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| Acute Phase | The fifth phase of the chronic illness trajectory, which is marked by the onset of severe or unrelieved symptoms or complications that necessitate re-hospitalization for management |
| Analysis Of Disability of Those W/Chronic Conditions | (1) variety of laws at federal level provide children & adults w/disabling illnesses equal access to education & employment. Nurse advocates inform clients of laws & where information may be obtained. Laws offer significant protection for people w/disabilities, but physical & psychological barriers to full acceptance remain. Disability rights advocates work at all levels of government & w/community organizations to decrease barriers (encouraging reference to clients as persons w/disabilities, rather than disabled persons), one example of how a simple word change makes major differences in perceptions of a person’s ability |
| Chronic Care Model | (1) looks at the internal and external components needed by health care organizations to manage chronic illness (2) first priority is to improve client care (3) followed by the goal of reducing costs (4) utilizes primary care practice as opposed to specialty practice (5) consists of four internal (health system) components & two external (community) components |
| Chronic Condition | (1) medical or health problem w/associated symptoms requiring long-term management (three months or longer) (2) may occur d/t injuries, congenital defects, or illness (4) usually have a slow onset characterized by periods of remission (when symptoms disappear) & exacerbation (when symptoms reappear) (5) result in increased mortality & loss of productive years of life (6) tend to have a long latency period (7) tend to have a specific course of development (8) are not necessarily life-threatening (9) tx is not about cure but care |
| Chronic Conditions Common Problems | (a) manage symptoms & maintaining an acceptable quality of life (b) preventing, managing, or adapting to disabilities (hemiplegia) (c) preventing & managing crises & complications (d) living w/altered daily routines, social isolation, & loneliness (e) identifying & maintaining support resources (f) continually affirming self-worth & family functioning (f) adapting to repeated alterations in functional ability (decline associated w/progressive neurological disorder) (g) normalizing individual & family life to greatest extent possible (h) managing financial resources (covering adequate self-care costs) (i) return to satisfactory life after acute phase of a chronic condition (j) managing moral dilemmas about dying w/dignity & comfort. Other incl vigilance to control condition requiring time, knowledge & commitment It is common for people to alter tx regimes or D/C medications considered time-consuming, fatiguing, or costly |
| Chronic Illness Trajectory | (1) one to two specific models of chronic illness (2) the nine phases through which a chronic condition develops and progresses (3) not all people w/chronic illness pass thru the nine phases of trajectory |
| Chronic Sorrow | (1) an emotional response exhibited by some parents of special needs children throughout the length of the parent-child relationship (2) tends to recur at each significant developmental milestone (remind parents of what could have been) and is interspersed with acceptance (3) acknowledgement that plans & dreams will not be met |
| Comeback Phase | (1) the seventh phase of the chronic illness trajectory, which marks recovery after an acute event (2) stage incl management of lifestyle changes to overcome disabilities & return to an acceptable way of living w/in limitations imposed by the chronic condition |
| Crisis Phase | the sixth phase of the chronic illness trajectory, during which a critical or life-threatening occurrence requires emergency care |
| Downward Phase | (1)the eighth phase of the chronic illness trajectory, which occurs when symptoms worsen and there is deterioration despite attempts to control symptoms (2) does not necessarily lead to death |
| Dying Phase | the ninth and final phase of the chronic illness trajectory, which is characterized by gradual or rapid decline and eventual failure of life maintaining functions. |
| Emotions Accompanying Chronic Illness Dx | (1) upon learning of illness dx, an individual & family may experience numerous difficult emotions (a) fear (b) guilt (c) anxiety (d) resentment (e) anger (2) support from significant others and hcps can help families effectively manage these feelings (3) other common phases of emotional adjustment & reaction include (a) shock (b) denial (c) disbelief (d) adjustment (e) reintegration (f) acknowledgement |
| Exacerbation | (1) a period during which the symptoms of a chronic condition reappear |
