chronic care concept

2. 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.

3. 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.

4.  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

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

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

7.  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.

8. • 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

9.  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

10.  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

11.  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.

12.  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

13. • 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.

14. • 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.

15.  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.

16. • 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:

17.  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

18.  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.

19.  coronary heart disease which is the major
cause of death for patients with diabetes
 peripheral vascular disease
 cerebrovascular disease

20.  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.

21.  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.

22. DISORDER Rheumatoid
Arthritis
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
Characteristic
s
-synovial joints
inflammation
- systemic
-wearing thin of
the weight bearing
joints
-local
-urate crystals
deposits in the
joints (TOPHI)
-local

23. • 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.

24.  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

25.  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

26. • 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.

27. Assessment
 Health history, family history
 Physical symptoms
 Social/cultural considerations
 Coping behaviors

28.  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

29.  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

30. 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 capabilities
oAllowing to choose social activities

31. 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


32. 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

33. 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

34.  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

35.  B. Family:
 1. Discusses positive and negative responses
to client’s illness
 2. Plans/engages in appropriate activities
with client

37.  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.

38. Case Study:
1. What interventions might you consider?
2. What patient/family teaching is essential?
3. What cultural considerations might be
assessed and addressed?