CONCEPT OF ILLNESS

1. CONCEPT OF ILLNESS

2. Illness is a personal state in which the person feels
unhealthy or ill.
•Illness may or may not be related to disease.
•Illness is a state in which a person’s physical,
emotional, intellectual, social, developmental or
spiritual functioning is diminished or impairment
compared with previous experience.
Although nurses must be familiar with
different kinds of diseases and their
treatments, they are concerned more with
illness, which may include disease

3. Etiology
Is the causation of the disease. Etiologic
description includes identification of all
factors that act together to bring a disease
condition.

4. Risk Factors of a Disease
1. Genetic and Physiological Factors-Heredity, or genetic predisposition to
specific illness, is a major physical risk factor.
2. Age increases or decreases susceptibility to certain illnesses (the risk of
heart diseases
•Age increases with age for both sexes)
•The risk of birth defects and complications of pregnancy increase in
women bearing children after age 35
3. Environment
•The physical environment in which a person works or lives can increase
the likelihood that certain illnesses will occur.

5. 4. Lifestyle
•Many activities, habits and practices involve risk factors.
Lifestyle practices and behaviors have positive or negative
effects on health.
•Stress can be a lifestyle risk factor if it is severe or prolonged,
or if the person is unable to cope.
Stress can threaten mental health & physical well-being

6. Common Causes of Disease
1. Biologic Agents
2. Inherited Generic Defects
3. Physical Agents
4. Chemical Agents
5. Tissue response to
irritation/injury (fever, inflammation)
6. Faulty chemical or metabolic process
7. Emotional or physical reaction to stress
8. Classification of Disease

7. According to Etiologic Factors
1. Hereditary. Due to defect in the genes of one or
other parent which is transmitted to the offspring.
2. Congenital. Due to a defect in the development,
hereditary factors, or prenatal infection; present
at birth. (e.g. cleft lip, cleft palate)
3. Metabolic. Due to disturbances or abnormality
in the intricate processes of metabolism.
4. Deficiency. Results from inadequate intake of
absorption of essential dietary factors.
5. Traumatic. Due to injury
.

8. 6. Allergic. Due to abnormal response of the body
to chemical or protein substances or to physical
stimuli.
7. Neoplastic. Due to abnormal or uncontrolled
growth of cells.
8. Idiopathic. Cause is unknown; Self-originated;
of spontaneous origin.
9. Degenerative. Results from the degenerative
changes that occur in tissue and organs.
10. Iatrogenic. Results from the treatment of a
disease

9. According to Duration or Onset
1. Acute Illness. Usually has a short duration and severe.
•The signs and symptoms appear abruptly, are intense and
often subside after a relatively short period.
•Following an acute illness a person may return to normal
level of wellness
2. Chronic Illness. Slow onset. Persists, usually longer than
6 months and can also affect functioning in any dimension.
•Chronically ill person have long term disease process
•The client fluctuate between maximal functioning and
serious relapses that may be life threatening.

10. Characterized by:
Remission - Period during which the disease is controlled
symptoms are not obvious
Exacerbation - The disease becomes more active again at a
future time, recurrence of pronounced symptoms. Other
classification of disease may be described as:
Organic - results from changes in the normal structure, from
recognizable anatomical changes in an organ or tissue of the
body
Functional - no anatomical changes are observed to account
for the symptoms ,present may result from abnormal
response to stimuli.
Occupational - results from factors associated with the
occupation engaged in by the patient (e.g. cancer among
chemical factory workers.

11. Familial -occurs in several individuals of the same
family (e.g. hypertension, cancer)
Venereal - Usually acquired through sexual relation
(AIDS, gonorrhea)
Epidemic. Attacks a large number of individuals in a
community at the same time (SARS)
Endemic. Present more or less continuously or recurs
in the community.
Pandemic. Epidemic diseases which is extremely
widespread involving an entire country or continent.
Sporadic. A disease in which only occasional cases
occur.

12. Terminologies
Disease. Disturbance of structure or of function of the
body or its constituent parts.
•Lack of or inadequate adaptation of the organism to his
environment.
•Failure of the adaptive mechanism to adequately
counteract the stimuli or stresses to which it is subject
resulting in disturbances in function and structure of any
part, organ or system of the body.
Morbidity. Condition of being diseased.
Morbidity Rate. The proportion of disease to health in a
community
Mortality. Condition or quality of being subject to death.

