Exam 1 Flashcards
How is Chronic Illness defined?
All impairments or deviations from normal which have one or more of the following characteristics:
Are permanent
Leave residual disability
Are caused by nonreversible pathological alteration
Require special training of the patient for rehabilitation
Expected to require a long period of supervision or care
Name 3 general features of chronic illness.
-Symptoms interfere with many normal activities and routines
-Medical regimen is limited in its effectiveness
-Treatment contributes substantially to disruption of usual patterns of living
SIGECAPS (for depression) Pneumonic
Sleep: insomnia or hypersomnia
Interest: reduced, with loss of pleasure
Guilt: often unrealistic
Energy: mental and physical fatigue
Concentration: distractibility, memory disturbance, indecisiveness
Appetite: decreased or increased
Psychomotor: retardation or agitation
Suicide: thoughts, plans, behavior’s.
Theory of Self-Care of Chronic Illness
-There are difference between general self-care and self-care as it applies to chronic illness
-In order to make a decision, one must have sufficient capacity to understand and weigh information
-Increased conflict arises when trying to incorporate advice from multiple providers
-Self-care monitoring
-Previous experiences with illness or caring for someone with similar illness
-Self-care should be reflective and purposeful
-Misunderstandings, misconceptions, and lack of knowledge contribute to insufficient self-care
-Mastery of self-care maintenance is needed to master self0care management
-Self-care monitoring for changes in signs and symptoms is necessary for self-care management
-Individuals who perform evidence based self-care have better outcomes
Intended Outcomes
-Illness stability, health, well-being, quality of life
-Awareness of perceived control over illness and decreased anxiety
Growing body of literature suggests…
-Self-care can decrease hospitalizations, cost, and mortality
-Self-care can also allow for a sense of denial and failure to seek help, guilt
Factors affecting self-care
-experience and skill
-motivation
-cultural beliefs and values
-confidence
-habits
-functional and cognitive abilities
-support from others
-access to care
Theory of Self-Care of Chronic Illness (summary)
Self-care is essential in the management of chronic illness, but the process of engaging in self-care is more complex than originally thought. We define self-care as a process of maintaining health through health promoting practices and managing illness. We divide the process into three interrelated elements labeled as;
*self-care maintenance,
*self-care monitoring, and
*self-care management.
Self-care maintenance, performed in healthy and illness states, involves all those behaviors used to keep oneself healthy – getting a good night sleep, taking prescribed medication, exercise, etc.
Self-care monitoring is a process of routine, vigilant body monitoring, surveillance, or “body listening”.
Self-care management involves an evaluation of changes in physical and emotional signs and symptoms to determine if action is needed. These changes may be due to illness, treatment, or the environment.
https://nursology.net/nurse-theories/theory-of-self-care-of-chronic-illness/#:~:text=Theory%20of%20self-care%20of%20chronic%20illness%201%20Authors%3A,Riegel%2C%20PhD%2C%20RN%2C%20FAAN%20Tiny%20Jaarsma%2C%20PhD%20
The Chronic Illness Trajectory Framework (summary)
The Chronic Illness Trajectory Framework is a conceptual model that describes the course of chronic conditions over time.
The framework is built around the idea that chronic illness is dynamic and therefore requires phases to address the disease evolution.
The Corbin and Strauss Chronic Illness Trajectory Framework consists of six steps, including;
identifying the trajectory phase,
identifying problems and
establishing goals,
establishing plans to meet goals,
identifying factors that facilitate or hinder attainment of goals,
implementing interventions, and
evaluating the effectiveness of interventions.
Wagner’s Chronic Care Model (summary)
The Wagner Model for chronic illness is a framework that helps to manage chronic conditions through a more collaborative approach. It was created by Wagner to improve the effectiveness of chronic care and to prevent complications. The model recommends linkages across different settings, services, and systems, as well as self-management support and flexible delivery models of care.
The Wagner Chronic Care Model is a framework that helps improve the quality of care for patients with chronic conditions.
It involves six elements;
community resources,
health system,
self-management support,
delivery system design,
decision support, and
clinical information systems.
Geriatric goals
Improvement in function (not cure for disease or disability).
Traditional problem-focused assessment is not effective because of multiple, complex needs
Geri immunizations
-Influenza 65+ annually
-Pneumococcal q 5 years for 65+ who are immunocompromised
-COVID
-Shingrix
-Tetanus q 10 years
Traditional geriatric general health assessment
Should be supplemented by briefly screening for common geriatric conditions
Dementia definition
Global impairment of cognitive function that interferes with normal activities.
