Welcome to

BSN311
BSN311: Adult Medical
Surgical Nursing II
Theory
First Semester 2021/2022
Week 1

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 LEARNING OUTCOMES:
 On completion of this lecture, the student will be able to:

 Define “chronic conditions.”

 Identify the major causes of chronic conditions.
 Describe characteristics of chronic conditions and
implications for people with chronic conditions and for
their families.
 Explain the phases of chronic illnesses using the
trajectory model.
 Identify types of care provided for patient with chronic
conditions.
 Describe application of nursing process using phases of 2

chronic illnesses.
Definition of Chronic Conditions*
 Chronic conditions are often defined as medical
conditions or health problems with associated
symptoms or disabilities that require long-term
management (3 months or longer).

 Illnesses or diseases that have a prolonged

course

 Conditions that are not resolve spontaneously

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 Complete cures are unlikely or rare.
 Acute Vs Chronic
 Chronicdiseases are diseases of long duration and
generally slow progression (Incurable).

 Increased costs due to longevity of illness, cost to

significant others & use of resources over a long
period.

 Acuteillnesses are defined as those with an abrupt

onset and those that usually run a short
course(Curable).
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Prevalence of Chronic Conditions in USA
 In 2000, an estimated 125 million people in the United States had
one or more chronic conditions, and 61 million people (21% of
the population) had multiple chronic conditions.

 By the year 2050, about 167 million people (about 50% of the
population) will have a chronic illness
 81 million (24%) will have two or more chronic health conditions
(Anderson & Horvath, 2004)

 Chronic disease is associated with 78% of health care costs in

the United States
(Anderson & Horvath, 2004).
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Public health highlights
Deparment of Health-Abu Dhabi-2016

 Population. 18.2% of residents are Nationals, of whom 67.3% are under 30.
Expatriates are predominantly aged between 20 and 40.
• A significant share are employed in construction and accommodated in labour
camps.
• The introduction of mandatory health insurance in 2006 provided all
residents in Abu Dhabi access to high quality care.

 Death. Mortality rates have also declined steadily, over the past years. In
2016, the diseases of circulatory system caused the highest number of deaths
in the Abu Dhabi Emirate. Injuries and neoplasms are the second and third
highest causes of death

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Public health highlights
Deparment of Health-Abu Dhabi-2016
 Non-communicable diseases. The Emirate has high rates of chronic diseases
related to lifestyle, such as obesity, diabetes, and cardiovascular diseases.
Without major changes, these rates are set to increase further as the young
population ages.
 Cardiovascular diseases (CVD) accounted for:
 37.1% of all death cases in 2016.
 A screening programme for cardiovascular risk factors for all adult Nationals was
initiated in 2008 as part of enrollment in Thiqa insurance.
 Individuals thought to be at high risk are being followed up.
 Education and awareness campaigns on risk factors; smoking, physical inactivity,
unhealthy nutrition as well as screening are conducted yearly to control CVD.

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Public health highlights
Deparment of Health-Abu Dhabi-2016
 Cancer caused 12.8% of all deaths in the Emirate in 2016.
 Breast (12.1%)
 Bronchus and lung (9.7%)
 and Pancreas (9.5%) cancers cause most of cancer deaths in Abu Dhabi.
 Regular screening exams can result in the detection and removal of precancerous growths, as well
as cancers at an earlier stage, when they are most treatable.
 Available screening exams are:
 mammogram for women 40+
 pap test for women 25-65 years .
 Colonoscopy or fecal blood exam for men & women 40-75 years.
Education and awareness campaigns have increased screening rates for all nationalities. The Abu
Dhabi Central Cancer Registry was established in 2012 to monitor the trends in cancer incidence rates
and effectiveness of the cancer screening programs
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Public health highlights
Deparment of Health-Abu Dhabi-2016
 Communicable diseases. Rates of childhood communicable diseases are very
low , due to immunization programs targeting children aged less than 5 years
old
 Expatriates are screened for communicable diseases before acquiring
residence status
 Respiratory infections are the first most common non-life threatening
condition in the Emirate after “signs, symptoms and ill-defined conditions”,
accounting for 17.2% of Episodes across all healthcare facilities.
 Respiratory infections mostly impact workforce productivity and quality of
life.

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Cancer incidence and prevalence-2015

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Causes of Chronic Conditions*
 A decrease in mortality from infectious diseases(eg., AIDS) and
from acute conditions (eg, myocardial infarction, trauma).

 Lifestyle factors, such as smoking, chronic stress, and

sedentary lifestyle, increase the risk of chronic health
problems.

 Longer lifespans.

 Improved screening and diagnostic procedures, enabling early

detection and treatment of diseases.
(Oeffinger, Mertens, Sklar 2006).
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Characteristics of Chronic Conditions
 Managing chronic illness involves more than treating medical
problems.

 Chronic conditions involve many different phases over the

course of a person’s lifetime.

 Keeping chronic conditions under control requires persistent

adherence to therapeutic regimens.

 One chronic disease can lead to the development of other

chronic conditions.

 Chronic illness affects the entire family. 14

Characteristics of Chronic Conditions cont.…
The day-to-day management of illness is largely the
responsibility of people with chronic disorders and their families.

The management of chronic conditions is a process of discovery.

Managing chronic conditions must be a collaborative process.

The management of chronic conditions is expensive.

Chronic conditions raise difficult ethical issues for patients, families,

health care professionals, and society.