| Etiology Of Chronic Conditions | (1) modern lifestyle habits lead to chronic conditions (smoking, obesity, lack of regular exercise lead to increased risk for chronic illnesses like (COPD) & cardiovascular disease) (2) improved diagnostic & screening programs lead to early detection & tx (3) longer life span because of advanced technology, advances in pharmacology, safer work environments, & (for some people) greater access to health care (4) prompt & aggressive management of acute illnesses (myocardial infarctions and AIDS-related infections) (5) a decrease in mortality rates from infectious diseases (smallpox, diphtheria, & other serious conditions) (6) tendency to develop single & multiple, chronic illnesses w/advancing age |
| Evaluate typical adjustment patterns associated w/dx of chronic ill | The process of adjusting to a chronic illness dx & accepting lifestyle changes varies w/individuals & their families. It is important for hcp to recognize & respect a variety of coping mechanisms. Some adjustments relate to illness behaviors & associated changes in roles, while others relate to the emotional changes that a person undergoes upon learning of the presence of chronic illness |
| Factors (Other Than Emotions) Influencing A Client’s Adjustment To Chronic Condition | include (1) sex (b) age & developmental level (c) individual & family patterns of response (d) physical condition (e) cultural variations (f) socioeconomic factors (g) environmental factors (h) psychological factors (i) role changes (j) stigmas (k) use of alternative treatments (l) attitudes of health care providers (m) shifting perspectives toward chronic illness (n) policy and politics |
| Factors Increasing Chances of Developing Chronic Conditions | (1) lifestyle incr risk for COPD & cardiovascular disease (a) smoking (b) obesity (c) lack of regular exercise |
| Illness Behaviors | refers to the different ways in people (1) respond to changes in bodily functions & health alterations (2) define & interpret their symptoms (3) make assumptions about changes taking place in their bodies (4) take remedial actions (5) network w/formal & informal systems of care. Illness behaviors are often accompanied by what is known as the sick role |
| Impaired Role | (1) learned role assumed by people w/chronic conditions (2) role involves a condition of permanent impairment (3) client is expected to maintain normal social responsibilities (w/adaptations if necessary) d/t being impaired not sick (4) individual is not expected to “want to get well,” but is expected to make the most of current capacity (5) client’s prognosis is known but is not considered grave (6) concept encompasses maximum wellness & rehabilitation (7) S&S, time boundaries are not as clear or defined as in the sick role |
| Individual w/Disabilities Education Act (IDEA) of 1975 | requires states to id, dx, educate & provide related services for special needs children between 5 & 18; extended to 3 to 21 |
| Individual & Family Patterns of Response | w/interacting w/hcp, family can be categorized as (1) silent in care (uncertain & quiet fluctuating between trust & mistrust) w/little communication (2) recipient of care (total trust in hcp, hcp makes all decisions (3) monitors of care (high level of mistrust w/belief mistakes will happen, observing everyone’s performance & wanting to be involved in decision-making, demand high level of information (4) managers of care (similar to monitors of care, but tend to be less angry |
| Interrole Conflict | role conflict related to problems within an individual; here, the person fails to demonstrate appropriate behavior as the result of occupying two competing roles |
| Intrarole Conflict | role conflict related to problems outside of an individual; here, the person receives divergent information that makes a good choice seem impossible |
| Latency Period | (1) time in which a disease develops at the cellular level w/no clinical manifestations in the affected person (2) chronic health problems tend to have long latency periods (3) disease onset is when S&S of the disease finally appear (4) numerous chronic conditions have long latency periods (e.g., malignant tumors of the pancreas) followed by dramatic symptom onset (sudden onset of jaundice) (5) because of this, there is an increased emphasis on promotion of healthy lifestyles in childhood. It will be years before it is known whether health promotion activities result in significant decreases in chronic conditions |
| Models of Chronic Illness | (1) chronic illness trajectory (nine stages) (2) chronic care model (looks at the internal & external components needed by hc organizations to manage chronic illness |
