1.

)Differentiate Acute Illness and Chronic Illness

Acute Illness is one caused by a disease that produces symptoms and

signs soon after exposure to the cause, that runs a short course and from
which there is usually a full recovery or an abrupt termination of death. It is
caused by the activation of nociceptors and is usually of short duration of
less than 6 months. It has an immediate onset, such as incisional pain after
surgery. Client used words such as “sharp”, “stabbing” and “shooting” to
describe acute pain. It indicates injury and motivates the person to seek
relief by treatment of the cause. It is usually reversible or controllable with
adequate treatment. It may be accompanied by observable physical
responses, including: increase or decrease blood pressure, tachycardia,
diaphoresis, tachypnea, focusing on the pain and guarding the painful body
area. While, Chronic Illness, is one caused by the disease that produces
symptoms and signs within a variable period of time, that runs a long
course, and from which there is only partial recovery. The pain last more
than 6 months. It has no foreseeable end unless it is associated with very
slow healing, as with burns. May have started as an acute pain or its origin
may have been so obscure that the person does not know when it first
developed. It may have localized or widespread pain and tenderness, some
with tender points in predictable spots, but with few other physical findings.

2.)Enumerate and discuss the factors influencing Chronic Illness

a.) Age – young are more likely to experience short, intense, acute
conditions that are quickly over. Chronic illness often accompanies
aging.

b.) Race and Ethnicity – race specific rates measure the association
between disease and occurrence.

i. Cancer : 16% of excess mortality among black males

or excess mortality among black males 70 and 10%
among black females.

ii. CVD and Stoke: 24% among male and 41% among
black female. Most of the deaths were due to
Hypertension.

iii. Chemical Dependence: 13% among native American

males and 22% among native American female under
age 70.
 iv. Diabetes: 38% of excess death among Mexican born
Hispanic females.

v. Homicide and Accidents: 60% of excess death among

Hispanic under age 65.

vi. Accident’s cause 44% of excess death among male

and 30% among female native American.

vii. Infant Mortality:

3.)Chronically Ill Persons and their Families

The effects of chronic illness on individuals and their families are numerous
and varied. The first impact of the disability may nearly immobilize them. Time
must be provided them to talk through their concerns and fears before they can be
expected to begin coping with their new situation.

Marked changes often take place, and are often required to take place, in
family living as a result of chronic illness. Some families may find themselves drawn
closer together. Other families drift apart, the individual members being incapable
of helping on another. At times, a chronic illness may threaten an individual’s basic
emotional stability, and the whole situation may be unbearable to others.
Sometimes the individual’s emotional stability may not have been apparent to the
family early in the illness, but when such needs grow obvious, relatives feel
inadequate to cope with the situation. The length of illness, periodic hospitalization,
and increased financial, emotional and social burdens are stressors that threaten to
family’s integrity.

Many persons struggle on their own to assume the full financial burden of the
illness and consequently expose other members to the family to lower standards of
nutrition, housing and care. Many times relatives move in with one another,
arguments develop, and family ties are strained or broken. Public assistance may
be acceptable in some families, whereas other find it impossible to accept.

Chronic illness imposes additional problems of learning how to cope with

restrictions on activities of daily living, how to prevent or identify medical crises that
occur, and how to carry out treatment regimens as delineated by the health care
provider. Family members also need to learn about restrictions, not only to be of
assistance to the chronically ill person, but also because their own activity pattern
may be disrupted by the person’s activities.

Because chronic illness may have periods of exacerbation when symptoms

become more acute and medical crises may occur, patients and family members
need to know which symptoms must be reported to health care provider as well as
the time interval for reporting these symptoms. They also need to know how to
contact the provider and what measures to take if a medical crisis occurs.

5.) Enumerate nursing diagnosis to chronically ill patient.

Diagnostic title
Possible etiologies

Activity intolerance Bed rest, immobility generalized

weakness, sedentary lifestyle

Adjustment, impaired Disability requiring change in

lifestyle; inadequate
support systems; impaired
cognition, sensory overload; altered
locus of control; incomplete
grieving.

