copyright © 2008 delmar. all rights reserved. chapter 21 populations with chronic diseases

Copyright © 2008 Delmar. All rights reserved.

Chapter 21

Populations with Chronic Diseases


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Chronic Disease

• Persists three or more weeks

• Linked to genetics, environmental factors, unhealthy lifestyle behaviors

• Many risk factors are modifiable– Tobacco use, sedentary lifestyle, improper

diet


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Chronic Disease

• Healthy People 2010 objectives aimed at decreasing the occurrence of chronic disease


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Chronic Disease

• Causes of morbidity and mortality have changed in most part due to: – Antibiotic therapy– Public health services

• Shift from acute to chronic disease– Steady increase in children and adults

• Obesity epidemic and aging population


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Aging Population

• People are living longer and surviving chronic health problems due to the advancement in health care and medicine


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Aging Population

• Health care resources will be faced with a major financial challenge – Larger elderly population will be supported by

a much smaller workforce


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Obesity Epidemic

• Body mass index of > 30 for adults

• At or above the 95th percentile on sex and age specific BMI for children and adolescents


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Obesity Epidemic

• BMI calculation formula

BMI= (weight in pounds)(height in inches)×(height in inches)×703


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Obesity

• Epidemic in the following areas:– Rural– Low socioeconomic region– Minorities


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Obesity

• Linked to the following chronic diseases– Hypertension

• Type II diabetes

– Cardiovascular diseases– Osteoarthritis– Polycystic ovary disease– Sleep apnea– Some forms of cancer


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Obesity

• Screening for prediabetes– Fasting glucose, glucose tolerance test

• Metabolic syndrome– Precursor for Type II diabetes and vascular injury

• Type II diabetes– Fasting glucose– Oral glucose tolerance test


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Obesity

• Insulin resistance– Acanthosis nigricans

• School screens

– Cutaneous acrochordons– Acne, android appearance– Hirsutism, menstrual dysfunction – Gestational diabetes


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Diabetes Mellitus

• Fifth leading cause of death in the United States

• Major cause of the following: – Blindness– Amputations– End Stage Renal Disease (ESRD)– Coronary Heart Disease (CHD)


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Cardiovascular System

• Cardiovascular disease includes:– Coronary heart disease

• Ischemic heart disease or acute coronary syndrome

– Stroke – Heart failure


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• Modifiable risk factors– Tobacco use and passive exposure – Obesity– Elevated cholesterol– Hypertension– Physical inactivity – High fat dietary intake


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• Hypertension increases risk for – Congestive heart failure– ESRD, myocardial infarction– Stroke

• Extent of damage may be lessened by – Diet, salt restriction, medications– Weight loss, physical activity


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• Contextual risk factors are variables beyond control of the individual– Socioeconomic status

• Being a single parent• Live in a medically underserved area• Lack of consistent health care provider• Low income, poor transportation system


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• Caregiver burden – Reduces the quality of life, additional role

• Predictors for development– Social isolation, poor coping– Limited family or social support– Poor knowledge of disease– Strain in relationship prior to illness


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• Nurse should assess for: – Support symptoms– Caregiver ability to problem solve– Knowledge of condition

• Interventions– Reduce social isolation

• Identify community resources


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• Disease trajectory– Downward illness trajectories

• Alzheimer’s Disease• Multiple Sclerosis

• Public health considerations

copyright © 2008 delmar. all rights reserved. chapter 21 populations with chronic diseases

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