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Behavior Med I Exam 2 > Chronic Disease > Flashcards

Chronic Disease Flashcards

1
Q

What percent of people deaths each year are due to chronic diseases?

A

70%

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2
Q

what percent of deaths are due to heart disease and cancer?

A

50%

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3
Q

what percent of adults have chronic diseases?

A

50%

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4
Q

what is the most common disability

A

arthritis

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5
Q

what is the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness?

A

diabetes

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6
Q

what are four modifiable health risk behaviors are related to suffering, illness, and death of chronic diseases?

A
  • lack of physical activity
  • poor nutrition
  • tobacco use
  • excessive alcohol consumption
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7
Q

what are health care costs driven by?

A

advancing technology applied to an aging population with chronic diseases

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8
Q

what percent of healthcare costs in US go to chronic diseases?

A

80%

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9
Q

how is chronic disease largely managed?

A

patient knowledge

behavior change

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10
Q

how do the onset and duration of chronic diseases compare to acute diseases?

A

chronic - gradual onset and indefinite durations

acute - rapid onset and short durations

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11
Q

how do the causes and treatments of acute illness and chronic illness differ?

A

chronic - many causes and cures are rare

acute - usually one cause and cures are common

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12
Q

how do the Dx and Dx testing of chronic and acute diseases differ?

A

chronic - diagnosis often uncertain (especially early) and Dx testing usually has limited value

acute - commonly accurate diagnosis and often useful testing

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13
Q

how do the role of the pt and professional in acute and chronic diseases differ?

A
  • chronic: professional serves as teacher and partners, pt serves as partner with health professionals, responsible for daily management
  • acute: professional selects & conducts treatment and patient follows orders
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14
Q

What components make up with vicious cycle of chronic disease?

A
  • pain
  • disease process/disability
  • depression
  • stress
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15
Q

what happens as you transition from disease process/disability to depression?

A

loss of self-esteem

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16
Q

what happens as you transition from depression to stress?

A

loss of control

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17
Q

what happens as you transition from stress to pain?

A

muscle tension

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18
Q

what happens as you transition from pain to disease process/disability?

A

immobility

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19
Q

what is erratic adherence?

A

failure to follow treatment because it is difficult and/or there are lifestyle disruptions that interfere with regimen

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20
Q

what is unwitting non-adherence?

A

pt believe they are complying but fail to do so due to language & culture barriers, cognitive impairment, lack knowledge

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21
Q

what is intentional non-adherence

A

make a clear decision to alter or stop treatment

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22
Q

Maslow’s theory of ______ and _____.

A

Motivation and Human Needs

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23
Q

What is level 5, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?

A

Self-actualization

needs - fulfillment of goals & dreams

motivation & behavior - creativity

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24
Q

what is level 1, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?

A

Your body

needs - physical safety & security

motivation & behavior - survival skills

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25
Q

what is level 2, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?

A

Family & work

needs - social safety & security

motivation & behavior - survival skills

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26
Q

what is level 3, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?

A

love & relationships

needs - communication & response

motivation & behavior - validation

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27
Q

what is level 4, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?

A

self - esteem

needs - self-respect & acceptance

motivation & behavior - brainpower

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28
Q

What are the 7 effects of chronic disease?

A
  • decreased level of activity
  • change in daily activities
  • decreased sex drive/ability
  • decreased self-esteem (altered body image)
  • changes in roles (relationship stress)
  • fear of abandonment
  • negative emotions: sadness, greif, anger, loss of control, anxiety
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29
Q

Top 5 leading causes of death?

A
  • heart disease*
  • cancer*
  • lower respiratory disease*
  • accidents
  • stroke*
  • = top 4 causes in VA
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30
Q

What is Healthy People 20/20?

A

National health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats.

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31
Q

Goal for heart disease & stroke from Healthy People 20/20?

A
  1. utilize prevention, detection, and treatment of risk factors
  2. early identification and treatment
  3. prevention of repeat events
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32
Q

what percent of adults have heart disease?

A

33%

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33
Q

what chronic diseases are most preventable?

A

heart disease & stroke

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34
Q

Leading modifiable risk factors for heart disease & stroke?

A
  • high BP
  • high cholesterol
  • smoking
  • DM
  • poor diet & physical activity
  • overweight/obesity
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35
Q

goal of DM from healthy people 2020?

A
  1. reduce DM
  2. reduce economic burden of DM
  3. improve quality of life for ppl with/at risk for DM
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36
Q

by how much does DM lower life expectancy?

A

15 years

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37
Q

Does DM increase risk of heart disease?

A

yes, 2-4x

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38
Q

goal of obesity, healthy people 2020?

A

promote health and reduce chronic disease risk via healthy diet, & achievement/maintenance of healthy body weights

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39
Q

people who are overweight or obese are at risk of what?

A
  • high BP
  • coronary heart disease
  • gallbladder disease
  • sleep apnea
  • cancer
  • T2 DM
  • stroke
  • osteoarthritis
  • respiratory problems
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40
Q

Goal of cancer 2020?