Anxiety Threats to self- concept; threat of

change in health status,
socioeconomic status, and role
functioning

Breathing pattern, ineffective Neuromuscular impairment,

pain, musculoskeletal impairment
 Communication, impaired Aphasia, physical impairment
verbal

Constipation Change in lifestyle, immobility,

inadequate nutrition, and
inadequate fluid intake

5.1 What is the priority nursing diagnosis?

Breathing pattern, ineffective Neuromuscular impairment, pain,

musculoskeletal impairment

6. Nursing Management and implementations:

Nursing Management for patient with chronic illness includes:

 Motivating patients to persist in necessary therapies and interventions and
helping them to achieve an ongoing, reasonable quality of life by means of
adjusting their lifestyle thru:

 Providing explanation information about necessary adjustments

 Making arrangements wherever possible to accommodate the client’s

lifestyle.

 Encouraging other health professionals to become aware of the

person’s lifestyle practices and to support healthy aspects of that
lifestyle.

 Reinforcing desirable changes in practices with a view to making a

permanent part of the client’s lifestyle.

Nursing Implementation for patient with chronic illness includes:

 Limiting activities

 Promoting self-care

 Promoting self-esteem

Show continued warmth and interest appropriately and keep

them updated on news (if confined). It is also better to provide
some reading materials, radio, television or any materials that
will give them opportunity to be creative with their own hands.

 Supporting coping skills

It is an effective way to cope with patients via listening and

helping to explore with their feelings. It is also a must to help
the family identify their feelings and strengthen communication
pattern.

 Clarifying Nurse-Patient values

We should distinguish between our own values, standards and

goals and that of the patient. Management of chronically ill
person requires a slow moving persistent pace with possibly
little or no change fro a long time.

 Supporting the person with a program disability

Provide a comprehensive care according to their needs in an

appropriate , continuous and dynamic pattern.

 Providing community resources

 The nurses should assist in the development of structural
change in the community such as providing programs , facilities
and regulation to assist the patient.

7. Physical and psychological support

Assessment:

A. Physical:

 Physical condition of the internal system i.e. cardiovascular,

pulmonary, G.I, G.U, endocrine, brain and etc.

 Upper extremities, shoulder girdle, cervical and upper dorsal spine.

 Lower extremities, pelvis, lower dorsal and lumbar sacral spine

 Sensory component relating to speech, vision and hearing

 Excretory including bladder and bowel

 Mental and emotional status

-Must include extent of difficulty in performing ADLs, desire and

ability to sex.

B. Psychological:

 Determine the attitudes and stage of adaptation to illness, feelings

concerning now illness affects the family and the patient.

-Feelings of anxiety, frustration, irritability, bitterness and guilt

maybe express by the patient.

8.) Rehabilitation Care

• Multi-disciplinary Approach

The number of professional people required to assist the patient and

family with rehabilitation will vary. Most often the patient, the family, the
physician, and the nurse can work out a practical plan. If a patient’s problems
are complex, other members may be added to the team. Typically, such a
team consists of a physician, nurse, discharge coordinator, medical social
worker, vocational counselor, psychologist, speech pathologist, occupational
and physical therapists, and a caseworker from the patient’s social agency.
Teamwork requires that members of the team be able to use their special
knowledge and skill and understand the value their contribution to the
 patient’s care. In addition, team members need some understanding of each
other’s professional functions and contributions. One of the cooperative
efforts of the involved team members is to regularly to evaluate patients and
their abilities thoroughly. Based on this assessment, each patient and the
team devise a plan to foster readjustment, compensation, and the learning of
new ways to manage self-care and living.

• Rehabilitation centers

Persons with very complex problems of rehabilitation may need to

receive

care at specialized centers for rehabilitation, or they may receive care at

home combined with visits to day rehabilitation centers. The variety of
specialized centers includes teaching and research centers (centers located
in and operated by hospitals and medical schools), community centers with
facilities for inpatients, community outpatient centers, insurance centers,
skilled nursing homes with an active rehabilitation service and staff, including
physical and occupational therapists and vocational rehabilitation centers. In
addition to centers that provide multiple services for the physically disabled,
specialized centers provide rehabilitation for blind, deaf, mentally ill, and
mentally retarded persons. Most centers offer a wide range of services that
usually fall into the following three areas:

1. Physical area
 Physical, nursing, and medical evaluation
 Physical therapy
 Occupational therapy
 Speech therapy
 Medical and nursing supervision of appropriate activities

 Psychosocial area
 Evaluation
 Personal counseling
 Social service
 Psychometrics
 Psychiatric service
 Recreational therapy

2. Vocational Area
 Work evaluation
 Vocational counseling
  Prevocational counseling
 Industrial fitness of programs
 Trial employment in sheltered workshops
 Vocational training
 Terminal employment in sheltered workshops
 Placement

9.)Role of the Nurses in Rehabilitation

Nurses who work with patients who have disabilities have two major
responsibilities: 1. to ensure what disability from disease or defused is limited as
much as possible 2. To see that a rehabilitation program is planned and
implemented.

