other chronic illnesses Flashcards by Julie T

• Degenerative disease of the brain
• Major source of cognitive disability around the
world
• Can only be diagnosed definitively by autopsy
– Plaques and tangles of nerve fibers in cerebral cortex and hippocampus
• Symptoms:
– Behavioral symptoms & memory loss
– Brain imaging can detect deterioration

alzheimer’s disease

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– Early onset (

2 types of alzheimer’s

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• Agitation and irritability, sleep difficulties, delusions, paranoia and suspiciousness, aggression, incontinence, inappropriate
sexual behavior, hallucinations
• Source of stress for patient and caregivers

behavioral problems of alzheimer’s

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• Goal: slow progression
• Pharmaceuticals:
– Donepezil Slows loss of neurons from the hippocampus
– Mematine Improves cognitive measures
– Statins
– Neuroleptic drugsReduce agitation and aggression
• Behavioral interventions
– Sensory stimulation and reality orientation
– Identification and analysis of problem situations
– Environmental modification

alzheimer’s treatment

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Even after patient has died caregivers still are
more distressed and immunocompromised than
non-caregivers
• Caregivers are more likely to be women,
especially daughters
• Help for caregivers
– Programs for caregivers provide knowledge and skills
– Support groups for caregivers
– Relief services

alzheimer’s effect of family

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• Syndromes that are marked by the symptoms 
and disability they cause
• but have no demonstrable tissue abnormality
– Chronic fatigue syndrome
– Fibromyalgia
– Irritable bowel syndrome
– Gulf War syndrome
– Silicone breast implant syndromes
– Chronic whiplash
– Chemical sensitivity
– Sick building

Functional Somatic Disorders

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• At any given time, 50% of the population has a
____condition
• Can range from mild to severe
• Medical management of these conditions
accounts for ¾ of the nation’s health spending
• Most of us will develop at least one chronic
disability or disease, which may ultimately be
the cause of our death

chronic illness

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– Involvement of the patient in all aspects of a chronic illness and its implications,
– Includes medical management, changes in social and vocational roles, and coping

self management of chronically ill

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Chronic illness is a stressor
primary appraisal :It is appraised as a harm, threat, or challenge
secondary appraisal: Are the coping abilities and resources sufficient?

emotional responses of chronic illness

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• Defense mechanism by which people avoid the
implications of an illness
• common early reaction to the
diagnosis of a chronic illness
– This illness is not severe
– This illness will go away soon
– There will be few long term implications

denial

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• Immediately after the diagnosis, denial can
serve a protective function
– Keeps patient from dealing with full range of problems posed by illness
– can reduce days in intensive care& side effects of treatment
• During the rehabilitative phase, denial may have adverse effects
– High deniers at this time show less adherence to treatment regimen

denial

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common after diagnosis &increases when people:
– Are waiting for test results
– Are anticipating adverse side effects
– Are awaiting invasive medical procedures
• ____ high when
– Substantial lifestyle changes are expected
– People feel dependent on health care professionals

anxiety

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• Assessment and treatment of ___may be
needed
• may increase over time
– Concern about possible complications
– Concern about implications for the future
– Concern about the impact of the disease on work and
leisure-time activities

anxiety

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• When the acute phase of chronic illness has
ended
– Then full implications begin to sink in
– is common
– Often is debilitating
• Impacts symptoms experienced and the overall
prospects for rehabilitation or recovery
– Longer hospital stays or discharge to nursing homes
– Less like to maintain gains made in rehabilitation or to restore quality of life
– Exacerbates symptoms and complicate treatment
– Linked to suicide
• Treatment may reduce symptoms and improve functioning

depression

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– Greater severity of illness
– Pain and disability
– Other negative life events, social stress, or lack of social support
– Physical limitations early in illness 
– Psychological factors later in illness

what predicts depression

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• Disabled individuals elicit ambivalence from
acquaintances
– Verbal signs may be of warmth, affection
– Gestures, body posture may convey rejection
• Distant relationships are more adversely
affected than are intimate relations with close
friends and family