| Older Adults | face particular risks because of normal physiological changes of aging, but are also more likely to suffer from common chronic illnesses. In fact, after age sixty-five, a person is likely to have an average of one to three chronic illnesses. Frequently occurring chronic illnesses in this age group are compromised respiratory, cardiovascular, and/or metabolic function |
| Pretrajectory Phase | (1) the first phase of the chronic illness trajectory, in which the person is at risk for developing a chronic condition (2) often d/t lifestyle |
| Remission | a period during which the symptoms of a chronic condition disappear |
| Role Ambiguity | (1) alack of clarity about the expectations of a role (2) is related to role insufficiency and means that there is a lack of clarity about the expectations of a role (3) in this situation, the person has little information about the behavioral expectations of his or her new role, and members of the person’s social system do not communicate clear expectations about the role |
| Role Conflict | (1) condition where the different roles or choices a person must assume or make are at odds with one another (2) relate to problems outside of the individual (intrarole conflict person w/epilepsy told by one neurologist to be active w/a stressfull life, another neurologist may say increased stress will worsen the seizure disorder) as well as conflict w/in the person (interrole conflict middle aged woman w/chronic illness may fail to care for self d/t caring for frail mother) |
| Role Insufficiency | the condition in which a person experiences problems and confusion related to role transitions. The person considers the costs and rewards of a certain role, and he or she may decide the costs outweigh the rewards |
| Role Strain | person feels his or her current role obligations are impossible to carry out producing anxiety, irritation, guilt, depression, grief & apathy |
| Sick Role | (1) a learned role often assumed by people who are ill (2) involves exemption from normal social roles (3) a lack of responsibility for one’s illness (4) an obligation to get well (5) an obligation to find and cooperate with competent care |
| Social Reintegration | the process in which a chronically ill client and his or her family broaden their activities to include relationships outside of the home, with the client as an acceptable and participating member of the group |
| Stable Phase | the third phase of the chronic illness trajectory, during which the condition is diagnosed and the symptoms are typically under control or managed |
| Stigma | (1) mark of shame or discredit arising from widely held social beliefs about illness, behaviors, or appearances (2) attitudes & behaviors about stigmatized person/groups are socially constructed (learned from significant persons & social institutions (3) When a stigmatized person covers, that individual makes their condition seem smaller or less significant than it really is. In other words, although the condition may be openly acknowledged, its consequences are minimized |
| Stigmatized People Reaction | (1) disregard especially if comfortable w/identity or have dealt w/it a long time (2) isolation when outsiders are seen as dangerous or threatening (3) resistance a response of anger or frustration; can also be a catalyst for change (American w/Disabilities Act positive result of resistance, pushing pack resulting in positive change (4) passing choosing not to disclose condition thus avoiding associated stigma (5) covering making condition seem smaller or less significant (condition openly acknowledged, it consequences are minimized); goal of covering is tension reduction |
| Trajectory Phase (Analytical Tool) | (1) the second phase of the chronic illness trajectory, which involves the initial occurrence of disability or symptoms (2) term for development of long-term chronic conditions, which tend to have a specific course of development and that can be somewhat controlled that can be helpful in anticipating client and family needs (3) not all people with a chronic condition pass through each phase of the trajectory model |
| Trajectory Model Nine Phases | chronic conditions tend to have a specific course of development called the trajectory (1) pretrajectory (2) trajectory (3) stable (4) unstable (5) acute (6) crisis (7) comeback (8) downward (9) dying |
| Unstable Phase | (1) fourth phase of the chronic illness trajectory, during which symptoms recur, complications develop, or the illness reactivates (2) activities may be disrupted by symptoms & may be need to develop new medical & lifestyle strategies to manage problem |
| Individuals with Disabilities Education Act (IDEA) | requires states to identify, diagnose, educate, and provide related services for special needs children between five and eighteen years of age. The age range was extended in 1977 to include children from three to twenty-one years of age. |
