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Lecture 4

NSE 21A/B Lecture Notes - Lecture 4: Substance Abuse, Chronic Condition, Health Promotion

Course Code
Franklin Gorospe

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Week 4
Medical Surgical Nursing in Canada – pg.68-75; 78-84
Acute Illness: sudden onset with signs & symptoms related to disease process
Best Buys: actions undertaken to produce accelerated results in terms of lives saved, diseases prevented &
heavy costs avoided
Caregiver Burden: physical, emotional & financial costs of caregiving
Co-morbidity: existence or 2 or > chronic illness in a person at the same time that aren’t directly related to
each other
Determinants of Health: interactions between social & economic factors, physical environment & individual
behaviours that determine health
Disability: difficulty in function at the body, personal or societal level in one or > life domains
Disease: pathophysiological
Health: state of complete physical, mental & social well-being and not just absence of disease/infirmity
Health-related Hardiness (HRH): personality resource characterized by sense of control, commitment &
Health-related Quality of Life (HRQL): subjective experience of impact of health status on quality of life
Illness: human experience of symptoms & suffering; how disease is perceived, lived with & responded to by
patient and their family
Illness Behaviour: different way patient "responds to physical symptoms: how they monitor internal states,
define & interpret symptoms, make attributions, take remedial actions & use various sources of informal &
formal care
Illness Trajectory: pathway along which the person with illness progresses
Informal Caregiver: person who provides care without pay & has personal ties to patient
Morbidity: rate of disease
Mortality: rate of death
Multimorbidity: simultaneous occurrence of many chronic illnesses in the same person
Nonmodifiable Risk Factors: factors (i.e. age & sex) that contribute to development of an illness but can’t be
Quality of Life: degree to which person enjoys important possibilities of their life
Self-efficacy: belief that one can successfully execute behaviour required to produce desired outcome
Self-management: management of illness physically & emotionally
Stigmatization: regarded by others as unworthy/disgraceful
Chronic Illness:
Demands response from patients & families over an long time period
Care for people with chronic illness is ideally within a health care system that promotes patient
Canadian health care still built around acute, episodic model of care that doesn’t address chronic health
Many failures (i.e. high rates of hospital readmission; medical errors; underdiagnoses; inconsistent
monitoring of chronic condition; lack of patient-centeredness; lack of health education; preventable
injuries, duplication & inappropriate omission of resources
Epidemiology of Chronic Diseases
Cardiovascular disease  responsible for highest proportion of global deaths
Chronic heart disease, lung disease & diabetes  account for over half of global deaths
Cancer  common cause of death in Canada
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Chronic illness contributes to morbidity & mortality
i.e. cancer (lung, prostate, breast, colorectal), cardiovascular disease (heart disease & stroke), diabetes,
digestive diseases, chronic respiratory diseases, arthritis, osteoporosis
Cardiovascular disease
oDeath rates declined due to lower smoking rates & improved treatment
Chronic Respiratory Disease
oTobacco most important preventable risk factor
Health, Acute Illness & Chronic Illness
Health dependent on determinants of health
Nursing practice must be informed by knowledge of disease & understanding illness experience
Acute Illness Chronic Illness
Sudden onset
Limited duration <6 months
Usually single cause
Diagnosis & prognosis commonly
Self-limited or specific therapy
Technological intervention usually
effective (lab testing, imaging,
medication, surgery)
Cure likely with return to normal health
Minimal uncertainty
Providers knowledgeable; patient
Gradual onset
Unfolds over time; undulating course
Long duration >6 months
Multivariate causation, changing over
Diagnosis may be uncertain; prognosis
Treatment has no definitive results &
therapies have adverse effects
Technological intervention may/may
not be helpful
No cure; management over time
Provider & patient partially and
reciprocally knowledgeable
Acute & chronic illness can occur at the same time
oi.e. patient with diabetes can develop an acute infection that changes blood glucose & insulin
oi.e. patient with chronic kidney disease undergoes surgery requires modified postoperative
fluid regimen
Co-morbidity  i.e. patient has heart disease, cancer & arthritis at the same time
oOptimal health challenging b/c treatment that helps 1 condition, makes coexisting condition
i.e. nonsteroidal anti-inflammatory disease helps arthritis but worsens hypertension &
renal disease
oDecreased quality of life, psychological distress, longer hospital stays, greater postoperative
complications, higher cost of care, higher mortality
oAffects care process; challenges accessibility, coordination, consultation time; increased use of
emergency facilities; costly; ineffective care
Factors Contributing to Chronic Illness
Determinants of health
Lifestyle factors
oSubstance abuse & high risk activities
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oAssociations between chronic illness & tobacco use, alcohol abuse, high BP, physical inactivity,
obesity & unhealthy diet
oPoverty & socioeconomic disadvantage lack of nutritious food, housing, access to health care
affects life expectancy
Risk Factors for Chronic Illness
Individual Risk Factors: sex, age, level of education & genetic characteristics
oi.e. smoking, unhealthy diet & physical inactivity
Intermediate Risk Factors: diabetes, hypertension & obesity
Community-level Risk Factors (social & economic factors)
oi.e. poverty, employment, family; climate, air pollution; cultural conditions practices, norms,
values; urbanization – housing, access to products/services
Prevention of Chronic Illness
4 modifiable risk factors: tobacco use, unhealthy
diet, insufficient physical activity, alcohol abuse
“Best Buys” for Chronic Illness
oprotect pop. from 2nd hand smoke & ban
smoking in public area
owarnings about dangers of tobacco use; ban
advertising, sponsorship of tobacco/alcohol
oraise taxes on tobacco & alcohol
oreduce salt intake & salt content of food
oreplace trans-fat food with polyunsaturated
opromote diet & physical activity
Role of Genetics
Genetic testing shows inherited predisposition to different types of cancer i.e. breast & ovarian cancer,
melanoma & colon cancer
oAlso for cystic fibrosis & Huntington’s disease
Assist in the prevention, detection & treatment of chronic illness
Role of Aging
Improved sanitation, vaccination, public health surveillance & advent of antibiotics increase average
life expectancy rate (m – 78 y/o; f – 82.7 y/o)
Aging associated with development of many chronic illness (85+ have 3 chronic illness than 64-75)
Cognitive decline (over 85 more prevalent)
Hypertension & arthritis and hypertension & heart disease common combos
Disability in Chronic Illness
Chronic illness associated with disability, but people aren’t disabled by their chronic illness
2 conceptual models – medical model & social model
Medical Model Social Model
Disability directly caused by
disease, trauma or other health
Disability socially created problem
& not inherent trait of person
Calls for political response b/c
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