chronic illness social interaction problems

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Substantial strain on primary caregiver
– Typical ___r: Women in her 60s caring for an elderly spouse
– Also common: Care for parents and disabled children
• Role commonly falls to women
• at risk for
– Distress, depression, declining health

caregiving, caregiver role

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• Chronically ill people may
– Perceive a narrow escape from death
– Reorder their priorities
– Find meaning in smaller activities of life
– Cancer samples had greater quality of life than nonill samples

positive changes

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• Differs from therapy with patients who have
primarily psychological complaints
• Therapy is more likely to be episodic rather than continuous
– Chronic illness raises crises and issues intermittently
• Psychological defenses should be respected
rather than challenged
• Therapist should have a comprehensive
understanding of the illness and treatment

individual therapy for chronic illness

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– Telling what to expect during treatment
• Forestalls anxiety
– Group coping skills training successful
• Enhances perceptions of control
– Therapy conducted over the telephone or internet
• Benefits patients by enhancing personal control
– Music, art, and dance therapies
• Improve patients’ responses to chronic illness

Brief Psychotherapeutic interventions

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– To inform patients about the disorder and its
treatment
– To train them in methods for coping with the disorder and its corresponding limitations

patient education programs

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Provides information in a cost-effective manner

– Patients/Families access appropriate Web sites

Study These Flashcards

internet

– Writing about cancer benefits the terminally ill

Study These Flashcards

Expressive Writing

– Widely used with the chronically ill
– Decreases anxiety and nausea from chemotherapy
– Decreases pain for cancer patients
– Used with stress management/blood pressure
monitoring to treat essential hypertension

Study These Flashcards

relaxation training

– Meditation – Focus on reality of present moment – Approach mindfully instead of automatically reacting – Long-term efficacy unknown, reduces stress

MBSR: Mindfulness-based stress reduction

– Most commonly undertaken with MI patients – May or may not have a direct impact on mood – Physical fitness is reliably improved – Exercise improves quality of life

exercise interventions

``` • Interventions can teach patients to – Recognize potential sources of support – Draw on these resources effectively • Family support – Enhances patient's physical/emotional functioning – Promotes adherence to treatment ```

social/family support

• Group of individuals who meet regularly – Share some common problem or concern • believed to help people cope because – People learn techniques that others have used successfully to combat problems – They provide opportunities to share concerns and exchange information with similar others • promote better health and long-term survival

support groups

• Medical care of the terminally ill.

terminal care

* Care designed to make the patient comfortable, but not to cure or improve the patient’s underlying disease * often part of terminal care

palliative

care designed to cure the disease

curative care

• Denial – A mistake must have been made; test results mixed up • Anger – Why me? Why not him? Or her? • Bargaining – A pact with God, good works for more time or for health • Depression – Coming to terms with lack of control, a time of “anticipatory grief” • Acceptance – Tired, peaceful (not always pleasant), calm descends

Kϋbler-Ross’s 5 Stages

• Her work is invaluable – As a description of dying patients’ reactions – In pointing out counseling needs of the dying – In breaking the taboos surrounding death • Her work has not identified stages of dying – There is not a predetermined order – Some patients never go through a particular “stage” – Her work does not fully acknowledge the importance of anxiety.

Evaluation of Kϋbler-Ross’s Theory

1. Practical– End of life arrangements (finances, medical care) 2. Relational– Reconciliation 3. Personal– Find meaning in life

dying role

____ may have debilitating side effects – Advanced diabetes • Amputation of extremities, such as fingers or toes – Advanced cancer • Removal of an organ, such as a lung • Patients feel they are being disassembled – Whether to continue treatment may become an issue

treatments

– Passed by Congress in 1990 – Applies to Medicare and Medicaid health care facilities – Must have written policies regarding patients’ wishes for life-prolonging therapy – Include provision of a DNR (Do Not Resuscitate) order in the case of cardiopulmonary arrest

Patient Self-Determination Act

– A will prepared by a person with a terminal illness – Requests that extraordinary life-sustaining procedures not be used in the event that the ability to make this decision is lost – Insures that the patients preferences, not those of a relative, are respected

Living Will

– Literally means “Good Death” – Ending the life of a person with a painful terminal illness for the purpose of terminating the individual’s suffering. – 1994 Oregon passed law permitting physician-assisted dying – 1997 Supreme Court physician-assisted dying is not a constitutional right but legislation is up to states

Moral and Legal Issues: Euthanasia

• Changes in the patient’s self-concept – Difficult maintaining control of biological functions (drooling, incontinent, shaking) – Mental regression, difficulty concentrating • Issues of social interaction – Fear that their condition will upset visitors – Withdrawal may occur for multiple reasons • Fear of depressing others • Fear of becoming an emotional burden

social issues related to dying

– Death is still a taboo subject in U.S. • Many people feel the proper thing to do is not bring up death • Survivors often try to bear their grief alone – Medical staff, family, and patient • May believe the others don’t want to discuss death

communication issues

– Patients may turn away from traditional care – Patients may seek alternative remedies – Life savings may be invested in quackery in the hopes of a “miracle cure”

When health deteriorates and communication | deteriorates

• Reactions often include – Shock and outrage – An acute sense of injustice • Medical staff – Difficult working with these patients • Young adults who are the parents of young children feel – Cheated of chance of watching children grow – Concerned about how children will fare without them

relations to young adult death