| Americans with Disabilities Act (ADA) | prohibits discrimination against individuals with disabilities. The act applies to children and adults and affects many businesses and services |
| The Education of the Handicapped Act Amendments | direct states to develop and implement comprehensive, coordinated, multidisciplinary, interagency programs of early intervention services for infants and toddlers with disabilities, as well as support services for their families. |
| Nursing Process | (1) offers a systematic approach to improving the quality of life for clients with chronic illness (2) identifies strategies for the management of symptoms related to chronic illness (3) provides a road map for continuity and coordination of care for the patient and their family |
| Components Of A Comprehensive Assessment Patients W/Chronic Conditions | (1) determining where the client & their family falls on the chronic illness trajectory (2) collect information on the functional burden faced by the client’s family (3) functional abilities sh/be determined through ADL assessments (to provide information on critical care areas like risk for physical injury d/t confused mental status & lack of caregiver availability) (4) psychological environment is an essential assessment area (collects data on the client’s support systems, response to hc workers & pattern of response to chronic condition) |
| Analyze (Diagnosis) Assessment Data Of Client W/Chronic Condition | (1) use data to formulate dxs (2) critical thinking includes finding patterns & (clusters) relationships in clues (3) identify gaps in data (4) make inferences (5) make interdisciplinary connections (6) identify factors adding to problem (7) made diagnoses (8) set priorities for care based on Maslow to ensure critical needs are met before others of less value i.e. self-esteem 9) develop care plan using critical-thinking & Maslow (10) use theoretical framework to analyze client’s response to chronic illness (11) developmental theories, e.g., are very helpful in applying critical-thinking strategies to nursing assessment data |
| Planning Formulate Care Plan For Client Facing Chronic Illness | Planning Formulate Care Plan For Client Facing Chronic Illness nursing dxs are used to (1) estab client-centered care goals r/t health restoration, maintenance, and protection (2) estab nursing standards r/t rest & activity patterns, cognitive skills, & ADL are used to identify desired outcomes (3) examine ethical & legal implications of various rationales for care. Ex: (a) consider legal protections of the Americans W/Disabilities Act (b) caregiver motivations (to rule out elder exploitation, etc.) (c) guardianship (d) access to services (e) medical fraud (f) advance directives & DNR orders (g) lack of control & self-determination (4) suffering must be considered r/t effective planning (5) psychological concerns of isolation (6) willingness to adhere to treatment regimes. The question: what plan will enhance client’s quality of life can be of guidance. (7) evidenced-based practice is important & any model of chronic illness applicable to the client can serve as a framework for decision-making. Management patterns for specific illnesses & prevention initiatives may help identify appropriate care plans. |
| Implement the patient’s plan of care, making sure to establish a collaborative relationship with the patient and provide information and instruction regarding health promotion, maintenance, and restoration. While therapeutic communication is needed throughout the nursing process, the implementation stage is where its success is tested | (1) use therapeutic communication to discuss client’s attitude toward receiving help & using mutual goals to deal w/presenting symptoms or needs. (2) dev strategies to monitor client mobility devices & equipment use (3) caregiver support is critical to help families adapt to & manage chronic conditions; suggest caregiver support groups (4) provide anticipatory guidance for difficult events or procedures (5) monitor compliance w/medical regimes (6) discuss issues r/t change & barriers negatively impacting change (7) uses appropriate measures r/t safety needs (correct use of turning schedules, assessing deconditioning after an exacerbation, monitoring for depression, potential self-violence, monitoring fatigue levels, & teaching the client use of electronic openers, light clappers, & call systems) (8) medication administration & polypharmacy (safety issues to prevent harm to client) (9) be advocator & educator for the client & family in the area of chronic illness empowerment. |
