Caring for Patients With Chronic Illness

Chronic disease

A pathophysiologic condition that lasts more than 1 year, requires ongoing medical care, and often limits daily activities.

Chronic illness

The patient's and family's personal experiences of and responses to a chronic disease.

Difference between chronic disease and chronic illness

Chronic disease is the medical condition; chronic illness is how the patient and family experience and respond to it.

Main characteristics of chronic disease

It lasts more than 1 year, often requires ongoing treatment, and may limit daily activities.

Examples of chronic diseases

Diabetes mellitus, hypertension, heart failure, asthma, arthritis, cancer, and chronic kidney disease.

Impact of chronic disease on health care costs

Chronic diseases increase expenses through medications, treatments, hospitalizations, and ongoing care.

How to reduce health care costs from chronic diseases

Through disease prevention, early screening, healthy lifestyle changes, and effective symptom management.

Incidence

The number of new cases of a disease in a population during a specific period.

Genetic mutation

A change or abnormality in genetic material.

Autosomal dominant disorder

A genetic disorder that can develop when a person inherits one altered copy of a gene.

Risk for a child with an autosomal dominant disorder

Each child has a 50% chance of inheriting the disorder.

Examples of autosomal dominant disorders

Huntington disease, familial hypercholesterolemia, and neurofibromatosis.

Autosomal recessive disorder

A genetic disorder that usually develops when a person inherits two altered copies of a gene.

Risk for a child when both parents carry an autosomal recessive disorder

Each child has a 25% chance of having the disorder.

Examples of autosomal recessive disorders

Cystic fibrosis and sickle cell anemia.

Multifactorial inheritance

The interaction of genetic, environmental, and lifestyle factors that increases the risk of developing disease.

Does inheriting a genetic mutation guarantee disease development?

No. A mutation may increase disease risk without guaranteeing the disease will develop.

Importance of family health history

It helps identify inherited disease risks and determine whether screening or genetic counseling is needed.

Genetic counseling

A service that helps individuals understand inherited disease risks, genetic testing, and possible preventive actions.

Genetic screening

Testing used to identify genetic changes associated with inherited diseases or increased disease risk.

Four types of genetic testing

Diagnostic testing, predictive and presymptomatic testing, carrier testing, and prenatal testing.

Positive BRCA1 or BRCA2 test indicates

An increased risk of certain cancers, not a definite cancer diagnosis.

Lynch syndrome

An inherited condition that increases the risk of colorectal cancer and several other cancers.

Environmental factors contributing to chronic disease

Contaminated water, pesticides, asbestos, mold, heavy metals, and other toxic exposures.

Nurse's role in reducing environmental risks

Assess exposures, educate patients, and help them reduce contact with harmful substances.

Risk behaviors

Actions or lifestyle choices that increase the likelihood of developing disease.

Modifiable risk factors for chronic disease

Smoking, excessive alcohol consumption, poor nutrition, physical inactivity, and unhealthy weight.

Nonmodifiable risk factors for chronic disease

Age, inherited genes, and family history.

Chronic diseases associated with tobacco use

Cancer, cardiovascular disease, and chronic pulmonary disease.

Effects of excessive alcohol consumption

Increased risk of liver disease, heart disease, cancer, and other health problems.

How does poor nutrition increase chronic disease risk?

It contributes to obesity, hypertension, type 2 diabetes, cardiovascular disease, and some cancers.

How does physical inactivity affect chronic disease risk?

It increases the risk of obesity, heart disease, type 2 diabetes, and some cancers.

Lifestyle changes to prevent type 2 diabetes

Regular physical activity, healthy eating, and maintaining a healthy weight.

Lifestyle changes to prevent cardiovascular disease

Physical activity, weight control, reduced sodium intake, and healthier fat and food choices.

Common physical effects of chronic illness

Pain, fatigue, weakness, reduced mobility, breathing difficulties, and limitations in self-care.

Why do patients with the same chronic disease have different care needs?

