2 elective 2 types of chronic diseases

Types of Chronic Diseases

What Are Chronic Diseases?

A chronic disease persistent or recurring disease, usually affecting a person for three months or longer.

are non communicable illnesses that are prolonged in duration,

do not resolve spontaneously, and are rarely cured completely.

There are different types of chronic disease from A to Z.

From Alzheimer's, arthritis and asthma to zoonoses, these diseases are many and varied.

WHO : A zoonosis is any disease or infection that is naturally transmissible from vertebrate animals to humans. Animals thus play an essential role in maintaining zoonotic infections in nature. Zoonoses may be bacterial, viral, or parasitic, or may involve unconventional agents. As well as being a public health problem, many of the major zoonotic diseases prevent the efficient production of food of animal origin and create obstacles to international trade in animal products.

Endometriosis, chronic fatigue syndrome, tetanus, different types of cancers, lyme disease, chronic ear infection and even obesity are considered chronic conditions.

Frequently the RESULT is a lifetime of discomfort, doctor's visits, medical tests, medications, therapies and sometimes surgeries

Heart disease Diabetes Cardiovascular Disease Cerebrovascular disease Hypertension Kidney disease Liver disease Alzheimer's Disease

Arthritis Cancer Chronic Obstructive Lung Disease Epilepsy Hereditary Hemochromatosis Iron Overload Oral Diseases Osteoporosis

Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all death each year.

Cancer, the second leading cause of death, claims more than half a million lives each year.

Key Chronic Diseases: The Facts

• Diabetes is the leading cause of kidney failure, nontraumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20–74 years.

• Arthritis, the most common cause of disability, limits activity for 19 million U.S. adults.  

• Obesity has become a major health concern for people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6–19 are obese

Asthma is a leading chronic illness among children and youth in the U.S. and one of the leading causes of school absenteeism.

In 2007, 5.6 million school-aged children and youth (5-17 years old) were reported to currently have asthma.

In addition, teachers and custodians have been identified as having higher rates of occupational asthma

Asthma

Airway inflammation contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.

the genetic predisposition for the development of an immunoglobulin E (IgE)-, is the strongest identifiable predisposing factor for developing asthma.

Viral respiratory infections are one of the most important causes of asthma

Heart Disease

The most common form of heart disease in the United States is coronary artery disease, which can lead to a heart attack. 

The risk of developing coronary artery disease may be greatly reduced through improvements lifestyle choices that include diet and exercise. 

If you have already been diagnosed with heart disease, you can maintain your condition by doing the following: 

Checking your blood pressure routinely Monitoring your cholesterol Managing diabetes Taking medications as prescribed by a

healthcare professional 

• A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. 

• Stroke can cause death or significant disability, such as paralysis, speech difficulties, and emotional problems. 

• Stroke is the third leading cause of death in the United States and, in many cases, can be prevented. 

Stroke

• Cancer is a general term for more than 100 diseases in which abnormal cells in a part of the body begin to grow out of control.  No matter where the cancer spreads, it is always named for the part of the body where it originated.

• Statistics state that half of all men and one third of all women will develop cancer in their lifetime.

Cancer

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy.

The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies.

Diabetes

• Chronic symptoms of diabetes are due to vascular damage from persistent hyperglycemia. Vascular damage leads to end-organ damage.

• Other conditions associated with diabetes, such as hypertension, dyslipidemia (as well as smoking) accelerate the development of vascular damage and the chronic complications of diabetes, which are the following:

Microvascular complications are a significant cause of morbidity. Persistent hyperglycemia is the major cause for the microvascular complications which are highly specific for diabetes

retinopathy with potential loss of vision nephropathy leading to kidney failure peripheral neuropathy leading to pain, foot

ulcers, and limb amputation autonomic neuropathy causing

gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction

Macrovascular complications are the main cause of mortality.

Although persistent hyperglycemia may contribute to macrovascular complications, it is the associated conditions (hypertension, dyslipidemia, smoking) that account for most of the burden of the macrovascular complications.

coronary heart disease which is the major cause of death for patients with diabetes

peripheral vascular disease cerebrovascular disease

Arthritis is the most common cause of disability in the U.S.  The word arthritis actually means joint inflammation.

The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. 

Arthritis

Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints.

The symptoms can develop gradually or suddenly. There are multiple forms of arthritis and each has its own unique symptoms.

