Chapter
10
● Chronic Illness
LEARNING OBJECTIVES ●
On completion of this chapter, the learner will be able to:
1. Define “chronic conditions.”
2. Identify factors related to the increasing incidence of chronic
conditions.
3. Describe characteristics of chronic conditions and implications for
people with chronic conditions and for their families.
4. Describe the phases of chronic conditions.
5. Apply the nursing process to the care of the patient with chronic
conditions.
146
, Chapter 10 Chronic Illness 147
C hronic health problems affect people of all ages—they occur
in the very young, the middle-aged, and the very old. Chronic
• Suddenness, extent, and duration of lifestyle changes ne-
cessitated by the illness
conditions do, however, increase in frequency with age, and • Family and individual resources for dealing with stress
elderly people often have multiple chronic disorders (Van den • Stages of individual/family life cycle
Akker, Buntinx, Metsemakers, Roos & Knottnerus, 1998). Chronic • Previous experience with illness and crises
illnesses are found in all socioeconomic, ethnic, cultural, and racial • Codependency in family systems (Lewis, 1998)
groups; certain diseases, however, occur more frequently in some
groups than in others (Kington & Smith, 1997). Native Ameri- Psychological, emotional, and cognitive reactions to chronic
cans between the ages of 45 to 64, for example, have a higher conditions are likely to occur at the initial onset, but they may
mortality rate from diabetes and cirrhosis than Caucasians in also recur if symptoms worsen or recur after a period of remis-
the same age range (Reeves, Remington, Nashold & Pete, 1997). sion. Symptoms associated with chronic illnesses are often un-
Being poor and lacking adequate health care coverage decreases predictable, and some are perceived as crisis events by patients
the likelihood of receiving preventive screening measures such and their families, who must contend with both the uncertainty
as mammography, cholesterol testing, and routine check-ups of chronic illness and the changes it brings to their lives. This
(Hagdrup, Simoes & Brownson, 1997). Although some chronic chapter describes some of the problems of living with chronic
conditions have little effect on quality of life, others have a con- conditions and offers a guide to nursing assessment and inter-
siderable effect because of related disability (Kempen, Ormel, vention when providing care to people with chronic illness.
Brilman & Relyveld, 1997). Certain conditions require advanced
technology for survival, as in the late stages of amyotrophic lat- DEFINITION OF CHRONIC CONDITIONS
eral sclerosis or end-stage renal disease. Some people with chronic
health conditions and disability function independently with “Chronic conditions” are defined as medical conditions or health
only minor inconvenience to their everyday lives; others require problems with associated symptoms or disabilities that require
frequent and close monitoring or placement in long-term care long-term (3 months or longer) management (Robert Wood
facilities. Johnson Foundation, 1996). The condition may be due to ill-
ness, genetic factors, or injury. Management of such conditions
includes learning to live with symptoms and/or disabilities and
The Phenomenon of Chronicity coming to terms with identity changes brought about by having
a chronic condition. It also consists of carrying out the lifestyle
Although each chronic condition has its own specific physiologic changes and regimens that are designed to keep symptoms under
characteristics, chronic conditions do share common qualities. control and to prevent complications. Although some people take
Many chronic conditions, for example, have pain and fatigue as on what might be called a “sick role” identity, most people with
associated symptoms. Some degree of disability is usually present chronic conditions do not consider themselves to be sick or ill and
in severe or advanced chronic illness, limiting the patient’s par- try to live as normal a life as is possible. Only when complications
ticipation in activities (Collins, 1997). Many chronic conditions develop or when symptoms become severe enough to interfere with
require therapeutic regimens to keep them under control. Unlike performance of daily life activities do most people who are chroni-
the term “acute,” which implies a curable and relatively short dis- cally ill think of themselves as being sick or disabled (Nijhof, 1998).
ease course, chronic describes a long disease course and conditions
that may be incurable. It is this characteristic of duration that
often makes managing chronic conditions so difficult for those PREVALENCE AND CAUSES
who must live with them. OF CHRONIC CONDITIONS
Psychological and emotional reactions of patients to acute and
Chronic conditions occur in people of every age group, socio-
chronic conditions and changes in their health status are de-
economic level, and culture. In 1995, an estimated 99 million peo-
scribed in detail in Chapter 7. People who develop chronic
ple in the United States had chronic conditions, and it has been
conditions may react with shock, disbelief, depression, anger,
projected that by the year 2030 about 150 million people will be
resentment, or a number of other emotions. How people react
affected (Robert Wood Johnson Foundation, 1996). Table 10-1
and cope with chronic conditions is usually similar to how they
shows the projected increase in rates of people with chronic con-
react to other events in their lives, depending, in part, on their
ditions by year, along with an estimate of the costs to be incurred
understanding of the condition and their perceptions of its po-
in managing those conditions.
tential impact on their own and their family’s lives. Adjustment
Not every chronic condition is disabling; some cause only
to chronic illness is affected by various factors:
minor inconveniences. Many, however, are severe enough to
• Personality before the illness cause major activity limitations. Figures 10-1 and 10-2 present
• Unresolved anger or grief from the past overviews of the projected number of people in millions with ac-
10
● Chronic Illness
LEARNING OBJECTIVES ●
On completion of this chapter, the learner will be able to:
1. Define “chronic conditions.”
2. Identify factors related to the increasing incidence of chronic
conditions.
