Illness and Disease

 
Effects of Illness
 
Impact on Client
Nurses can help client adjust to their lifestyles by means:
 Providing explanation 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 view to make them a permanent
part of the client's lifestyle

Impact on Family
The kind of effect and its extent depend chiefly on 3 factors:
a. member of the family who is ill
b. seriousness and length of illness
c. cultural and social customs the family follows.
 
The changes that can occur in the family include the following:
 Role changes
 Task reassignments and increased demands on time
 Increased stress due to anxiety about the outcome of the illness for the client and
conflict about unaccustomed responsibilities
 Financial problems
 Loneliness as a result of separation and pending loss
 Change in social customs
 
Health Care Delivery System
 
Health Care System
 It is the totality of service offered by all health discipline
 Previously, major purpose of a health care system was to provide care to ill and
injured
 However, with increasing awareness of health promotion, illness prevention and
levels of wellness, health care system are changing as the roles of nurses in
these areas
 The services provided by a health care system are commonly categorized
according to type and level
 
Types of Health Care Services
1. Primary prevention – consists health promotion and illness prevention
(immunization)
2. Secondary prevention – consists of diagnosis and treatment (screening for
tuberculosis)
 3. Tertiary prevention – consists of rehabilitation, health restoration and palliative
care. (Rehabilitation services for clients who have/had cerebrovascular accident
stroke)
 

Primary Prevention: Health promotion and illness prevention

 Primary prevention programs address areas such as adequate and proper
nutrition, weight control and exercise and stress reduction
 Health promotion activities emphasize the important role client play in
maintaining their own health and encourage them to maintain the highest level of
wellness they can achieve
 Illness prevention programs may be directed at the client/community and involve
such practice as providing immunization, identifying risks factors for illness and
helping people make measure to prevent illness from occurring. It also includes
environmental programs that can reduce incidence of illness/disability.
 
Secondary Prevention: Diagnosis and Treatment
 Hospital and physicians' office have been major agencies offering complex
secondary prevention services. Hospital continue to focus significant resources
on pt requiring emergency, intensive and around the clock acute care.
 Freestanding diagnostic and treatment facilities
 Early detection of disease - accomplished through routine screening (regular
dental exams, bone density studies for women at menopause to evaluate for
early osteoporosis)
 Community-based agencies - clinics (mammograms, voluntary HIV testing and
counseling) malls and shopping centers (walk-in clinics, screening for cholesterol
and high blood pressure)
 
Tertiary Prevention: Rehabilitation, Health Restoration and Palliative care
 The goal is to help people move to their previous level of health (i.e., to their
previous capabilities) or highest level they are capable of given their current
health status
 Rehabilitative care – emphasizes the importance of assisting clients to function
adequately in physical, mental, social, economic and vocational areas of their
lives
  Rehabilitation may begin in hospital, but will eventually lead clients back to the
community for further treatment and follow up once health has been restored
 Palliative care - providing comfort and treatment for symptoms. End-of-life care
may be conducted in many settings including home
 

Types of Health Care Agencies and Services

 
Public Health
 Government (official) agencies are established at the local, state and federal
level to provide public health services
 Local health department have responsibility for developing programs to meet the
health needs of people, providing the necessary nursing and other staff and
facilities to carry out these programs, continually evaluating the effectiveness of
programs and monitoring changing needs.
 Its function includes:
A. the conducting research and providing training in the health field
B. providing assistance to communities in planning and developing health
facilities
C. assisting states and local communities though financing and provision of
training personnel.
 
Physician's Office
 A primary care setting. Majority of physician either have their own office or work
with several other physicians in a group practice
 Clients usually go for a routine health screening, illness diagnosis and treatment.
 Often, does not require expertise of registered nurses. Roles and responsibilities
of RNs includes:
1. Client registration
2. preparing client for examination
3. obtain health information
4. providing health information
 Others functions:
1. obtaining specimen
2. assisting with procedures
3. providing some treatment.
 