…lets compare

DISORDER RheumatoidArthritis

Osteoarthritis Gouty Arthritis

cause autoimmune, genetic

Weight bearing or trauma

purine metabolic d/o

Risk women both sexes males

Pain -early morning stiffness-better as day progress-relieve by movement- > 30 mins. Unrelive by rest

-Stiffness worsen as day progress-Aggravated by movement- <30 mins relieve by rest

-most painful-pain at night-aggravated by exercise/ activity

Joints -symmetrical-inflammation-subcutaneous nodules

-asymmetrical-no inflammation-weight bearing

-inflammation-great toe/ankle

Characteristics

-synovial joints inflammation- systemic

-wearing thin of the weight bearing joints-local

-urate crystals deposits in the joints (TOPHI)-local

Signs &

Symptoms

-edema, warm & tender joints-fatigue, weakness, anorexia-Late: wt loss, fever, anemia, muscle atrophy

-pain, muscle spasm, joint grating, flexion contractures of hip & knee

-pain-inflammation sign at the site

• Chronic diseases are the most common and costly of all health problems, but they are also the most preventable.

• Four common, health-damaging, but modifiable behaviors—1. tobacco use, 2. insufficient physical activity, 3. poor eating habits, and 4. excessive alcohol use

—are responsible for much of the illness, disability, and premature death related to chronic diseases.

Chronic Diseases Are Preventable

Health ranking are options for policy makers Strategies for Chronic Care Problems;

◦ Affordability◦ Improve delivery of quality of healthcare

Promoted chronic care collaboration◦ help to implement innovations that improve the

management of population with chronic conditions

◦ Serves a non – product specific compilation of evidence and resources sharing my health team

Behavioral management in chronic illness◦ Active SELF management approach◦ Cognitive therapy

Government Efforts

is at the forefront of the nation’s efforts to promote health and well-being through the prevention and control of chronic diseases.

NCCDPHP provides national leadership to achieve three primary goals:

Commission on chronic illness criteria for Chronic Illness is;◦ permanent◦ leaves residual disability◦ requires a long period of supervision, observation or care◦ Most are irreversibly

CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)Department of Health

• Prevent, delay, detect, and control chronic diseases. 

• Contribute to chronic disease research and apply that research to put practical and effective intervention strategies into practice. 

• Achieve equity in health by eliminating racial and ethnic disparities and achieving optimal health for all.

Assessment

Health history, family history Physical symptoms Social/cultural considerations Coping behaviors

Nursing Process

Goals: A. Client will : 1. receive appropriate treatment for any

physiologic symptoms 2. be able/willing to discuss responses to

illness 3. recognize effect of illness on aspects of

self-concept

Planning

4. develop realistic plans for activities and role functions

5. contract with nurse to report depression/ suicidal ideation

B. Family will: 1. be able to discuss responses to client

illness 2. develop plans to deal with alterations in

client’s behaviors and functions

1. Provide nursing care specific to physiologic problems

2. Develop nurse/client relationship through active listening, acceptance of positive and negative client responses◦ Teaching positive health behaviors

3. Encourage client to plan activities within present capabilitiesoAllowing to choose social activities

Intervention

4. Provide information about illness, suggestions for activities (health teachings)◦ Readiness to learn

Assess when patients are too distresses physically or psychologically to learn

5. Contract with client to request support in times of depression and to report suicidal ideation

6. Encourage family members to discuss their response to client’s illness require them to participate during health teaching

mainly because patients have been shown to have better outcomes when the entire family are involved

7. Be accepting and nonjudgmental of negative responses (e.g. anger, hopelessness)

8. Support family efforts to develop plans for their participation in client’s care

9. Clients and families should be treated with respect communication should be open and honest

10. Collaborative interventions; shares and implements orders of the health

team to ensure quality care Competent in communicating, establish trust

and sound decision making

11. May refer to self help groups◦ Mirroring of the disease◦ Coach and receive emotional support from those people

who had experienced the disease or chronic problems

12. Encourage Autonomy◦ Allowing to choose social activities◦ Respecting their values and beliefs

13. Be a clients advocate

A. Client 1. Receives appropriate treatment for any

physiologic problems 2. Recognizes/discusses positive and

negative responses to illness 3. Understands effects of feelings about

body image, self-esteem, role function 4. Agrees to report depression or suicidal

thoughts

Evaluation

B. Family:

1. Discusses positive and negative responses to client’s illness

2. Plans/engages in appropriate activities with client

end

Mr. C. is a 75-year-old man with end-stage cardiac disease and long standing congestive heart failure including pulmonary edema. He lives at home with his wife, who is frail. He has led a very active life, but in the past few months has experienced severe fatigue that leaves him unable to participate in or enjoy previous activities. He often says, “I feel as if I have no ambition,” and “I can’t do anything anymore. I am worthless.” In the past few weeks, Mr. C. has been experiencing shortness of breath, initially relieved with oxygen. Unfortunately, the dyspnea has progressed during the past week and he has developed a dry cough.

Case Study:

1. What interventions might you consider?2. What patient/family teaching is essential?3. What cultural considerations might be

assessed and addressed?