Limiting Disability

Limitation of disability is the nurses first responsibility and requires attention to

the prevention of complications, to the early recognition of symptoms of
exacerbations or complications and to prevention of deformity.

A. Prevent Complication

1. Ensure early recognition of symptoms indicating patient’s condition is

worsening.

a. Review signs and symptoms and pathology of chronic illness to

recognize changes.

b. Review signs and symptoms of complications frequently associated

with the chronic illness, such as infection.

2. Prevent deformities

a. Maintain proper body alignment.

b. Position limbs to prevent contractures.

c. Turn frequently; keep skin clean and dry to prevent ski breakdown.

d. Provide adequate nutrition.

 e. Provide adequate fluid intake to maintain bladder and bladder
program.

f. Take precaution to prevent infection.

Planning and implementing a rehabilitation program

The second responsibility, planning and implementing a rehabilitation program in

accordance with the patient’s goals, is a process in which nurses are intimately
involved:

A. Determine patients own goals for rehabilitation.

B. Plan appropriate nursing interventions based on mutually agreed-on goals.

Early in rehabilitation nurse may have to assume total responsibility for

assisting with activities of daily living, bathing, dressing, intake of foods and
fluids, bowel and bladder programs, maintaining skin integrity, turning
patient and so on.

C. Plan nursing interventions that encourage patient to assume responsibility for

own ADL as soon as possible.

1. Set short-term goal with patient.

2. Goals should be realistic and attainable.

3. Reinforce patients progress ( no matter how small) with positive feedback.

4. Work with other members of the rehabilitation team in providing a

consistent, coordinated rehabilitation plan.

5. Keep patients significant others inform to patient progress so they can

give positive feedback to patient.

6. Reassess goals periodically and set new goals as appropriate.

7. Teach patient, family and if necessary, employer about patients

limitations and rehabilitative expectations.
11.) Vocational Rehabilitation Services

If you are disabled, one of the most important organizations you need to
contact is your State Vocational Rehabilitation Service. Vocational Rehabilitation can
provide funding for school, training, and assistive technology in most states, some
even a 100%. If this does not get you to people who can actually assist you let me
know and I will give you a link to your specific contact information. Depending on
your State, Voc Rehab may be part of a One Stop Career Center along other
agencies like Workforce.

If you are not a current disabled client of your State Vocational Rehabilitation
services, I suggest you contact them soon as some states have a waiting list.
You don't want to be on a Vocational Rehabilitation disabled waiting list when you
are ready to use a Social Security PASS plan. You want that already taken care of
so you can use the Voc Rehab funds in addition to the PASS funds.

Drug Treatment Centers That Promote Psychological Healing

Depression treatment is often an essential element of the drug recovery

process. Drug addiction is always at least in part a psychological disease, and the
most successful drug treatment centers are those which most effectively promote
psychological healing. The drug treatment program that’s right for you is the one
that can help you get better in mind as well as in body. Under the circumstances,
you simply can’t afford to settle for anything less from your drug treatment center
experience.

You already know that addition ruins lives. The good news is that drug
treatment centers can save them—but only if they provide their clients with holistic
drug treatment programs. The day you seek help from a drug treatment facility that
understands the importance of depression treatment and recovery will be the day
you start healing from the inside-out, in a way that will help you rediscover yourself
as you used to be. Here’s hoping you’ll be wise enough—and brave enough—to take
the first step towards a better future.

Physical Rehab Center

Getting people back to work...play...to living!

HealthSouth/Outpatient-Rehabilitation Center at Seton Medical Center is a

state-of-the-art outpatient rehabilitation clinic. Affiliated with Seton Medical Center,
HealthSouth/ Outpatient-Rehabilitation Center believes that Caring is Powerful
Medicine. Their dedicated and experienced medical staff works closely together to
meet the unique needs of each patient.

The Center is committed to providing a full range of outpatient services and

treatment. The Center provides general orthopedic and sports medicine treatments
from ankle sprains to ligament reconstruction and joint replacement. Our patients
range from elite athletes to the weekend warriors, from teens to senior citizens. All
treatments are designed to return patients quickly to their maximum ability and
independence.

