NURS 1730 Chapter Notes - Chapter 1: Health Promotion, Atherosclerosis, Oxygen Therapy
Introduction to Nursing II - Week One
Chapter 1:
- Gerontological nursing is an opportunity to make a significant difference in the lives of
older adults.
- The meaning of aging is influenced by many factors.
- Nurses have a responsibility to contribute to societal values of accessible health care
and reduction of health disparities.
- Health, history and gender are among the major factors influencing the aging experience
- Each age cohort is distinctly different from others.
- Individual persons become more unique the longer they live. Nurses must be cautious in
attributing any specific characteristics of older adults to “old age”.
- All persons, regardless of age, illness conditions, or life situation, can be helped to
achieve a higher level of wellness, which is uniquely and personally defined.
Chapter 15: Living with Chronic Illness (pgs. 247 - 259)
Chronic Illness
→ Chronic Illness are “Conditions that last a minimum of six months or a year or more and
requires ongoing medical attention and/or limit activities of daily living.
→ Nursing Perspective: “Chronic illness is the irreversible presence,
accumulation, latency of disease states or impairments that involve the total
human environment for supportive care and self-care maintenance of function
sna prevention of further disability.”
- The rising cost prevalence and associated cost of chronic illnesses, is a global health
concern.
- Chronic illnesses can cause burdens on family (expenses).
Chronic Illness and Aging
- Many factors influence the rapid rise in the number of individuals with chronic
illness, including:
- The age of the population
- Advances in medical sciences in extending the life span and in treating
illness.
- A rise in some chronic conditions (ie. asthma, and diabetes in younger
people)
- Longer life = living longer with chronic illness.
- Chronic illness in older people can be categorized as follows:
- Nonfatal chronic illness - conditions such as osteoarthritis or hearing or
vision impairments. → contribute to disability and increased healthcare
costs.
- Serious, potential fatal chronic conditions - cancers, organ system
failures, dementia, stroke.
- Frailty - a condition in which the body has few reserves, left and any
disturbance can cause multiple health conditions and costs.
- The effect of a chronic illness on an elderly person can be as little as an
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inconvenience or as great as an impairment of a person’s ability to perform ADLs
Acute versus Chronic Illness
- Acute illnesses are those that occur, suddenly and without warning (ie. stroke,
hip fracture, infection) and with signs and symptoms related to the disease
process itself.
- A person with a chronic illness may have episodic exacerbations or remain in
remission with no symptoms for a long time. Managed rather than cured, person
learns to live with the illness. Continues indefinitely.
Frailty Syndrome
- Frailty is a “stage of age-related physiological vulnerability, resulting from
impaired homeostatic reserve and a reduced capacity of the organism to
withstand stress.”
- 70% of elderly people are classified as frail.
- Factors responsible for the pathogenesis of frailty include:
- Sarcopenia
- Cognitive impairment
- Atherosclerosis
- Malnutrition
- Frailty often goes unnoticed as the symptoms are attributed to the aging process.
-Interventions are aimed at maintaining homeostatic balance and focus on
resistance and balance exercises; aggressive nutritional support; treatment of
depression; delirium; diabetes and appropriate social support.
Prevention of Chronic Illness
- The common risk factors for most chronic illness are:
- Poor diet
- Inactivity
- Smoking
-Key strategies
- Healthy lifestyle
- Injury prevention
- Delivery of culturally appropriate clinical preventive services
- Immunization and preventative screenings
- Self-management techniques for those with chronic illness
- A focus on healthy aging requires nurse to implement health promotion and disease
prevention activities
Care Delivery System
- The current healthcare system focus’ on immediate medical needs to manage
acute events such as accidents, sudden bouts of illness.
- → It does not meet the needs of individuals with chronic illness or support
health promotion and disease prevention.
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Theoretical Frameworks for Chronic Illness
Competencies to Improve Care for Chronic Conditions
- A wellness approach suggests that every person has an optimal level of
functioning to achieve a good and satisfactory existence or well-being.
- The wellness model moves in a positive direction rather than focusing on
deterioration.
- Adaptation of lifestyle is the greatest factor in establishing wellness
Chronic Illness Trajectory
- The trajectory model of chronic illness traces the course of illness through eight
phases.
- The shape and stability of the phases is influenced by the efforts, attitudes and
beliefs of the elderly person, family and involved healthcare provider.
Phase Definition
1. Pertrajectory Before the illness course begins, the preventative phrase, no signs or symptoms present.
2. Trajectory onset Signs and symptoms are present, includes diagnostic period.
3. Crisis Life-threatening situation
4. Acute Active illness or complications that require hospitalization.
5. Stable Illness course - symptoms controlled by regimen
6. Unstable Illness course - symptoms not controlled by regimen but not requiring hospitalization.
7. Downward Progressive deterioration in physical status, mental status, or both, characterized by
increasing disability, symptoms, or both.
8. Dying Immediate week, days, hours preceding death.
The Shifting Perspectives Model of Chronic Illness
→ Key points in the Chronic Illness Trajectory Framework:
- The majority of health problems in late life are chronic
- Chronic illnesses may be lifelong and entail lifetime adaptations
- Chronic illness and its management can greatly affect the life/identities of
both the individual the family members.
- The acute phase of illness management is designed to stabilize
physiological processes and promote a comeback from the acute phase.
- A primary care nurse is often the coordinator of the multiple resources
that may be needed to promote quality of life along the trajectory.
- Maintaining stable phases is central in the work of managing chronic
illness.
- This model views living with a chronic illness as an ongoing, continually shifting
process in which the person moves between the perspectives of wellness-in-the-
foreground and illness-in-the-foreground.
- The “illness-in-the-foreground” perspective is characterized by a focus
on sickness, suffering, loss and burden caused by the illness.
- Occurs when people newly diagnosed, when new symptoms
surface etc.
- It can help a person learn more about their illness and come to
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Document Summary
Gerontological nursing is an opportunity to make a significant difference in the lives of older adults. The meaning of aging is influenced by many factors. Nurses have a responsibility to contribute to societal values of accessible health care and reduction of health disparities. Health, history and gender are among the major factors influencing the aging experience. Each age cohort is distinctly different from others. Individual persons become more unique the longer they live. Nurses must be cautious in attributing any specific characteristics of older adults to old age . All persons, regardless of age, illness conditions, or life situation, can be helped to achieve a higher level of wellness, which is uniquely and personally defined. Chronic illness are conditions that last a minimum of six months or a year or more and requires ongoing medical attention and/or limit activities of daily living.