13. Epidemiology. Study of the patterns of health and
disease, its occurrence and distribution in man, for
the purpose of control and prevention of disease.
Susceptibility. The degree of resistance the potential
host has against the pathogen.
Etiologic Agent. One that possesses the potential for
producing injury or disease. (e.g.Streptococcus,
Staphylococcus)

14. Virulence. Relative power or the degree of
pathogenicity of the invading microorganism, the ability
to produce poisons that repel or destroy phagocytes.
Symptomatology. Study of symptoms.
Symptom. Any disorder of appearance, sensation or
function experienced by the patient indicative of a
certain phase of a disease. Manifestation of perceptible
changes in the body which indicate the presence of a
disease or disorder.
Sign. An objective symptom or objective evidence or
physical manifestation made apparent by special
methods of examination or use of sense.

15. Syndrome. A set of symptom, the sum of which constituents a
disease.
•A group of symptoms which commonly occurs together
•A group of signs and symptoms which when considered
together characterize a disease.
Pathology. The branch of medicine which deals with the cause,
nature, treatment and resultant structural and functional
changes of disease.
Diagnosis. Art or act of determining the nature of a disease,
recognition of a diseased state.
Complication. A condition that occurs during or after the
course of an illness.

16. Prognosis. Prediction of the course and of a
disease, medical opinion as to the outcome of a
disease process. Good prognosis means that there
is great possibility to recover from the disease and
poor prognosis means that there is great risk for
morbidity or mortality.
Recovery. Implies that the person has no
observable or known after effects from his illness;
there is apparent restoration to the pre-illness state

17. Four aspects of sick role:
1. Clients are not responsible for their condition
2. Clients are excused from certain social roles and tasks
3. Clients are obliged to try to get well as quickly as possible
4. Clients or their families are obliged to seek competent help
Three distinct criteria to determine if a person is ill
1. The presence of symptoms
2. The perception of how they feel
3. Their ability to carry out daily activities

18. Effects of Illness
Privacy
Autonomy
Financial burden
Life-style
Family and significant others

19. Factors that determine the extent of effect of illness:
The member of the family who is ill
The seriousness and length of the illness
Cultural and social customs the family follows
The changes that can occur in the family:
Role changes
Tasks reassignments and increase demands on time
Increase stress due to anxiety about the outcome of the
illness
Financial problems
 Loneliness resulting from separation and pending loss
Change in social customs

20. Promoting Health and Wellness
Health Promotion - an activity undertaken for
the purpose of achieving higher level of
health and wellness.

22. CHRONIC ILLNESS

23. •affect people of all ages, the very young, the middle-aged,
and the very old.
•are found in all ethnic, cultural, and racial groups,
although some disorders occur more frequently in
some groups than in others (Centers for Disease
Control and Prevention [CDC], 2004
•account for 7 of the 10 leading causes of death in the
United States, including the three most frequently
occurring diseases that result from preventable
causes(tobacco use, improper diet and physical
inactivity, and alcohol use).
•occurs in all socioeconomic groups, but people who
have low incomes and disadvantaged backgrounds are
more likely to report poor health (RWJF, 2001).

24. •Factors such as poverty and inadequate health
insurance decrease the likelihood that people with
chronic illness or disability receive health care and
health screening measures such as mammography,
cholesterol testing, and routine checkups(United
States Department of Health and Human
Services[USDHHS],2005).
•How people react to and cope with chronic illness is
usually similar to how they react to other events in
their lives, de-pending, in part, on their
understanding of the condition and their perceptions
of its potential impact on their own and their family’s
lives.

25. •Adjustment to chronic illness (and disability) is
affected by various factors:
• Suddenness, extent, and duration of lifestyle
changes necessitated by the illness
•Family and individual resources for dealing with
stress
•Stages of individual/family life cycle
• Previous experience with illness and crises
•Underlying personality characteristics
•Unresolved anger or grief from the past

26. CHRONIC CONDITION
•are often defined as medical conditions or health problems
with associated symptoms or disabilities that require long-term
management (3 months or longer).
•illnesses or diseases that have a prolonged course, that do
not resolve spontaneously, and for which complete cures are
rare.
•The specific condition may be a result of illness, genetic
factors, or injury; it maybe a consequence of conditions or
unhealthy behaviors that began during childhood and
young adulthood.

27. MANAGEMENT OF CHRONIC CONDITIONS
•includes learning to live with symptoms or
disabilities and coming to terms with identity
changes resulting from having a chronic
condition.
•It also consists of carrying out the lifestyle
changes and regimens designed to control
symptoms and to prevent complications.

