1. Copyright © 2008 Delmar. All rights reserved. Chapter 21 Populations with Chronic Diseases

2. Copyright © 2008 Delmar. All rights reserved. 2 Chronic Disease Persists three or more weeks Linked to genetics, environmental factors, unhealthy lifestyle behaviors Many risk factors are modifiable –Tobacco use, sedentary lifestyle, improper diet

3. Copyright © 2008 Delmar. All rights reserved. 3 Chronic Disease Healthy People 2010 objectives aimed at decreasing the occurrence of chronic disease

4. Copyright © 2008 Delmar. All rights reserved. 4 Chronic Disease Causes of morbidity and mortality have changed in most part due to: –Antibiotic therapy –Public health services Shift from acute to chronic disease –Steady increase in children and adults Obesity epidemic and aging population

5. Copyright © 2008 Delmar. All rights reserved. 5 Aging Population People are living longer and surviving chronic health problems due to the advancement in health care and medicine

6. Copyright © 2008 Delmar. All rights reserved. 6 Aging Population Health care resources will be faced with a major financial challenge –Larger elderly population will be supported by a much smaller workforce

7. Copyright © 2008 Delmar. All rights reserved. 7 Obesity Epidemic Body mass index of > 30 for adults At or above the 95 th percentile on sex and age specific BMI for children and adolescents

8. Copyright © 2008 Delmar. All rights reserved. 8 Obesity Epidemic BMI calculation formula

9. Copyright © 2008 Delmar. All rights reserved. 9 Obesity Epidemic in the following areas: –Rural –Low socioeconomic region –Minorities

10. Copyright © 2008 Delmar. All rights reserved. 10 Obesity Linked to the following chronic diseases –Hypertension Type II diabetes –Cardiovascular diseases –Osteoarthritis –Polycystic ovary disease –Sleep apnea –Some forms of cancer

11. Copyright © 2008 Delmar. All rights reserved. 11 Obesity Screening for prediabetes –Fasting glucose, glucose tolerance test Metabolic syndrome –Precursor for Type II diabetes and vascular injury Type II diabetes –Fasting glucose –Oral glucose tolerance test

12. Copyright © 2008 Delmar. All rights reserved. 12 Obesity Insulin resistance –Acanthosis nigricans School screens –Cutaneous acrochordons –Acne, android appearance –Hirsutism, menstrual dysfunction –Gestational diabetes

13. Copyright © 2008 Delmar. All rights reserved. 13 Diabetes Mellitus Fifth leading cause of death in the United States Major cause of the following: –Blindness –Amputations –End Stage Renal Disease (ESRD) –Coronary Heart Disease (CHD)

14. Copyright © 2008 Delmar. All rights reserved. 14 Cardiovascular System Cardiovascular disease includes: –Coronary heart disease Ischemic heart disease or acute coronary syndrome –Stroke –Heart failure

15. Copyright © 2008 Delmar. All rights reserved. 15 Cardiovascular System Modifiable risk factors –Tobacco use and passive exposure –Obesity –Elevated cholesterol –Hypertension –Physical inactivity –High fat dietary intake

16. Copyright © 2008 Delmar. All rights reserved. 16 Cardiovascular System Hypertension increases risk for –Congestive heart failure –ESRD, myocardial infarction –Stroke Extent of damage may be lessened by –Diet, salt restriction, medications –Weight loss, physical activity

17. Copyright © 2008 Delmar. All rights reserved. 17 Cardiovascular System Contextual risk factors are variables beyond control of the individual –Socioeconomic status Being a single parent Live in a medically underserved area Lack of consistent health care provider Low income, poor transportation system

18. Copyright © 2008 Delmar. All rights reserved. 18 Cardiovascular System Caregiver burden –Reduces the quality of life, additional role Predictors for development –Social isolation, poor coping –Limited family or social support –Poor knowledge of disease –Strain in relationship prior to illness

19. Copyright © 2008 Delmar. All rights reserved. 19 Cardiovascular System Nurse should assess for: –Support symptoms –Caregiver ability to problem solve –Knowledge of condition Interventions –Reduce social isolation Identify community resources

20. Copyright © 2008 Delmar. All rights reserved. 20 Cardiovascular System Disease trajectory –Downward illness trajectories Alzheimer’s Disease Multiple Sclerosis Public health considerations