| Evaluate the patient’s response to the care provided and revise the plan of care as Appropriate | (1) documents effectiveness of any nursing interventions in relation to the expected outcomes (clients and caregivers follow up with appointments; whether clients maintain organized, routine medication regimes; whether clients report fewer symptoms that interfere with their lifestyle, responses r/t changes in self-reporting of distressing life events, in control over pain and pain management); record client’s and caregivers’ responses to nursing actions, reassesses and revises care plan as necessary (client’s cognitive abilities decrease, or in which a client revises his or her ADLs after an acute exacerbation of symptoms, changes in the client’s perception of social isolation or stigmas are also evaluated, and revisions to the care plan are made based on results; also evaluate the client’s response to care administered by other members of the health care team |
| Normalization | involves alleviating an affected individual’s feelings of being different. Normalization typically occurs through the process of preparation (providing anticipatory guidance related to changes that may occur because of a disability), participation (including the client in as many decisions as possible about his or her care regime), control (communicating with the client and identifying areas where he or she can have control in order to decrease feelings of uncertainty, passivity, and helplessness), and positive attitude (helping the client and his or her family focus on areas of ability and competence) |
| Evaluate | the patient’s response to the care provided and revise the plan of care as Appropriate documents (1) effectiveness of nursing interventions r/t expected outcomes (clients and caregivers follow up w/appointments (2) if clients maintain organized, routine medication regimes (3) if clients report fewer symptoms that interfere w/lifestyle, responses r/t changes in self-reporting of distressing life events, in control of pain & pain management) (4) record client’s & caregivers’ response to nursing actions, reassesses & revises care plan as necessary (client’s cognitive abilities decrease, or where a client revises ADLs after acute exacerbation of symptoms, changes in client’s perception of social isolation or stigmas are evaluated, & revisions to care plan are made based on results; evaluate client’s response to care administered by hc team |
| Normalization | involves alleviating an affected individual’s feelings of being different. Normalization typically occurs through the process of preparation (providing anticipatory guidance related to changes that may occur because of a disability), participation (including the client in as many decisions as possible about his or her care regime), control (communicating with the client and identifying areas where he or she can have control in order to decrease feelings of uncertainty, passivity, and helplessness), and positive attitude (helping the client and his or her family focus on areas of ability and competence) |
| Functional Burden Concept | refers to relationship between caring for person w/chronic illness & family’s resources & ability to cope w/person’s care needs. Areas to consider when assessing functional burden include the following (1) client’s need for medical & nursing care (2) number & severity of client’s unchangeable deficits (e.g., cognitive impairment from a traumatic brain injury) (3) client’s age-appropriate dependency in ADLs (4) disruption in family routines d/t by care (5) psychological burden of prognosis on the family (5) physical, social, emotional & educational resources available to family (6) family’s social support & available help (7) competing demands for family members’ time & energy (8) client’s cognitive loss as determined by mental status testing |
| Trajectory Chronic Illness | when working with a patient who has a chronic illness, one of the initial pieces of assessment data collected should be a determination of where the client and his or her family fall on the chronic illness trajectory |
| Polypharmacy | (1) occurs when providers prescribe more than one medication of the same class for a condition (2) term also applies to a patient’s concurrent mixing of over-the-counter (OTC) drugs, nutritional supplements, and/or herbal products with his or her prescription medications (3) puts all clients (and elders in particular) at risk for excessive doses, drug interactions, and dangerous adverse reactions |
| Nursing Diagnoses | may be r/t chronic illness incl: (1) Health maintenance impaired d/t decreased mobility (2) Ineffective health maintenance r/t feelings of being overwhelmed (3) Caregiver strain r/t twenty-four-hour home care responsibility (4) Self-care feeding deficit r/t depressed mental state (5) Impaired home maintenance management r/t lack of motivation (6) Disturbed body image r/t chronic illness (7) Social isolation r/t feelings of rejection (8) Chronic low self-esteem r/t inability to deal w/events |