``` • Does not have to cope with : – Pain, – Physical deterioration, – Loss of mental faculties • Financial and other resources are not severely taxed ```

sudden death advantages

``` Family members may be – Estranged, now no hope for reconciliation – Poorly prepared to cope financially with the loss ```

sudden death disadvantages

Thanatologists – Those who study death and dying. • Clinical thanatology – The clinical practice of counseling people who are dying on the basis of knowledge of reactions to dying. • Can apply cognitive-behavioral therapy techniques with patients who are terminally ill – Progressive muscle relaxation – Positive self talk

Counseling

– The sense that one is leaving a lasting impact on the world, as through one’s children or one’s work – The last weeks of life can crystallize the meaning of a lifetime

Symbolic immortality

• Common issues – Communication – Death-related plans and decisions – Need to find meaning in life while making a loving separation • Family and patient may be mismatched in adjusting to the illness – Family may be hopeful, patient may be resigned

family therapy

• Typically, staff serve limited rotations in units with terminally ill children – Hardest death to accept – Death can be physically painful – Children and parents are confused and fearful – Children may not express their concerns in a direct way

ill Children

– Institutions for the dying that encourage personalized, warm, palliative care – Acceptance of death in a positive manner – An alternative to hospital and home care, designed to provide comfort for terminally ill patients and their families – May be residential or home based

hospice/ hospice care

• Psychological comfort is stressed – Patients encouraged to personalize their living areas – Patients wear their own clothes – Patients establish their own routines • Hospice care is less stressful for the families of the dying – Families encouraged to spend full days and stay over if possible

hospice care

– Choice of care for many terminally ill patients – Sometimes problematic for family members – Escalating hospital costs mean many people cannot afford extended hospitalization

home care

– Before death filled with illness-related activities – After death, it is hard to remember what one used to do – Often doesn’t feel like doing those activities that are remembered – Has to take on new and unfamiliar tasks

survivors routine

– A response to bereavement involving a feeling of hollowness – Often marked by preoccupation with the dead person, expressions of hostility toward others, and guilt over death – May involve restlessness, inability to concentrate, and other adverse psychological and physical symptoms

grief

– May expect the dead person to return – May believe a parent left because the child was “bad” – May feel “responsible” for a sibling’s death

child survivor

other chronic illnesses Flashcards

(54 cards)