Disease severity, symptoms, treatments, and individual abilities vary.

Psychosocial effects of chronic illness

Depression, anxiety, loneliness, social isolation, fear, and changes in self-image or relationships.

Illness representation

A patient's personal understanding and response to the physical and functional changes caused by illness.

Why are patients with chronic illnesses at increased risk for depression?

They may experience loss of control, physical limitations, fear, frustration, and uncertainty about the future.

How can depression affect chronic disease management?

It can increase fatigue and isolation and reduce adherence to treatment.

Social isolation

A lack of meaningful social contact or interaction with others.

How can nurses help patients experiencing loneliness or social isolation?

Assess social needs, encourage supportive relationships, and connect patients with community resources.

Internal coping strengths for patients with chronic illness

Positive outlook, courage, persistence, knowledge, and confidence.

External coping strengths for patients with chronic illness

Support from family, friends, peers, and health care professionals.

How can chronic illness affect children?

It can interfere with school attendance, learning, friendships, and emotional development.

How should nurses care for children with chronic illness?

Use family-centered care, assess emotional needs, and involve the interprofessional team.

Important nursing priorities for older adults with chronic illness

Control symptoms, maintain comfort, prevent crises, and maximize functional independence.

Family caregiver

A family member or other person who provides ongoing care and support to someone with an illness or disability.

Caregiver burden

The physical, emotional, social, and financial strain associated with providing care.

Family caregivers at increased risk for poor health outcomes

Older caregivers, long-term caregivers, those caring for patients with dementia, and those with limited support or resources.

How can nurses support family caregivers?

Assess their needs, provide education, connect them with resources, and arrange respite care when appropriate.

Respite care

Temporary care provided to a patient so the regular caregiver can rest or take a break.

Chronic Care Model

A framework that improves chronic disease care by connecting patients, health care teams, community resources, and health systems.

Goal of the Chronic Care Model

To improve patient outcomes through coordinated care, patient participation, and effective disease self-management.

Six elements of the Chronic Care Model

Community → Self-management support → Health system → Delivery system design → Decision support → Clinical information systems.

Community element of the Chronic Care Model

Using community resources, partnerships, and policies to support chronic disease management.

Self-management support in the Chronic Care Model

Helping patients develop the knowledge, skills, and confidence to manage their chronic diseases.

Health system element of the Chronic Care Model

Organizing health care to improve safety, quality, and chronic illness management.

Delivery system design

Organizing coordinated, patient-centered, evidence-based care across health care settings.

Decision support

Using evidence-based guidelines and clinical knowledge to guide patient care and education.

Clinical information systems

Systems that maintain and share patient health information to improve communication and quality of care.

Hospital improving electronic health records

Clinical information systems.

Self-management

The patient's ability to manage symptoms, treatments, lifestyle changes, and daily challenges related to chronic illness.

Adherence

The extent to which a patient follows an agreed-upon treatment plan.

Factors interfering with adherence

Cost, complicated treatment plans, poor understanding, limited support, low motivation, and difficulty accessing care.

Motivational interviewing

A patient-centered counseling technique that helps patients explore concerns and find motivation to change behaviors.

How can nurses improve adherence to treatment?

Identify barriers, simplify instructions, provide education, encourage support, and arrange follow-up.

Teach-back

Asking patients to explain information in their own words to confirm understanding.

Importance of teach-back for patients with chronic illness

It helps confirm that patients understand medications, treatments, symptoms, and home care instructions.

Nurse's role in chronic disease prevention

Provide health education, identify risk factors, promote screening, assess family history, and support healthy public policies.

Purpose of disease screening

To detect disease early so treatment can begin before serious complications develop.

Purpose of chronic disease self-management education programs

To teach patients problem-solving, decision-making, goal-setting, and symptom-management skills.

Nurse's priority when assessing a patient with chronic illness

Understand how the disease and treatment affect the patient's symptoms, daily functioning, emotions, and ability to manage care.