Ambulatory Care Centers
 Used frequently in many communities.
 Most have diagnostic and treatment facilities providing medicine, nursing,
laboratory and radiological services and they may or may not be associated with
an acute care hospital.
 Some provide services to people who require minor surgical procedures that can
be perform outside the hospital. After surgery, client returns home, often the
same day.
  These centers offer two advantages
1. They permit the client to love at home while obtaining necessary health
care
2. They free costly hospital beds for seriously ill clients
 The term ambulatory care center has replaced the term clinic in many places
 
Occupational Health Clinic
 It is gaining importance as setting for employee health care
 Employee health has long been recognized as important to productivity. Today,
more companies recognize the value of healthy employees and encourage
healthy lifestyles by providing exercise facilities and coordinating health
promotion activities.
 Worker safety has always been a concern of occupational nurses. Today,
nursing functions in industrial health care include work safety and health
education, annual employee health screening for tuberculosis and maintaining
immunization information
 Other functions:
A. screening for hypertension and obesity
B. caring for employees following injury and counseling.
 
Hospitals
 It can be classified according to their ownership/control as government (public) or
non-governmental (private)
 Also classified by services they provide. Ex: general hospitals admit client
requiring a variety of services such as medical, surgical, obstetric, pediatric and
psychiatric services. Other hospitals offer only specialty services, such as
pediatric or psychiatric care.
 Variety of health care services hospitals provide usually depends on their size
and location.

Subacute Care Facility

 A variation of inpatient care designed for someone who has an acute illness,
injury, or exacerbation of a disease process.
 This requires the coordinated services of an interdisciplinary team including
physicians, nurses, and other relevant professional disciplines.

Extended Care (Long-term care) Facilities

 Formerly called nursing homes, now often multilevel campuses that include
independent living quarters for seniors, assisted living facilities, skilled nursing
facilities (intermediate care) and extended care (long term care) that provide
levels of personal care for those who are chronically ill or unable to care for
themselves without assistance.
 Intended for people who require not only personal services (bathing, hygiene,
eating) but also some regular nursing care and occasional medical attention
 Nurses assist clients with their daily activities, provide care when necessary and
coordinate rehabilitation activities.
 Retirement and Assisted Living Centers
 Consist of separate houses, condo/apartment for residents.
 Residents live relatively independently; however, many of these facilities offer
meal, laundry services, nursing care, transportation and social activities.
 Nurses in retirement and assisted living centers provide limited care to residents
usually related to the administration of medication and minor treatment but
conduct significant health promotion activities.
 
Rehabilitation Center
 These are independent community centers/special units. However, because
rehab ideally starts the moment the client enters the health care system, nurses
who are employed on pediatric, psychiatric or surgical units of hospitals also help
to rehabilitate clients
 Plays important role in assisting clients to restore their health and recuperate
 Nurses coordinate client activities and ensure that clients are complying with their
treatment. This type of nursing often requires specialized skills and knowledge.
 
Home Health Care Agencies
 Nurses and other staff offer education to clients and families and also provide
comprehensive care to acute, chronic and terminally ill clients
 
Day-Care Centers
 These serve many functions and many age groups. Some provide care for
infants and children while parents work. Other centers provide care and nutrition
for adults who cannot be left at home alone but do not need to be in the
institution. Some centers provide counseling and therapy
 Nurses may provide medication, treatment and counseling, thereby facilitating
continuity between day care and home care
 
Rural Care
 Created as result of 1987 Omnibus Budget Reconciliation Act to provide
emergency care to rural areas
 Nurses in this setting must be generalists — able to manage a wide variety of
clients and health care problems

Hospice Services
 An inter-professional health care service for dying, provided in the home or
another health setting
 Central concept is not saving a life but improving/maintaining quality of life until
death
 Nurses perform ongoing assessments of needs of the client and family and helps
to find appropriate resources and additional services for them as needed
Crisis Centers
 Provide emergency services to clients experiencing life crises.
 These may operate out of a hospital or in the community and most provide 24-
hour telephone service.
 Nurses need well-developed communication and counseling skills.

Mutual Support and Self-Help Groups

 These groups may be for the client or for the friends and family of the client, who
also need education, guidance, and support.
 Such groups arose largely because people felt their needs were not being met by
the existing healthcare system (e.g., Alcoholics Anonymous)