28. Although some people assume what might
be called a ‘sickrole´ identity, most
people with chronic conditions do not
consider themselves to be sick or ill and try
to live as normal a life as possible. Only
when complications develop or symptoms
interfere with activities of daily living
(ADLs) do most people with chronic health
conditions think of themselves as being
sick or disabled (Nijhof,1998)

29. CAUSES OF THE INCREASING NUMBER OF PEOPLE
WITH CHRONIC CONDITIONS INCLUDE THE
FOLLOWING:
•A decrease in mortality from infectious diseases,
such as smallpox, diphtheria, and other serious
conditions
•Longer life spans because of advances in
technology and pharmacology, improved nutrition,
safer working conditions, and greater access (for
some people) to health care
•Improved screening and diagnostic procedures,
enabling early detection and treatment of diseases

30. •Prompt and aggressive management of acute
conditions, such as myocardial infarction and
acquired immuno-deficiency syndrome (AIDS) +
related infections
•The tendency to develop chronic illnesses with
advancing age
•Lifestyle factors, such as smoking, chronic
stress, and sedentary lifestyle, that increase the
risk for chronic health problems such as
respiratory disease, hypertension,
cardiovascular disease, and obesity

31. CHARACTERISTICS OF CHRONIC CONDITIONS
Managing chronic illness involves more than managing
medical problems. Associated psychological and social
problems must also be addressed
Chronic conditions usually involve many different
phases over the course of a person’s lifetime. There can
be acute periods, stable and unstable periods, flare-ups,
and remissions.
Each phase brings its own set of physical, psycho-logical,
and social problems, and each requires its own
regimens and types of management.

32. Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens.
Failing to adhere to a treatment plan or to do so
consistently increases the risks of developing
complications and accelerating the disease process
includes learning to live with symptoms or disabilities
and coming to terms with identity changes resulting
from having a chronic condition.
It also consists of carrying out the lifestyle changes
and regimens designed to control symptoms and to
prevent complications.

33. THE CHALLENGES OF LIVING WITH CHRONIC CONDITIONS
INCLUDE THE NEEDTO ACCOMPLISH THE FOLLOWING:
Alleviate and manage symptoms
Psychologically adjust to and physically
accommodate disabilities
Prevent and manage crises and complications
Carry out regimens as prescribed
Validate individual self-worth and family functioning
Manage threats to identity

34. Normalize personal and family life as much as
possible
Live with altered time, social isolation, and
loneliness
Establish the networks of support and resources
that can enhance quality of life
Return to a satisfactory way of life after an acute
debilitating episode (eg, another myocardial
infarction or stroke) or reactivation of a chronic
condition
Die with dignity and comfort

35. APPLYING THE NURSING PROCESS USING THE
PHASES OF THE CHRONICILLNESS SYSTEM
Step 1: Identifying Specific Problems and the
Trajectory Phase .
The fist step is assessment of the patient to
determine the specific problems identified by the
patient, family, nurse, and other health care
providers. Assessment enables the nurse to identify
the specific medical, social, and psycho-logical
problems likely to be encountered in a phase.

36. Step 2: Establishing and Prioritizing Goals
Once the phase of illness has been identified for a
specific patient, along with the specific medical
problems and related social and psychological
problems, the nurse helps prioritize problems and
establish the goals of care. Identification of goals must
be a collaborative effort, with the patient, family

37. Step 3: Defining the Plan of Action to Achieve Desired
Outcomes
Once goals have been established, it is necessary to
identify a realistic and mutually agreed-on plan for
achieving them including specific criteria that will be
used to assess the patient’s progress. The identification
of the person responsible for each task in the action
plan is also essential. In addition, identification of the
environmental, social, and psychological factors that
might interfere with or facilitate achieving the desired
outcome is an important part of planning

38. Step 4: Implementing the Plan and Interventions
This step addresses implementation of the plan. Possible
nursing interventions include providing direct care, serving as
an advocate for the patient, teaching, counseling, making
referrals, and case-managing (eg, arranging for resources).
Nurses can help patients implement the actions that allow
patients to live with the symptoms and therapies associated
with chronic conditions, thus helping them to gain
independence. The nurse works with each patient and family to
identify the best ways to integrate treatment regimens into
their ADLs to accomplish two tasks: (1) adhering to regimens to
control symptoms and keep the illness stable, and(2) dealing
with the psychosocial issues that can hinder illness
management and affect quality of life.

39. Step 5: Following Up and Evaluating Outcomes
The final step involves following up to determine if the
problem is resolving or being managed and if the patient and
family are adhering to the plan. This follow-up may uncover
the existence of new problems resulting from the
intervention, problems that interfere with the ability of the
patient and family to carry out the plan, or previously un-expected
problems. Maintaining the stability of the chronic
condition while preserving the patient’s control over his or
her life and the patient’s sense of identity and
accomplishment is a primary goal. Based on the follow-up
and evaluation, consideration of alternative strategies or
revision of the initial plan may be warranted.