A

reduce new cases

reduce illness, disability, death

41
Q

what is the second leading cause of death in US?

A

cancer

42
Q

what percent of people are expected to be alive 5 years after diagnosis of cancer?

A

40%

43
Q

What risk factors reduce risk of cancer?

A
  • tobacco products
  • physical inactivity & poor nutrition
  • obesity
  • UV light exposure
44
Q

what is goal of respiratory disorders 2020?

A

promote respiratory health through better prevention, detection, treatment, and education efforts

45
Q

what are the significant public health burdens related to respiratory disorders?

A

asthma
COPD
obstructive sleep apnea

46
Q

is COPD preventable?

A

Yes

47
Q

what are the 2 most common causes of chronic illness in children?

A 
#1 chronic sinusitis
#2 asthma
48
Q

what populations are at the greatest risk for death from asthma?

A
  • african americans
  • hispanics
    (2-6x more likely than caucasians)
49
Q

what to address when assessing risk factors?

A
  • unhealthy eating
  • physical inactivity
  • overweight
  • tobacco use
  • under-use of screening practices (cholesterol, lipids, blood pressure, blood sugar, pap smear, mammography, bone density)
  • alcohol abuse
50
Q

how long should kids and adults be active each day?

A

kids - 60 minutes

adults - 30

51
Q

what amount of activity is required to prevent weight gain or sustain weight loss?

A

60-90 minutes

52
Q

How much grain should be consumed daily? what type?

A

6 ounces

half should be whole grains

53
Q

how much vegetables should be consumed daily?

A

2.5 cups

vary type

54
Q

how much fruit should be consumed daily?

A

2 cups
vary type
not too much juice

55
Q

how much dairy should be consumed daily? what type?

A

3 cups

low fat or fat free

56
Q

how much meat should be consumed daily? what type

A 
5.5 ounces
lean cuts
seafood
beans
avoid frying
limit red meat
57
Q

how much oil should be consumed daily?

A

low
it should come from fish, nuts, vegetable oils

limit butter (solid fats)

58
Q

keep consumption of saturated fats, trans fats, and sodium…

A

low

59
Q

how much exercise do adults need? (minimum)

A

150 minutes of moderate aerobic activity and muscle strengthening activity on 2 or more days of the week

OR

75 minutes of vigorous intensity aerobic activity and muscle strengthening activity on 2 or more days of the week

OR

an equivalent mix of moderated/vigorous activity and muscle strengthening activity on 2 or more days of the week

60
Q

How much exercise should adults get if they want to get the greatest benefit from it?

A

300 minutes moderate aerobic activity and muscle strengthening activity on 2 or more days of the week

OR

150 minutes of vigorous activity and muscle strengthening activity on 2 or more days of the week

OR

equivalent mix of vigorous/moderate activity and muscle strengthening activity on 2 or more days of the week

61
Q

Benefits of physical activity?

A

Increase endurance
Increase inner size of arteries
Decrease BP
Decrease blood lipids (HDL)
Lower risk for coronary artery disease and high blood pressure
Increase lung capacity
Greater resistance to fatigue
Burns calories
Improves metabolism
Suppresses appetite
Improves insulin sensitivity
Muscle relaxation
Self-image
Mental release

62
Q

what comprises disease management?

A

A system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts
are significant

63
Q

When is a disease or condition amendable to disease management?

A
  • significant morbidity/mortality
  • numerous lifestyle and therapeutic challenges
  • high cost to healthcare system
  • multidisciplinary and fragmented approach
  • variability in treatment practices
  • pt have the potential to be empowered with cognitive and behavioral tools
64
Q

how do pt have the potential to be empowered with cognitive and behavior tools in disease management?

A
  • enhance clinical outcomes
  • increase adherence
  • reduce system demands
65
Q

describe the stanford self-management program for chronic disease management?

A
  • +20 years
  • developed, tested, and evaluated self management programs
  • small-group workshops
    generally 6 weeks long, meeting once a week for about 2 hours
  • led by a pair of lay leaders with health problems of their own
  • meetings are highly interactive, focusing on building skills, sharing experiences and support
  • Arthritis, Chronic Disease, Positive (HIV), Diabetes
  • Spanish, Online
66
Q

benefits of physical activity

A

Increase endurance
Increase inner size of arteries
Decrease BP
Decrease blood lipids (HDL)
Lower risk for coronary artery disease and high blood pressure
Increase lung capacity
Greater resistance to fatigue
Burns calories
Improves metabolism
Suppresses appetite
Improves insulin sensitivity
Muscle relaxation
Self-image
Mental release

67
Q

what are frustrating problem-centered interactions associated with usual care?

A
  • uninformed passive patient

- unprepared practice team

68
Q

what are the outcomes of usual care?

A

suboptimal functional and clinical outcomes

69
Q

what are the downsides of community related to usual care?

