Trajectory Phases

Pre trajectory

General factors or lifestyle behaviors that place a person or community at risk for a chronic condition

Pre Trajectory N/C

►Refer for genetic testing & counseling if

indicated

►provide education about prevention of modifiable risk factors & behaviors

Trajectory Onset

Appearance or onset of noticeable symptoms

assoc. with chronic disorder;includes period of diagnostic work-up & announcement of Dx;

accompanied by uncertainty, begins to

discover& cope with implications of Dx

Trajectory Onset N/C

►Provide explanation of diagnostic

tests&procedures

►reinforce information & explanations given by primary health care provider

►provide emotional support to patient&family

Stable

Illness course &symptoms are under control as symptoms,resulting disability&everyday life activities are being managed within limitations of illness,illness mgt centered in the home

Unstable

exacerbation of illness symptoms,development of complications, reactivation of illness in remission

Unstable

Period of inability to keep symptoms under control, difficulty in carrying out ADLs

Unstable

• May require diagnostic testing and trial of new txt or adjustment of current regimen

Unstable N/C

• Provide guidance and support

• Reinforce previous teaching

Acute

Severe and unrelieved symptoms or the development of complications necessitating hospitalizations, bed rest, interruption of person's usual activities to bring illness course under control

Acute N/C

Provide direct care and emotional support to the patient and family members

Crisis

Critical or life threatening situations requiring emergency treatment or care and suspension of everyday life activities until the crisis has passed

Crisis N/C

• provide direct care

• Collaborate with other health care team members to stabilize patient’s condition

Comeback

Gradual comeback after an acute period and learnung ti live wuth or to overcome disabilities and return to an acceptable way of life within the limitations by chronic conditions or disability, involves physical health, limitations stretching thru rehab procedures, psychosocial coming to terms and biographical engagement with adjustments in everyday activities

Comeback N/C

• Assist in coordination of care

• Rehab focus may require care from other health care providers

• Provide positive reinforcement for goals identified and accomplished

Downward

Rapid or gradual worsening of condition, physical decline accompanied by increasing disability or difficulty in controlling symptoms, biographical adjustments and alterations un activities with each major downward step

downward N/C

• provide home care and other community based care to help patients and family adjust to changes and come to terms these changes

• Assist patients and family to integrate new treatment and management strategies

• Encourage identification of end of life care preferences and planning

Dying

• Finals days or weeks before death, gradual or rapid shutting down of body procceses, biographical disengagement and closure, relinquishment of everyday life interests and activities

Dying N/C

• provide direct and supportive care ti patient and family thru hospice program