3. Describe characteristics of chronic conditions and implications for
people with chronic conditions and for their families.
4. Describe the phases of chronic conditions.
5. Apply the nursing process to the care of the patient with chronic
conditions.
146
, Chapter 10 Chronic Illness 147
C hronic health problems affect people of all ages—they occur
in the very young, the middle-aged, and the very old. Chronic
• Suddenness, extent, and duration of lifestyle changes ne-
cessitated by the illness
conditions do, however, increase in frequency with age, and • Family and individual resources for dealing with stress
elderly people often have multiple chronic disorders (Van den • Stages of individual/family life cycle
Akker, Buntinx, Metsemakers, Roos & Knottnerus, 1998). Chronic • Previous experience with illness and crises
illnesses are found in all socioeconomic, ethnic, cultural, and racial • Codependency in family systems (Lewis, 1998)
groups; certain diseases, however, occur more frequently in some
groups than in others (Kington & Smith, 1997). Native Ameri- Psychological, emotional, and cognitive reactions to chronic
cans between the ages of 45 to 64, for example, have a higher conditions are likely to occur at the initial onset, but they may
mortality rate from diabetes and cirrhosis than Caucasians in also recur if symptoms worsen or recur after a period of remis-
the same age range (Reeves, Remington, Nashold & Pete, 1997). sion. Symptoms associated with chronic illnesses are often un-
Being poor and lacking adequate health care coverage decreases predictable, and some are perceived as crisis events by patients
the likelihood of receiving preventive screening measures such and their families, who must contend with both the uncertainty
as mammography, cholesterol testing, and routine check-ups of chronic illness and the changes it brings to their lives. This
(Hagdrup, Simoes & Brownson, 1997). Although some chronic chapter describes some of the problems of living with chronic
conditions have little effect on quality of life, others have a con- conditions and offers a guide to nursing assessment and inter-
siderable effect because of related disability (Kempen, Ormel, vention when providing care to people with chronic illness.
Brilman & Relyveld, 1997). Certain conditions require advanced
technology for survival, as in the late stages of amyotrophic lat- DEFINITION OF CHRONIC CONDITIONS
eral sclerosis or end-stage renal disease. Some people with chronic
health conditions and disability function independently with “Chronic conditions” are defined as medical conditions or health
only minor inconvenience to their everyday lives; others require problems with associated symptoms or disabilities that require
frequent and close monitoring or placement in long-term care long-term (3 months or longer) management (Robert Wood
facilities. Johnson Foundation, 1996). The condition may be due to ill-
ness, genetic factors, or injury. Management of such conditions
includes learning to live with symptoms and/or disabilities and
The Phenomenon of Chronicity coming to terms with identity changes brought about by having
a chronic condition. It also consists of carrying out the lifestyle
Although each chronic condition has its own specific physiologic changes and regimens that are designed to keep symptoms under
characteristics, chronic conditions do share common qualities. control and to prevent complications. Although some people take
Many chronic conditions, for example, have pain and fatigue as on what might be called a “sick role” identity, most people with
associated symptoms. Some degree of disability is usually present chronic conditions do not consider themselves to be sick or ill and
in severe or advanced chronic illness, limiting the patient’s par- try to live as normal a life as is possible. Only when complications
ticipation in activities (Collins, 1997). Many chronic conditions develop or when symptoms become severe enough to interfere with
require therapeutic regimens to keep them under control. Unlike performance of daily life activities do most people who are chroni-
the term “acute,” which implies a curable and relatively short dis- cally ill think of themselves as being sick or disabled (Nijhof, 1998).
ease course, chronic describes a long disease course and conditions
that may be incurable. It is this characteristic of duration that
often makes managing chronic conditions so difficult for those PREVALENCE AND CAUSES
who must live with them. OF CHRONIC CONDITIONS
Psychological and emotional reactions of patients to acute and
Chronic conditions occur in people of every age group, socio-
chronic conditions and changes in their health status are de-
economic level, and culture. In 1995, an estimated 99 million peo-
scribed in detail in Chapter 7. People who develop chronic
ple in the United States had chronic conditions, and it has been
conditions may react with shock, disbelief, depression, anger,
projected that by the year 2030 about 150 million people will be
resentment, or a number of other emotions. How people react
affected (Robert Wood Johnson Foundation, 1996). Table 10-1
and cope with chronic conditions is usually similar to how they
shows the projected increase in rates of people with chronic con-
react to other events in their lives, depending, in part, on their
ditions by year, along with an estimate of the costs to be incurred
understanding of the condition and their perceptions of its po-
in managing those conditions.
tential impact on their own and their family’s lives. Adjustment
Not every chronic condition is disabling; some cause only
to chronic illness is affected by various factors:
minor inconveniences. Many, however, are severe enough to
• Personality before the illness cause major activity limitations. Figures 10-1 and 10-2 present
• Unresolved anger or grief from the past overviews of the projected number of people in millions with ac-
