CONCEPT OF ILLNESS

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

Etiology

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

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 353. Environment•The physical environment in which a person works or lives can increase the likelihood that certain illnesses will occur.

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

Common Causes of Disease

1. Biologic Agents2. Inherited Generic Defects3. Physical Agents4. Chemical Agents5. Tissue response toirritation/injury (fever, inflammation)

6. Faulty chemical or metabolic process7. Emotional or physical reaction to stress8. Classification of Disease

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.

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

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.

Remission - Period during which the disease is controlled symptoms are not obviousExacerbation - 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 bodyFunctional - 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.

Characterized by:

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.

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 communityMortality. Condition or quality of being subject to death.

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)

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.

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.

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

Four aspects of sick role:

1. Clients are not responsible for their condition2. Clients are excused from certain social roles and tasks3. Clients are obliged to try to get well as quickly as possible4. Clients or their families are obliged to seek competent help

Three distinct criteria to determine if a person is ill

1. The presence of symptoms2. The perception of how they feel3. Their ability to carry out daily activities

Effects of Illness

PrivacyAutonomyFinancial burdenLife-styleFamily and significant others

Factors that determine the extent of effect of illness:The member of the family who is illThe seriousness and length of the illnessCultural and social customs the family followsThe changes that can occur in the family:

Role changesTasks reassignments and increase demands on time Increase stress due to anxiety about the outcome of the illnessFinancial problems Loneliness resulting from separation and pending loss Change in social customs

Promoting Health and Wellness

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

CHRONIC ILLNESS

•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).

•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.

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

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.

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.

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)

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

•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

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.

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.

THE CHALLENGES OF LIVING WITH CHRONIC CONDITIONS INCLUDE THE NEEDTO ACCOMPLISH THE FOLLOWING:

Alleviate and manage symptomsPsychologically adjust to and physically accommodate disabilitiesPrevent and manage crises and complicationsCarry out regimens as prescribedValidate individual self-worth and family functioningManage threats to identity

Normalize personal and family life as much as possibleLive with altered time, social isolation, and lonelinessEstablish the networks of support and resources that can enhance quality of lifeReturn to a satisfactory way of life after an acute debilitating episode (eg, another myocardial infarction or stroke) or reactivation of a chronic conditionDie with dignity and comfort

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.

Step 2: Establishing and Prioritizing Goals

Once the phase of illness has been identified for aspecific patient, along with the specific medicalproblems and related social and psychologicalproblems, the nurse helps prioritize problems andestablish the goals of care. Identification of goals mustbe a collaborative effort, with the patient, family

Step 3: Defining the Plan of Action to Achieve DesiredOutcomes

Once goals have been established, it is necessary toidentify a realistic and mutually agreed-on plan forachieving them including specific criteria that will beused to assess the patient’s progress. The identificationof the person responsible for each task in the actionplan is also essential. In addition, identification of theenvironmental, social, and psychological factors thatmight interfere with or facilitate achieving the desiredoutcome is an important part of planning

Step 4: Implementing the Plan and Interventions

This step addresses implementation of the plan. Possiblenursing interventions include providing direct care, serving asan advocate for the patient, teaching, counseling, makingreferrals, and case-managing (eg, arranging for resources).Nurses can help patients implement the actions that allowpatients to live with the symptoms and therapies associatedwith chronic conditions, thus helping them to gainindependence. The nurse works with each patient and family toidentify the best ways to integrate treatment regimens intotheir ADLs to accomplish two tasks: (1) adhering to regimens tocontrol symptoms and keep the illness stable, and(2) dealingwith the psychosocial issues that can hinder illnessmanagement and affect quality of life.

Step 5: Following Up and Evaluating Outcomes

The final step involves following up to determine if theproblem is resolving or being managed and if the patient andfamily are adhering to the plan. This follow-up may uncoverthe existence of new problems resulting from theintervention, problems that interfere with the ability of thepatient and family to carry out the plan, or previously un-expected problems. Maintaining the stability of the chroniccondition while preserving the patient’s control over his orher life and the patient’s sense of identity andaccomplishment is a primary goal. Based on the follow-upand evaluation, consideration of alternative strategies orrevision of the initial plan may be warranted.