Chronic Health Test 1

• Social worker

• psychologist

• clergy member

• Acute pain nurse

• palliative care physician

• Physiotherapist

• Occupational therapist

• Recreational therapist

Injury recovery \ long term body stress

Full body movement, ADLs

Promote hobbies and leisure, social engagement

• dietician

• Speech language pathologist

Audiologist

Respiratory therapist

Pharmacist

Develops suddenly and lasts a short time.

Develops slowly and requires long term treatment.

• Non-modifiable risk factors

• Behavioural risk factors

• Cultural and environmental conditions

• high blood pressure (hypertension)

• elevated blood lipids (hyperlipidemia)

• obesity

• pre-diabetes

Rate of deaths

Rate of disease in a population

The human experience of symptoms and suffering

The diverse ways individuals respond to symptoms

• Health conditions that persist over extended periods of time.

• Complex to manage for patients and families.

• Often require a coordinated plan of care from many health care team members.

• Hypertension

• Osteoarthritis

• Mood disorders

• Osteoporosis

• Diabetes

• Asthma

• COPD

• Ishemic heart disease

• Cancer

• Dementia

• At risk

• Problem focused

• Health promotion

the process of supplying oxygen to the body’s cells

Gas exchange takes place in the alveolis in the lungs

inhaled oxygen moves from the alveoli to the blood in the capillaries, and carbon dioxide moves from the blood in the capillaries to the air in the alveoli

If gas exchange is impaired, you cannot effectively get enough oxygen, or rid your body of carbon dioxide.

• Dyspnea (shortness of breath)

• Coughing

• High heart rate

• Increased respirations

• Accessory muscle use

• Restlessness

• Lethargy

• Cyanosis

• Diaphoresis (sweating)

• Confusion

• Clear airways.

• Effective lung expansion + contraction.

• Clear bronchi + bronchioles (for oxygen to reach alveoli).

• Healthy alveoli (for gas exchange to occur).

• Effective heart pump.

• Adequate amount of hemoglobin.

Asthma

Spasm of the bronchi due to inflamed and narrowed airways (inflammatory reaction to triggers)

• Allergens

• Exercise

• Drugs

• Food additives

• Air pollutants

• Emotional stress

1. Airway inflammation

2. Increased mucus production

3. Contraction of smooth muscles (bronchospasm)

• Wheezing

• Breathlessness

• Chest tightness

• Coughing

• Increased HR, RR, and decreased SPO2

Low oxygen in tissues

Low oxygen in blood

Flare up

• Position of comfort

• Frequent assessment of respiratory status

• Medications (rescue, possibly oral / iv corticosteroid)

• Supplemental oxygen

• Bronchodilator (rescue / reliever)

  • Short acting Beta-2 Adrenergic Agonists. eg. Salbutamol

• Corticosteroid (maintenence)

  • eg. Fluticasone, Prednisone

• Normal activity level

• Proper nutrition

• Demonstrates education

• Can manage triggers

• Normal vitals

• Clear lung sounds

Exhalation

• Chronic bronchitis

• Chronic emphysema

Long-term bronchial inflammation with overproduction + hypersecretion of mucous

Damage to the air sacs in the lung.

Destruction of the alveolar wall, respiratory bronchioles, alveolar ducts, and alveolar sacs. This causes permanent dilatation, decreasing the surface area of the ventilatory units.

• Long term exposure to lung irritants

• Genetics

• Asthma: maintain lung function between flares.

• COPD: progressive deterioration, decrease in lung function over time.

• Comprehensive health history (including exposure to risk factors)

• Confirmed by spirometery

Early signs:

• Intermittent productive cough.

• Dyspnea (SOB) on exertion.

Symptoms when disease has progressed:

• Barrel chest.

• Ribs fixed in inspiratory position.

• Weight loss, anorexia.

• Fatigue.

• Prolonged expiratory phase.

• Wheezes, decreased lung sounds.

• Tripod position.

• Cyanosis.

• Fingernail clubbing.

• Chronic disease

• Surgery

• Hospitalization

• Impaired mobility

• Older age

• WBC count

• Hemoglobin

• SpO2

• ABG (arterial blood gasses)

• Sputum culture

• Alpha-1 antitryspin (genetic marker for COPD)

• Chest x-ray (hyperinflation)

• Peak flow

• Spirometry (how much oxygen lungs can hold)

• CT scan (more detailed than x-ray)

Abnormal enlargement of right side of heart due to lung disease

• Reposition

• Auscultate lungs

• Vitals

• Supplemental oxygen

• Medications

• Push fluids

Rescue medications taken at onset of exacerbation:

• Bronchodilator: eg. Salbutamol

• Corticosteroid: eg. Prednisone

• Supplemental oxygen

Salbutamol / Ventolin / Albuterol

^ all same medication, just different brand names

• Prednisone

• Fluticasone

Maintenance: take once or twice everyday.