A

no links to community agencies or resources

70
Q

what are the downsides of the health system related to usual care?

A
  • leadership concerned about the bottom line
  • incentives favor more frequent and shorter visits
  • no organized quality assurance
  • patient’s problems in managing the illness not solicited or dealt with
  • counseling didactic
  • care depends on MD in short, unplanned visits
  • pt initiated follow-up
  • no protocol, specialist input by traditional referral
  • pt information limited to chart, no population data
71
Q

essential element of successful chronic disease management

A

success lies in fostering a pt centered partnership

72
Q

what builds productive interactions in the chronic care model?

A

informed, active patient and prepared practice team

73
Q

how does the chronic care model address community?

A
  • provides resources and policies

- builds relationships with healthcare organization and community agencies

74
Q

how does the chronic care model address the healthcare system

A

healthcare organization

  • self management support
  • delivery system design
  • decision support
  • clinical information systems
75
Q

what are the outcomes of the chronic care model?

A

improved

76
Q

how do community agencies fill gaps in the chronic care model?

A
  • pt education classes
  • exercise classes
  • smoking cessation programs
  • home health services
77
Q

what is the purpose of the delivery system design

A
  • expanded primary care team
  • team roles and tasks
  • planned interactions
  • case management services
  • care that understands and fits their culture
  • regular follow up
78
Q

what is decision support

A
  • evidence based guidelines
  • specialist expertise
  • provider education
  • guidelines for patients
79
Q

what are the clinical information systems?

A
  • available, accurate timely information
  • individual care planning, sharing info with patient
  • care reminders
  • feedback
80
Q

what is self-management support?

A

helping people to understand their health behaviors and develop strategies to live as fully, productively, and well as they can

81
Q

what is self-management support?

A
  • assists pt and families with gaining knowledge, skills, & confidence to manage condition
  • helps set goals
  • provides active support in a partnership role
  • helps pt access community resources
82
Q

what are the 5 A’s of self-management support

A 
arrange
assess
advise
assist
agree
83
Q

describe the function of “arrange” from 5 A’s of self-management support

A

specify plan for follow-up (visit, call, mail)

84
Q

describe the function of “assess” from 5 A’s of self-management support

A

beliefs, behavior, & knowledge

85
Q

describe the function of “advise” from 5 A’s of self-management support

A

provide specific information about health risks and benefits of change

86
Q

describe the function of “assist” from 5 A’s of self-management support

A

identify personal barriers, strategies, problem-solving techniques, and social and environmental support

87
Q

describe the function of “agree” from 5 A’s of self-management support

A

collaboratively set goals based on patients interest and confidence in ability to change the behavior

88
Q

What is the personal action plan created by 5 As of self-management support

A
  1. list specific goals in behavioral terms
  2. list barriers and strategies to address barriers
  3. specify follow-up plan
  4. share plan with practice team and pt social supporters
89
Q

what are pt self-management tasks?

A
  • take care of illness (medical management)
  • carry out normal activities (role management)
  • manage emotional changes (emotional management)
90
Q

what are the 7 characteristics of a self-manager?

A
  • takes responsibility for their health
  • forms partnership with provider
  • establishes goals, sets action plan, carries these out
  • checks results and shares with provider
  • explores alternative solutions and makes changes as needed
  • asks for help from support network as needed
  • committed to living well with a chronic condition
91
Q

describe how self-management support is used to help people

A
  1. understand
  2. decide and choose
  3. adopt and change behavior
  4. overcome barriers
  5. cope
  6. follow through
92
Q

what ISN’T self-management support

A
  • didactic pt education
  • lecturing
  • “You should…”
  • finger waving
  • waiting for pt to ask for help
93
Q

why is self-management support so important

A
  • pt does the vast majority of the work in caring for illness
  • self-management support is often ignored
  • it is the place where practice team collaborates with pt and caregivers
94
Q

how to provide self-management support

A
  • ask pt to assess unhealthy aspects of lifestyle
  • ask about health, concerns, & lifestyle
  • identify management areas of concern
  • assess readiness to change
  • specific plan (goals/action plan)
  • check confidence level
  • assist with identifying barriers and solutions
  • follow up at each visit
95
Q

what are qualities of successful action plans?

A
  • pt wants to do it
  • reasonable
  • behavior specific
  • confidence level >7
  • if lower ask what would make it higher
96
Q

describe how to make behavior-specific action plan?

A
  • what will be done
  • how much will pt do
  • when and where will pt do it
  • how often will the pt do it
97
Q

how to address low confidence levels

A
  • identify barries/problems
  • brainstorm several solutions
  • ask pt if they think any will work
  • adjust action plan
  • reassess confidence level
98
Q

how does successful chronic illness management differ from usual care?

A
  • support is reinforced at each visit
  • care is structured and provided by a team
  • close follow up required during periods of poor disease control
  • care guided by protocol featuring intensification of therapy
  • specialists support primary caregivers
  • computer database is a tool for care

Behavior Med I Exam 2 (3 decks)

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