The most common treatments include back and spine rehabilitation, chronic
and acute pain management, and hand therapy. Treatments include, but are not
limited to, stretching, muscle re-education, conditioning, and strengthening. Other
orthopedic programs are designed for those recovering from stroke, amputation,
brain or spinal cord injury. Outpatient rehabilitation also provides comprehensive
occupational medicine services to industries for the early treatment and prevention
of work-related injuries.

In addition, HealthSouth/Outpatient-Rehabilitation Center has a fully

equipped gym with pilates and weight machines. The Center also has access to a
nearby pool, for aquatic therapy treatments.

Physical Rehabilitation Center

Recuperating from major surgery, illness or an accident can be challenging.

What if you're well enough to leave the hospital, but aren't yet ready to go home?
For many patients, the solution is a short stay at Highline Physical Rehabilitation
Center.

The center is the only hospital-based skilled nursing facility in the Puget
Sound region. That means you'll have on-site access to the comprehensive
resources of a hospital, including the emergency department, laboratory,
respiratory therapy and imaging services. It also means RN nursing staff is on site
24 hours a day, with 24-hour physician availability.

Nurses are dedicated to caring for the whole person – and his or her family –
in a way that is individualized and nurturing.

The Care You Need to Get Back to Your Life

Whether you are recovering from injury, illness or major surgery, our
comprehensive program can help you regain the strength and stamina you need to
return home. Highline Physical Rehabilitation Center offers both acute and sub-
acute rehabilitative care and skilled nursing services – all in a supportive, healing
environment.

A Program Personalized for You

Because each patient's needs are unique, so is each patient's plan of care.
We'll work with you and your family to develop an individualized program of
rehabilitation that is effective for you. We place a strong emphasis on patient and
family education. We know the more informed and involved you are, the quicker
and less traumatic your healing process will be. We'll even help you transition to
home by providing specialized training to your family on equipment or supplies that
you might need.

The team might include:

 Our physiatrist (a medical doctor who specializes in rehabilitation)

 Internal medicine physicians
 Registered nurses
 Social workers
 Physical, recreational and occupational therapists
 Speech/language pathologists
  Respiratory therapists
 Registered dietitians
 Certified nursing assistants

A dedicated RN case manager will help coordinate your care to assure that all
your needs are met.

Accreditations

Highline Physical Rehabilitation Center is state-certified and nationally

accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities,
and The Joint Commission.

A Healing Environment

Nurses should be dedicated to caring for the whole person, with genuine
respect, compassion and dignity. Our facility includes homelike touches. We also
offer a wide variety of activities that provide enjoyable and therapeutic diversions
from the rehab routine.

Comprehensive Services to Meet Every Need

Acute Rehabilitation

The intensive program allows patients to quickly regain strength following

orthopedic surgery, a stroke, injury or other illness. Most patients need only a brief
stay — about one to two weeks — before returning home or to other living
arrangements. Acute rehab is geared to those patients able to tolerate a more
intensive level of daily therapy. Patients generally must be able to tolerate 2.5
hours of daily therapy, including physical, occupational, speech/language and
recreation therapy. Community and home evaluations are often done to facilitate
transition to home or assisted-living environments. A physiatrist (a medical doctor
specializing in physical medicine and rehabilitation) oversees the rehab program in
collaboration with the patient’s primary care or consulting physician.

Sub-Acute Rehabilitation

Sub-acute care provides patients with the same rehab services at a less
intensive pace than acute rehab. Patients who are weakened by illness, injury or
surgery may benefit most from Sub-Acute Rehab. They are able to recuperate and
gain strength according to their ability. sub-acute rehabilitation offers skilled
nursing and rehabilitation services for patients in transition between hospital and
home or assisted-living arrangements. This hospital-based transitional care unit
provides patients with a rehab program of physical, occupational, speech/language
and recreation therapy at the sub-acute level.

Skilled Nursing Care

 As a Medicare-certified skilled nursing unit, nurses are able to treat wounds,
administer IV medications and deliver a broad range of other specialized nursing
services.

Services Available

• Physiatry (a medical specialty in physical medicine and rehabilitation)

• Specialty physician consults
• 24-hour nursing care
• Physical therapy
• Occupational therapy
• Speech/language pathology
• Massage therapy
• Prosthetics and orthotics
• Respiratory therapy
• Medical social work
• Nutrition and dietary counseling
• Therapeutic recreation
• Psychological testing
• On-site laboratory and radiology
• Planetree Library and information service

Source: Medical-Surgical Nursing

A Nursing Process Approach

Long, Phipps, Cassmeyer

3rd edition