Transcript Chronic-Illness

Concepts
of
Chronicity
Keith Rischer, RN, MA, CEN
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Today’s Objectives…
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Examine the ethical challenges of chronic illness.
Discuss the many common characteristics shared by
persons and their families with chronic illness.
Describe the inherent differences between acute
illness care and chronic care.
Investigate the sources of hope in chronic illness.
Discuss the rehabilitation concepts for acute and
chronic problems.
Discuss the need for collaboration and advocacy in the
care of the patients and families with chronic illness.
Describe the use of complementary and alternative
therapies in the care of the chronically ill.
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Chronic vs Acute Illness
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Acute
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Onset sudden
S/S are related to disease/condition itself
Alter normal routine pattern for a short time
Has a predictable end
Life returns to pre-baseline
Chronic
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Onset varies; may be sudden or slow
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3 months or longer
S/S often difficult to associate with disease
Alters normal routine indefinitely, perhaps for a lifetime
No predictable end
Becomes an identity
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Chronicity Concepts
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Acute hospitalization over 30 days or medical supervision
or rehabilitation over 3 months
Symptoms can be gradual or insidious onset
 Diabetes
 CVA
Can have episodic flare-ups, exacerbations, or remain in
remission
80% of adults 65 yrs of age or older have one or more
chronic illnesses
Can be managed, but not cured
Family integral to the care
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Chronic Illness Trends
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By 2020 more than 20% of population will be 65 and older
(53 million)
Frail elderly are the fastest growing population-over 85
over 76 million by 2020
In 2007, total national health expenditures were expected
to rise 6.9 percent — two times the rate of inflation
 Total spending $2.3 TRILLION in 2007, or $7600 per
person
Ethical questions- where do you put your money???
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Costs of Chronic Illness
510 billion dollars in 2000
 Expected to increase to 20 trillion dollars
by 2020
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 Aging
baby boomers
125 million afflicted
 Implications for nursing
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End of Life Care
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27% of Medicare's annual $327 billion budget
goes to care for patients in final year of life
Oregon $14,000 vs. Manhattan $35,000 last 6
months of life
Futile vs. non-futile care
Boomer generation
Nursing implications
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Ethical Challenges
 “Slow debilitating chronic illness will most likely be our
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companion in the twilight of our lives” (Hastings Report)
Lacks activity, pace, and fascination of acute illnesses
High technologic treatment inappropriate
Demographics of aging will ensure a chronic care avalanche
Not sufficient to seek prevention and cures, nor to extend
the duration of life with chronic illness
Food and fluids…optional or essential???
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Why increasing numbers
People living longer
 Research finding more means of treatment
 Healthier environment
 Advances of medications
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Impact on client
Age and life stages influences
 Infancy to adolescence
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 growth
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Young to middle age
 Family
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and development
and work concerns
Older adult
greatest number
 normal aging process
 aging and chronicity - bad combo
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Coming to terms with chronicity
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Achieving highest level of wellness by
 Juggling
act
 Focusing on abilities
 Following medical regimen
 Prevent further disability
 Resist isolation
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Rehabilitation
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Learning to live with chronic illness
Stroke leading cause of disability - $30 billion
each year
What are we doing about these costs???
Accidents leading cause of death among young
adults
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Goals of Rehabilitation
Prevention of injury
 Restoration of function
 How does this differ for someone 5 years
old vs someone 85 years old?????
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Rehab Physical Assessment Priorities
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CV
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Resp
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Motor ability, sensation, cognition
Musculoskeletal
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Po intake…painful/difficulty swallowing…wt. loss
Renal-Urinary
Neuro
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SOB w/activity…activity tolerance
GI-Nutrition
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Fatigue/rest needed
ROM/PROM
Skin
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Risk for breakdown
Albumin
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Nursing Priorities
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Impaired physical mobility
Self care deficit
Risk for impaired skin integrity
Impaired urinary elimination
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Bladder training p.129
Constipation
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Iggy p. 123-131
Bowel training p.130-131
Ineffective coping
Knowledge deficit
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Bowel & Bladder Concerns
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Research shows:
 Many
times the reason that a person quits
their job
 The reason caregivers put family members in
long term facilities
 Younger people do not want to openly discuss
bladder and bowel concerns, while elderly
sometimes become overly concerned
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Assessment Scales
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Scales to assess skin breakdown –
Braden
 Law
suits if skin breakdown
 Routine photographs
 Sufficient nutrition needed to prevent
pressure ulcers
Scales to assess cognitive – Mini Mental
 Scales to assess fall risk – Fall Risk
 Scales to assess ADLs - Katz
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Sources of hope
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“Sources of Hope in Chronic Illness” by
Edith D. Hunt Raleigh
 90
pts, 45 with cancer & 45 with chronic
illness
 Most common reported sources for supporting
hopefulness were family, friends, and religious
beliefs (family, friends, faith)
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Genomics
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Human Genome Project – International
New gene based strategies for disease detection,
management, and treatment.
Nurses link between patient and services
Recognize patterns of inheritance
Genetic information may be empowering or
disabling (stigmatizing)
Nurses need to know how to obtain genetic
information
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Alternative Therapies
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Holism-define
Alternative Therapies
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Music therapy
Acupuncture/accupressure
Healing touch/therapeutic touch
Relaxation/guided imagery
Massage
Meditation/relaxation therapy
Aromatherapy
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“Energy” vs “non-energy”
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http://www.allina.com/ahs/anw.nsf/page/ihh_ho
me
http://www.woodwinds.org/Careservice/4_Healin
g_Arts/index.cfm?loadfile=1_oils.cfm#
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