Impaired short-term memory
Deficits in abstract thinking, judgement, speech, coordination, planning, or organization
Other possible causes of dementia
-Depression
-Delirium
-Medications
-Infections
-Other co-existing medical conditions
ADHD evaluation includes
medical, developmental, educational, and psychological evaluation
ADHD
-May require several office visits
-For any child who is 4y-18y that exhibits academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity
Tool to eval and monitor for ADHD
-Child Behavior Checklist
-Connors/Connors short version
-ADHD 5
-**Vanderbilt (VERY common in primary care)
Diagnostic criteria for ADHD for children </ 17 years
> / 6 symptoms of hyperactivity and impulsivity or
> / 6 symptoms of inattention
Diagnostic criteria for adolescents >/ 17 years and adults
> / 5 symptoms of hyperactivity and impulsivity or
> / 5 symptoms of inattention
Symptoms of hyperactivity and impulsivity
-Excessive fidgetiness
-Difficulty remaining seated when sitting is required
-Feelings of restlessness (in adolescents) or inappropriate running around or climbing in younger children
-Difficulty playing quietly
-Difficult to keep up with, seeming to always be “on the go”
-Excessive talkming
-Difficulty waiting turns
-Blurting out answers too quickly
-Interruption or intrusion of others
Symptoms of inattention
-Failure to provide close attention to detail, careless mistakes
-Difficulty maintaining attention in play, school, or home activities
-Seems to not listen, even when directly addressed
-Fails to follow through
-Difficulty organizing tasks, activities, and belongings
-Avoids tasks that require consistent mental effort
-Loses objects required for tasks or activities
-Easily distracted by irrelevant stimuli
-Forgetfulness in routine activities
According to DSM-5 criteria ADHD symptoms must
-occur often
-***be present in more than one setting
-persist for at least 6 months
-Be present before the age of 12 years
-Impair function in academic, social, or occupational activities
-Be excessive for the developmental level of the child
Non-Modifiable Risk Factors for Chronic Diseases
Older age
Heredity
Race
Ethnicity
Socioeconomic
Cultural
Political
Environmental
Modifiable Risk Factors
Unhealthy diet
Lack of exercise
Obesity
Tobacco use
Excessive Alcohol Intake
80% of heart disease, stroke, and diabetes could be
prevented and 40% of cancers are avoidable with
risk factor modification
ADHD (boys v girls)
-Boys are more than twice as likely as girls to receive an ADHD diagnosis
-Boys are more likely to exhibit externalizing behaviors such as oppositional defiant disorder or conduct disorder
-Girls are more likely to exhibit an internalizing condition such as anxiety or depression
ADHD treatment (peds)
-Offer info regarding local support groups if avail
-Treatment may involve; behavioral interventions, medication, school based interventions, or psychological interventions alone or in combination.
-Children ages 4-18 WITHOUT comorbid conditions CAN be managed by their PCP.
ADHD (peds) first line treatment
-behavior management
-classroom interventions
-methylphenidate (stimulant) if behavioral interventions do not provide significant improvement and the child continues to have serious problems
Methylphenidate / stimulants (What to monitor)
-ECG and peds cardiac consult if fam hx or has cardiac disease
-height (monitor for height suppression)
-weight (can cause appetite suppression)
-BP & HR
-tics
-no lab monitoring required
-Vanderbilt scores, grades, comorbidities, etc.
Methylphenidate brand names
-short acting (3-6 hrs);
Focalin, Methylin, Ritalin
-intermediate acting (6-8 hrs);
Metadate CD, Ritalin LA
-long acting (8-12 hrs);
Concerta, Daytrana, Focalin XR, Quillvant XR
Non-stimulant medications for ADHD
-Straterra (Atomoxetine)
-box warning: increased risk of suicidal ideation
-Alpha-2 Adrenergic agonists (Clonidine, Guanfacine)
When assessing for depressive disorders in children in teens, always consider…
bipolar disorder
Major Depressive Disorder
5 or more of the following symptoms during the same 2 week period and represent a change from previous functioning;
-At least one symptom is either depressed mood or loss of interest or pleasure
-Depressed mood most of the day, nearly every day (in children, can be irritable mood)
* Markedly diminished interest or pleasure in all, or almost all activities, most of the day,
nearly every day
* Significant weight loss or gain or decrease or increase in appetite nearly every day (in
children, consider failure to make expected weight gain)
* Insomnia or hypersomnia nearly every day
* Psychomotor agitation or retardation nearly every day
* Fatigue or loss of energy nearly every day
* Feelings of daily worthlessness or excessive guilt
* Diminished ability to think or concentrate, or indecisiveness, nearly every day
* Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without
a specific plan, or a suicide attempt or a specific plan for committing suicide
What is the third leading cause of death in 10 to 24 year olds?
suicide
(T or F) The United States Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years
True
We would use the *PHQ-9 (ages 12 - 18)
Should ALL depressed individuals be screened for suicide?
Yes
labs for depression
TSH, FT4, CBC with diff, vit D, vit B12, urine tox, pregnancy test
First line treatment for moderate or severe depression not responding to therapy
SSRIs (Prozac, Zoloft, Celexa, Luvox, Lexapro)
How long does it take to see a positive effect for someone taking a SSRI?
4 - 6 weeks
(trial should be for at least 8 - 12 weeks)
What is the only medication approved by the FDA for use in treating depression for children 8 years old and older?
Fluoxetine (Prozac)
Common side effects of SSRIs
+ Excitation/agitation
+ Nausea/vomiting
+ Diarrhea
+ Dizziness
+ Chills
**Always educate regarding risks of serotonin syndrome (e.g.
agitation, insomnia)
SSRI black box warning
increased risk of suicidal tendencies in young people (up to 25 years old)
Follow up after SSRI is started
2 - 4 weeks
Anxiety diagnosis DSM-5
excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities
Anxiety screening
SCARED (starting at ages 4/5 up to age 11)
GAD-7 for ages 12 and up
Acute stress disorder
+ beginning /worsening after the traumatic event occurred
+ 3 days – 1 month after event
PTSD
duration more than a month, delayed expression – criteria not met until 6
months after the event
