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Lecture 4

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


Department
Nursing
Course Code
NSE 21A/B
Professor
Franklin Gorospe
Lecture
4

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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 &
challenge
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
changed
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
empowerment
Canadian health care still built around acute, episodic model of care that doesn’t address chronic health
problems
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
accurate
Self-limited or specific therapy
available
Technological intervention usually
effective (lab testing, imaging,
medication, surgery)
Cure likely with return to normal health
Minimal uncertainty
Providers knowledgeable; patient
inexperienced
Gradual onset
Unfolds over time; undulating course
Long duration >6 months
Multivariate causation, changing over
time
Diagnosis may be uncertain; prognosis
obscure
Treatment has no definitive results &
therapies have adverse effects
Technological intervention may/may
not be helpful
No cure; management over time
required
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
requirements
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
Multimorbidity
oOptimal health challenging b/c treatment that helps 1 condition, makes coexisting condition
worse
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
food
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
condition
Disability socially created problem
& not inherent trait of person
Calls for political response b/c
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