N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide

Chapter Three: Chronic Illness Learning Objectives 1. Define and discuss the concept of chronic illness. 2. Discuss the trajectory model of chronic illness. 3. Discuss factors that influence chronic illness. 4. Describe tools the nurse can use to assess chronic illness. 5. Using the nursing process, develop a plan of care related to chronic illness. 3.1 Acute vs. Chronic Illness Chronic illness is a disease or condition that is a deviation fromnormal. It is permanent or irreversible and requires long periods of supervision, care, or rehabilitation. This is contrasted with acute illness, which is a disease or condition with sudden onset that resolves relatively quickly or results in death. An acute illness may become chronic if not treated. The duration of a chronic illness is typically six months or more, with some lasting a lifetime. Incidence of chronic illness is most common in the aging adult, but may be identified in any age group. The older population has an 85% chance of having at least one of the most common chronic conditions, including diabetes, visual impairment, heart disease, hearing impairment, osteoporosis and hip fractures, Alzheimer’s disease andmemory impairment, stroke, incontinence, depression, and Parkinson’s disease. Because of the length of disability, chronic conditions are often managed in the home and community. 3.2 Trajectory Model of Chronic Illness Corbin and Strauss developed a trajectory model of chronic illness. In this model, the term “trajectory” refers to the course of a chronic disease and the actions taken by patients and caregivers to manage the course of the disease. Eight stages are identified in this model: • Pre-trajectory phase: This phase occurs before any signs or symptoms are present but risk is present due to genetic or lifestyle factors. The goal during this phase is to prevent the onset of the disease. • Trajectory onset phase: This phase occurs with the first onset of signs and symptoms and includes the diagnostic period. The goal of this phase is to develop a plan. • Crisis phase: This phase happens when a potentially life-threatening situation arises. Thegoal during this phase is to remove the threat. • Acute phase: This phase follows the crisis phase and refers to the period when the patient’s symptoms can be controlled by a prescribed course of treatment. • Stable phase: This phase starts once symptoms are controlled. The goal is to maintain this phase during the course of the disease. • Unstable phase: This occurs when the patient’s symptoms are uncontrolled by the previously

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