Living with chronic illness means living with uncertainty.

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Implications of Managing Chronic Conditions

Preventing
 chronic conditions, by preventing the
unhealthy lifestyles or behaviors such as smoking and
overeating.

When
 the chronic conditions occur, The focus shifts to
managing the symptoms, avoiding complications (and avoiding
the development of other acute illnesses.

Health-promoting
 behaviors, such as exercise, are essential to
improve the quality of life even in people who have chronic
illnesses and disabilities, because they help to maintain
Functional status (USDHHS, 2005a; Stuifbergen, Seraphine,
Harrison, et al., 2005).
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 Phases of Chronic Conditions
 Pre-trajectory : Genetic factors or lifestyle behaviors
that place a person or community at risk for a chronic
condition.

 Trajectory onset: Appearance or onset of noticeable

symptoms associated with a chronic disorder; includes
period of diagnostic workup and announcement of
diagnosis.

 Stable: Illness course and symptoms are under control as

symptoms. 17
Phases of Chronic Conditions cont…
Unstable: Characterized by an exacerbation of illness

symptoms, development of complications, or
reactivation of an illness in remission.

Acute: Severe and unrelieved symptoms or the


development of illness complications necessitating
hospitalization, bed rest, or interruption of the person’s
usual activities to bring illness course under control.

Crisis: Critical or life-threatening situation requiring


emergency treatment or care and suspension of
everyday life activities until the crisis has passed.
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Phases of Chronic Conditions cont…
 Comeback: Gradual recovery after an acute period ,
learning to live with or to overcome disabilities, and return to
an acceptable way of life.

 Downward: Illness course characterized by rapid or

gradual worsening of a condition; physical decline
accompanied by increasing disability or difficulty in
controlling symptoms.

 Dying: Final days or weeks before death.

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 Keep in Mind that:
 Not
all phases occur in all patients; some phases do not
occur at all, and some phases may recur.

 Eachphase is characterized by different medical and

psychosocial issues.

 Notevery chronic condition is necessarily life-

threatening, and not every patient passes through each
possible phase of a chronic condition in the same order.
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Nursing Care of Patient with chronic
Conditions
 Direct care:
 Provided in the clinic or physician’s office, a nurse-
managed center or clinic, the hospital, or the patient’s
home, depending on the status of the illness.

 Examples:
 Assessing the patient’s physical status,
 Providing wound care,
 Managing and overseeing medication regimens.
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 Nursing Care of Patient with chronic
Conditions
 Telehealth care:

 (Use of the telephone in health care) to:

 Monitor patients with chronic illnesses,
 Deliver selected nursing interventions (eg, counseling),
 And provide ongoing education and support (Coyle, Duffy &
Martin, 2007).

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 Nursing Care of Patient with chronic
Conditions
 Supportive care:

 Include ongoing monitoring, teaching, and counseling.

 Serving as an advocate for the patient.
 Making referrals,
 And managing the case.

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Applying the Nursing Process Using the
Phases of the Chronic Illness System

 The focus of care for patients with chronic conditions

is determined largely by the phase of the illness and is
directed by the nursing process, which includes
assessment, diagnosis, planning, implementation, and
evaluation.

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 Applying the Nursing Process Using the
Phases of the Chronic Illness System

 Step 1: Identifying Specific Problems and the Trajectory Phase

 Step 2: Establishing and Prioritizing Goals

 Step 3: Defining the Plan of Action to Achieve Desired Outcomes

 Step 4: Implementing the Plan and Interventions

 Step 5: Following Up and Evaluating Outcomes

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The Crescent of Care Nursing Model :A
nursing model to guide the care of Arab
Muslim patients

 A model illustrates the values that have an impact on the

care of Arab Muslim patients and the components of caring
action.

 The model provides a holistic approach to caring for Arab

Muslim patients in meeting spiritual, cultural, psychosocial,
interpersonal and clinical care needs as derived from
spiritual, cultural and professional nursing values.

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The Crescent of Care Nursing Model :A nursing
model to guide the care of Arab Muslim patients

 The Crescent of Care model guide the care of Muslim

patients, whether in Arab cultures, Islamic societies or
immigrant Arab Muslim populations.

 As a culturally specific model for Arab Muslim populations,

the model also guide nursing education curricula in the
Gulf States and improve the image of nursing in the Arab
world.

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The Component of the Model
 Centre : the patient and family as the focus of care, reflecting the
cultural importance of family as the primary social unit in Arab culture.

 Inner circle: are the components of professional nursing care,

including the Spiritual care, psychosocial care, Cultural care,
Interpersonal care , and Clinical care.

 Crescent: a symbol of Islam, surrounds the components of care and

symbolises the inseparability of nurses’ caring and Islam.

 Outer circle: identifies the values that have an impact on care,

including the Spiritual values, Cultural values , and Professional values. 29
 REFERENCES:
Potterand Perry (2010). Clinical Nursing Skills and
Techniques. Mosby (7 th ed.)

 Potter and Perry (2008). Fundamental’s of Nursing (7 th ed.)

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., Cheever, K.H. (2010).

Brunner & Suddarth’s textbook of medical-surgical nursing
(12th ed.). Philadelphia: Lippincott Williams & Wilkins.

https://www.haad.ae/HAAD/LinkClick.aspx?
fileticket=gCldzf5KGsQ%3d&tabid=1516 30