1.1 Chronic Illness and Professional Nursing Practice Flashcards
Chronic Illness
- Perception and experience of living with a chronic disease
Chronic Disease
- Non-communicable disease/condition that lasts longer than 3 months
- 7/10 leading cause of death and disability
- Increasing in lower income areas
- These types of diseases are the leading cause of disability and require long term management
- Chronic disease can be controlled but not cured
- They are also unlikely to be resolved spontaneously
Common Chronic Conditions
- Hypertension, high cholesterol, arthritis, heart disease, diabetes, chronic kidney disease, heart failure, Alzheimer’s, depression, dementia, COPD
- 80% of adults 65+ have a chronic condition
- 68% have 2 or more conditions
- 25% of all adults have 2 or more chronic conditions
Disability
- Lack of ability to preform an activity in a normal manner
- These can be developmental, acquired or age related
- Dynamic between
Developmental Disability
- Happen between birth and 22 years old.
- Cerebral Palsy (ability to maintain balance)
- Down syndrome
- Spina Bifida
Acquired Disability
Traumatic - Result of acute injury (brain/spinal cord injury)
Non Traumatic - Result of stroke or heart attack
Can also be the result of a chronic disorder such as arthritis, multiple sclerosis, COPD
Age related disabilities are often sensory, vision/hearing loss
Arthritis is the most common cause of disability
Americans with Disabilities Act
- 1990
- Protects individuals with mental and physical impairment
- Provides patients with visual/hearing aides
- Access to service dogs in acute care settings
Patient Centered Care
- Respect for patients values, preferences and expressed needs
- Coordination/integration of care
- Information/communication/education
- Physical Comfort/Emotional Support
- Alleviation of anxiety
- Involvement of family and friends
- Continuity/transition of care (where they need to go)
- Access to care
Chronic Illness and Professional Nursing Practice
- 1/4 adults have 2+ chronic health conditions
- This increases the complexity of care
- This increases risk of conflicting medical advice, adverse effects of medication, unnecessary and duplicate tests, preventable hospitalizations
- Cost of care increases with number of chronic conditions
Chronic Conditions
- Day to day management of care of chronic conditions is mainly up to the patient and their family
- This can cause financial and ethical burdens.
Experience of Chronic Illness
Nursing Care Goals
- Prevent complications by managing symptoms
- Educate lifestyle changes to manage illness
- Improve quality of life (what they consider)
Polypharmacy
Use of multiple medications
- Comorbidity can result in drug interactions and lead to complications.
Pharmacodynamics in Older Adults
- Organ systems have decreased function which affect medications.
- BEERS Criteria - Medications that may be inappropriate for older adults.
Absorption
- Decreased gastric pH can cause delay in absorption of medications in older adults
- Decreased function of liver and kidneys cause decreased metabolism and excretion of drugs
- Decreased blood flow cause decreased absorption
- Decreased gastric emptying causes medication to remain in stomach (nausea/vomiting)
Distribution
- Decreased cardiac output, increased body fat, decreased muscle mass, decreased body fluid, decreased serum albumin.
- Hepatic enzymes decrease (less metabolism of drugs)
- Medication half-life is longer in older adults
Excretion
- Diminished renal blood flow, GFR, number of functioning nephrons.
- Takes longer for patients to excrete medication (increased toxicity)
How to prevent Adverse Effects?
- Assess medication list
- Assess patients ability to excrete medications by assessing blood urea nitrogen and CrCl (Creatinine clearance)
- Assess liver function
- Assess therapeutic drug levels
- Assess patients medication knowledge and compliance
Nursing Implications for Drugs
- Start drugs slow and go slowly to reduce adverse effects
- Assess patient/family members knowledge of medication/use
- Assess whether a patient is taking their medication and if they are not find out why
- Keep medication regime as simple as possible
Medication Adherence and Aging
What effects patients not adhering to medication regime?
- Polypharmacy
- Economic factors
- Starting low and going slow
- Asymptomatic (patient doesn’t feel they need it)
Chronic Care Model
- Self Management and Support
- Delivery System Design
- Decision Support
- Clinical Information Systems
- Organization of Health Care
- Community
