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Chronic Illness

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Chronic Illness Chronicity ... mental disorders 1980- advocacy program OBRA ... right to refuse treatment PSDA (patient self determination act) ... – PowerPoint PPT presentation

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Title: Chronic Illness


1
Chronic Illness
  • Lisa B. Flatt, RN, MSN, CHPN

2
Chronic Illness
  • Chronicity last indefinitely
  • Medical care treating symptoms vs. curing

3
Models
  • Chronic Illness Trajectory Model
  • Pretrajectory phase wellness
  • Trajectory phase onset of symptoms
  • Stable phase start treatment
  • Unstable phase changes in treatment/decrease in
    improvement or management
  • Acute phase Sick hospital
  • Crisis phase life-threatening
  • Comeback phase get a little better
  • Downward phase moving towards death
  • Dying phase actively dying

4
Chronic vs. Acute
  • Chronic lasting
  • Acute short term with end in sight

5
Adjustment Patterns
  • Kubler Ross stages -- LOOK IT UP
  • Change lifestyle
  • Change location/environment
  • Acceptance of limitations
  • Modifications

6
Disability
  • Limitations
  • Face discrimination
  • Limitations at home and work
  • ADA of 1990 protection
  • Deal with environmental conditions that we dont
    think about - curbs

7
Chronic Illness Issues
  • Self-care ADL assistance
  • Deterioration of Health progressively grow
    worse ie. COPD
  • Quality of life decreases, increased problems
    such as financial, depression
  • Caregiver Dimension family steps in if there
    is one dramatic changes in family life and
    dynamics

8
Factors Influencing Adjustment
  • Gender roles caregiver is male or female
  • Age is there a spouse/SO still there, adult
    children
  • Age ability to continue with their disability
  • Preferences who they want to help
    relationship with their HCPs
  • Spiritual/religious/cultural beliefs
  • Support
  • Physical condition at start
  • Role insufficiency- loss of job, changes

9
Assumptions
  • People want to return to their previous state
  • Intrarole conflict inability of client to meet
    new demands of new role
  • Interrole conflict cannot perform expected or
    previous role
  • Hiding symptoms are normal
  • Want to pass

10
And more
  • Culture Chinese (oldest male cares for parents)
    Middle Eastern women caregivers hard to be sick
    and step down Different rituals
  • Some cultures remove from society
  • Different interpretations of quality of life
  • Response to chronic illness and why you became
    ill in the first place

11
And more.
  • Socioeconomic factors
  • Unemployment
  • Cost
  • Health insurance or lack of
  • Food and healthy eating

12
And more.
  • Environmental factors
  • Structural
  • Transportation
  • Occupational hazards
  • Safety issues
  • Patient safety needed equipment/lifts

13
Psychological
  • Depression
  • Anger
  • Isolative
  • Stigma to be ill
  • Dependence
  • Clingy
  • Want to be normal
  • Learned helplessness

14
Review
  • Alternative and complementary therapies
  • Right to Health Care
  • ??What kind of and how good is it???

15
Model of Chronic Illness
  • 133 million Americans have a chronic illness
  • This number will increase 1 a year until 2030
  • CDC CV disease, cancer, diabetes
  • Medicare/medicaid/private insurance/HMO
  • Ethical and legal implications Patient advocate

16
Developmental Disabilties Acts
  • 1975 mental disorders
  • 1980- advocacy program
  • OBRA (omnibus reconciliation act) 1990 right to
    refuse treatment
  • PSDA (patient self determination act) 1991
    inform of rights and have signed papers
  • Advanced and DNR

17
Nursing Process
  • Assessment adls advocacy ethical and legal
    aspect
  • Analysis collaboration, establish diagnosis and
    goals
  • Planning plan short term realistic goals for
    illness caregiver will state plan for respite
  • Implementation intervene for person, simple
    measures
  • Evaluation effectiveness of interventions
    determine further needs
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