• Short acting Beta-2 Agonist (Salbutamol) OR short acting Muscanaric Antagonist.

  • Combo: Combivent

• Long acting Beta-2 Agonist OR long acting Muscanaric Antagonist

  • Combo: Ellipta

• Short acting Beta-2 Agonist

• Bronchodilator

• Decreases inflammation, relaxes lung muscles

• Corticosteroid

• Decreases inflammation in airways

• Stops normal muscle action by blocking acetylcholine receptors (inhibits broncoconstriction)

• Increases airflow

A combination of a short acting Beta-2 Agonist and a short acting Muscanaric Antagonist

A combination of a long acting Beta-2 Agonist and a long acting Muscanaric Antagonist

Serevent

Tiotropium / Spiriva

Bronchodilators are always taken first

• Help quitting smoking

• Physical activity

• Nutrition (4-6 small meals a day allows your diaphragm to move more easily and for you to breathe better)

• How to use a peak flow meter

• Lung exercises

• Maintenance medications + how to take meds

• Supplemental oxygen as disease progresses

• Returns to baseline respiratory status.

• Demonstrates effective respirations.

• “Normal” breath sounds for the person.

• Demonstrates effective coughing.

• Reports decreased dyspnea (SOB
  ).

• Maintains clear airway

• Maintains “normal” SpO2 for the person.

• Reports improved mental status and sleep.

• Improved nutritional intake.

• Comfortable position (tripod).

• Inhale through mouth.

• Pursed-lips on exhalation.

• Belly breathing.

• Can damage organs, brain + heart damage.

• Cognitive impairment.

• Low immunity.

• Muscle strength.

• Energy.

• Skeletal stability.

• Joint function.

• Neuromuscular synchronization.

Musculoskeletal:

• Pain

• Falls

• Muscle atrophy

• Contractures

• Fatigue

• UTI

• Constipation

• Malnutrition

• Delirium

• Anxiety

• Depression

• Aspiration

• Hypoxia

• Pneumonia

• Skin breakdown

• Deep vein thrombosis

• Disorder of the synovial joints.

• Cartilage that cushions the ends of bones in your joints gradually deteriorates

• Systemic autoimmune & inflammatory disease.

• Occurs when your immune system mistakenly attacks your own body's tissues (not just joints).

• Affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Arthritis is more common in women

• History / physical

• X-ray

• CT scan

• MRI

• Bone scan

• History / physical

• X-ray

• Serology (antibodies in blood)

• CBC (Complete Blood Count)

• CRP (C Reactive protein)

• ESR (Erythrocyte Sedimentation Rate)

• RF (Rheumatic factor)

• Analysis of synovial fluid

• Older age

• Sex (women more common)

• Obesity

• Joint injuries

• Repeated stress on joint

• Genetics

• Bone deformities

• Metabolic disease (ex. diabetes)

• Age

• Sex (common in women)

• Genetics

• Smoking

• Having children

• Obesity

• Early life exposures (ex. formula fed)

• Pain management

• Decrease inflammation

• Prevent disability

• Maintain joint function

• Early treatment

• Promote / maintain joint function

• Effective pain management

• Stop / slow progression

• Education

• Salicylates

• Analgesic

• NSAIDS

• Topical analgesics

• Analgesic (painkiller) and anti-inflammatory.

  • ex. Aspirin

• Analgesic (painkiller) and antipyretic (reduce fever).

  • ex. Acetaminophen

• Analgesic (painkiller) and anti-inflammatory

  • ex. Ibuprofen

• Analgesic (painkiller) and anti-inflammatory that is applied to the skin.

  • ex. Voltaren Emulgel

given early in the diagnosis phase to manage lower rated pain

given during a flare up but should be short term

DMARDs are prescribed early in diagnosis phase but take 3-6 weeks to work, so NSAIDs and Corticosteroids will be given until the DMARDs take effect.

• Anorexia

• Fatigue

• Weight loss

• Generalized stiffness

Deformity and disability

• Salicylates

• NSAIDS

• Topical analgesics

• Corticosteriods

• DMARDS (Disease-Modifying Antirheumatic Drug)

• Antimetabolites (decreasing the activity of your immune system)

  • ex. Methodextrate

• Analgesic (painkiller) and anti-inflammatory

  • ex. Hydrocortisone, Prednisone, Methylprednisolone

Osteoarthritis:

• A condition of mechanical “wear and tear” on joints.

• Affects joints asymmetrically.

• Age of onset: > 40.

Rheumatoid arthritis:

• Systematic autoimmune disease with exacerbations, body attacks joints.

• Affects joints symmetrically.

• Age of onset: young - middle age.

• Use firm mattresses and seats.

• Alternate between periods of rest and activity.

• Protect joints from stress.