Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

from chronic illness is twice that of patients dying from infec­ tions (including HIV infection), maternal and perinatal con­ ditions and nutritional deficiencies combined (World Health Organisation [WHO], 2010). Chronic illness accounts for 80% of the total burden of illness in Australia, and mental problems and injury are the leading causes of disability in the community (Australian Bureau of Statistics [ABS], 2010a). Although chronic illnesses are common, people have many myths or misunderstandings about them (Table 10-1). Causes of the increasing number of people reported with chronic con­ ditions include the following: • A decrease in mortality from infectious illness (e.g. smallpox, diphtheria, acquired immunodeficiency syndrome [AIDS]–related infections) and from acute conditions because of prompt and aggressive management of acute conditions (e.g. myocardial infarction, stroke, trauma). • Lifestyle factors, such as smoking, chronic stress and a sedentary lifestyle, which increase the risk of chronic health problems such as respiratory illness, hypertension, cardiovascular illness and obesity. Although signs and symptoms of chronic illness often first appear during older age, risks may begin earlier, even during fetal development. • Longer lifespan because of advances in technology and pharmacology, improved nutrition, safer working conditions and greater access (for some people) to healthcare. • Improved screening and diagnostic procedures, enabling early detection and treatment of illness, resulting in improved outcomes of management of cancer and other disorders (Wenham & Russell, 2011). Chronic illnesses typically do not result in sudden death but often result in   progressive illness and disability. People with chronic disease often die slowly, painfully and prematurely. Although there are exceptions (some people who live unhealthy lives live to old age   and some people who live healthy lives develop chronic illnesses), the majority of chronic illnesses can be traced to common risk factors and can be prevented by eliminating these risks. A full range of chronic disease interventions are very cost-effective for all regions of   the world, including the poorest. Many of these interventions are inexpensive to The major causes of chronic diseases are known, and if these risk factors were   eliminated, over 80% of heart disease, stroke and type 2 diabetes would be prevented; and over 40% of cancer would be prevented. Individual responsibility can have its full effect only if individuals have equal access   to a healthy life and are supported to make healthy choices. Poor people often   have limited choices about the food they eat, their living conditions, and access to education and healthcare. Chronic diseases, including heart disease, affect women and men almost equally. Almost half of chronic disease deaths occur prematurely, in people under 70 years of   age. People who are poor are much more likely than the wealthy to develop chronic   diseases and are more likely to die as a result. Chronic diseases cause substantial financial burden and can push people and families into poverty. Although infectious diseases are an issue, low-income and middle-income countries   are experiencing a rapid increase in chronic disease risk factors and deaths, especially in urban settings.   Almost half of all deaths due to chronic illness occur in women.   implement. The reality about chronic disease

restriction in performing an activity in a normal manner) is usually present in severe or advanced chronic illness. However, not all disabilities are a result of chronic illness, and not all chronic illnesses cause disability. In this chapter, chronic illness is discussed, followed by a discussion of disability, rehab­ ilitation and the implications for nursing practice. The psychological and emotional reactions of older indi­ viduals to acute and chronic conditions and changes in their health status are described in detail in Chapter 3. Symptoms associated with chronic illnesses are often unpredictable, and some are perceived as crisis events by individuals and their families, who must contend with both the uncertainty of chronic illness and the changes it brings to their lives. These possible effects of chronic conditions can guide nursing assess­ ment and interventions for the patient who has a chronic illness. Prevalence and causes of chronic conditions The prevalence of chronic conditions and illness is evident in the mortality, morbidity, and disability statistics of industri­ alised Western societies. These conditions have become the major cause of health-related problems in developed countries such as Australia and New Zealand (Australian Institute of Health and Welfare [AIHW], 2008), as well as in develop­ ing countries that are trying to cope with new and emerging infectious illnesses such as malaria, tuberculosis and HIV (human immunodeficiency virus), which also become chronic health problems. In almost all countries, chronic illnesses are currently the major cause of death among adults. More than 36 million people died of chronic illness worldwide in 2010. In contrast to common belief, the total number of people dying

Table 10-1  Myths and Truths about Chronic Disease Common misconceptions about chronic disease

 1. Everyone has to die of something.

 2. People can live to old age even if they lead unhealthy

lives (smoke, are obese).

 3. Solutions for chronic disease prevention and control are too expensive to be feasible for low-income and

middle-income countries.

 4. There is nothing that can be done anyway; chronic

diseases cannot be prevented.

 5. If individuals develop chronic disease as a result of unhealthy ‘lifestyles’, they have no one to blame but

themselves.

 6. Certain chronic diseases, especially heart disease,

primarily affect men.

 7. Chronic diseases primarily affect the elderly.

 8. Chronic diseases mainly affect people who are rich

(affluent).

 9. The priority of low-income and middle-income countries should be on control of infectious diseases.

10. Chronic diseases affect mostly high-income countries. Eighty per cent of deaths due to chronic disease are in low-income and middle-   income countries. Based on World Health Organization. (2005). Widespread misunderstandings about chronic disease—and the reality. Facing the facts #2. Viewed April 2013 at www.who.int/entity/ chp/chronic_disease_report/media/Factsheet2.pdf.