Concepts of Chronicity

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Concepts of Chronicity

• Keith Rischer, RN, MA, CEN

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Todays Objectives

• 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

• Acute
• 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
• Onset varies may be sudden or slow
• 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

• 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

• 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
• Aging baby boomers
• 125 million afflicted
• Implications for nursing

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End of Life Care

• 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 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 fluidsoptional 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
• growth and development
• Young to middle age
• Family and work concerns
• Older adult
• greatest number
• normal aging process
• aging and chronicity - bad combo

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Coming to terms with chronicity

• Achieving highest level of wellness by
• Juggling act
• Focusing on abilities
• Following medical regimen
• Prevent further disability
• Resist isolation

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Rehabilitation

• 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

• CV
• Fatigue/rest needed
• Resp
• SOB w/activityactivity tolerance
• GI-Nutrition
• Po intakepainful/difficulty swallowingwt. loss
• Renal-Urinary
• Neuro
• Motor ability, sensation, cognition
• Musculoskeletal
• ROM/PROM
• Skin
• Risk for breakdown
• Albumin

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Nursing Priorities Iggy p. 123-131

• Impaired physical mobility
• Self care deficit
• Risk for impaired skin integrity
• Impaired urinary elimination
• Bladder training p.129
• Constipation
• Bowel training p.130-131
• Ineffective coping
• Knowledge deficit

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Bowel Bladder Concerns

• 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

• 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

• 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

• 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

• Holism-define
• Alternative Therapies
• Music therapy
• Acupuncture/accupressure
• Healing touch/therapeutic touch
• Relaxation/guided imagery
• Massage
• Meditation/relaxation therapy
• Aromatherapy
• Energy vs non-energy
• http//www.allina.com/ahs/anw.nsf/page/ihh_home
• http//www.woodwinds.org/Careservice/4_Healing_Art
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