Meticulous skin care & oral hygiene o Prevention of pressure sores Elimination Regulation of activity Intelligent execution of medical orders B. Prevention of complication, accident, injury C. Psychosocial care Patient reactions o Depression o Discouragement o Resigned to invalidism o May show magnificent courage in overcoming problems o Living productively from day to day o Weakened body, mind & spirit o Bored & dissatisified o Extremely sensitive Interventions Recognize what is meaningful to the patient Help patient preserve feelings of usefulness Help patient to learn how to assist himself Do things with the patient rather than for the patient Provide encouragement Listen to patient Help maintain a positive attitude about his progress & prognosis Realistic optimism Consider family relationships

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 Assist patient & family in planning Provide diversional activities D. Continued assessment of the patient E. Provision for follow-up & home care Health teachings Make adaptations of care at home Special Consideration Plans be made w/ the one responsible for the patient Instruction in written forms Include the ff: Needed treatment & medication Diet Activities Kind of equipment needed for home care Where they can be obtained Visit to physicians clinic Community agencies/facilities for continuing care Out-patient services o For ambulatory patient ambulatory care Institutional services o Convalescent homes o Rest homes o Nursing homes Foster homes