STUDY GUIDE | DR.
SVCN
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CHRONIC ILLNESS
● A chronic or long-term illness means having to
adjust to the demands of the illness and the therapy
used to treat the condition.
● There may be additional stresses, since chronic
illness might change the way you live, see yourself,
and relate to others.
Characteristics of a Chronic Illness
● Complex causes
● Many risk factors
● Long latency periods (time between onset of the
illness and feeling its effects)
● A long illness
● Functional impairment or disability
● Most chronic illnesses do not fix themselves and are
generally not cured completely.
● Some can be immediately life-threatening, such as
heart disease and stroke.
● Others linger over time and need intensive
management, such as diabetes. Most chronic
illnesses persist throughout a person’s life, but are
not always the cause of death, such as arthritis.
Common Stresses of Long-Term Illness
● Chronic or long-term illness and its treatment pose
special problems. You need to learn how to:
⮚ Live with the physical effects of the illness
⮚ Deal with the treatments
⮚ Make sure there is clear communication
with doctors
⮚ Maintain emotional balance to cope with
negative feelings
⮚ Maintain confidence and a positive
self-image
Additional Demands of Chronic Illness
● As well as needing to find ways to deal with stress
involves with chronic illness, you also need to:
⮚ Understand the condition
⮚ Know about the treatment and therapy
⮚ Maintain trust and confidence in the doctors,
especially when recovery isn’t possible
⮚ Know how to control the symptoms
⮚ Maintain social relationships and a strong
support network when faced with an
uncertain medical future or when symptoms
arise.
⮚ Avoid social isolation
Ways to Cope with Chronic Illness
● Finding information – this can help if you feel
helpless or out of control.
● Emotional support from others – particularly family
and friends, this can be a source of great help.
● Joining a well facilitated group.
● Setting concrete, short-term goals – to restore
certainty, power, and control.
● Thinking about possible outcomes – discussing
them with your doctor can help you to face them
before they become a reality.
● The overall aim of these strategies is to help put
your illness into context and give some meaning to
what is happening.
REVIEW OF THE PATHOPHYSIOLOGY OF COMMON
CHRONIC CONDITIONS
HEART FAILURE
● Heart failure (HF), sometimes referred to as
congestive HF, is the inability of the heart to pump
sufficient blood to meet the needs of the tissues for
oxygen and nutrients.
● HF is a clinical syndrome characterized by signs and
symptoms of fluid overload or inadequate tissue
perfusion. The underlying mechanism of HF involves
impaired contractile properties of the heart (systolic
dysfunction) or filling of the heart (diastolic) that
leads to a lower-than-normal cardiac output.
● The low cardiac output can lead to compensatory
mechanisms that cause increased workload on the
heart and eventual resistance to filling of the heart.
● HF is a progressive, life-long condition that is
managed with lifestyle changes and medications to
prevent episodes of acute decompensated HF, which
are characterized by an increase in symptoms,
decreased CO, and low perfusion.
● HF results from a variety of cardiovascular
conditions, including chronic hypertension, coronary
artery disease, and valvular disease.
● These conditions can result in systolic failure,
diastolic failure, or both. Several systemic conditions
(eg, progressive renal failure and uncontrolled
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hypertension) can con- tribute to the development parenchymal disease, hyperaldosteronism
and severity of cardiac failure. (mineralocorticoid hypertension), certain
medications, pregnancy, and coarctation of the
HYPERTENSION aorta.
● Hypertension can also be acute, a sign of an
● Hypertension is defined as a systolic blood pressure
underlying condition that causes a change in
greater than 140 mm Hg and a diastolic pressure
peripheral resistance or cardiac output.
greater than 90 mm Hg, based on two or more
measurements. Hypertension can be classified as CHRONIC OBSTRUCTIVE PULMONARY DISEASE
follows:
● COPD is a disease characterized by airflow limitation
⮚ Normal: systolic less than 120 mm Hg;
diastolic less than 80 mm Hg that is not fully reversible.
● The airflow limitation is usually progressive and
⮚ Prehypertension: systolic 120 to 139 mm
associated with an abnormal inflammatory response
Hg; diastolic 80 to 89 mm Hg
⮚ Stage 1: systolic 140 to 159 mm Hg; of the lung to noxious particles or gases, resulting in
narrowing of airways, hypersecretion of mucus, and
diastolic 90 to 99 mm Hg
changes in the pulmonary vasculature.
⮚ Stage 2: systolic 160 mm Hg; diastolic 100
mm Hg ● Other diseases such as cystic fibrosis,
bronchiectasis, and asthma that were previously
● Hypertension is a major risk factor for
classified as types of COPD are now classified as
atherosclerotic cardiovascular disease, HF, stroke,
and kidney failure. chronic pulmonary disorders, although symptoms
may overlap with those of COPD.
● Hypertension carries the risk for premature
● Cigarette smoking, air pollution, and occupational
morbidity or mortality, which increases as systolic
and diastolic pressures rise. Prolonged blood exposure (coal, cotton, grain) are important risk
factors that contribute to COPD development, which
pressure elevation damages blood vessels in target
may occur over a 20- to 30- year span.
organs (heart, kidneys, brain, and eyes).
● Complications of COPD vary but include respiratory
Essential Hypertension (Primary) insufficiency and failure (major complications) as
well as pneumonia, atelectasis, and pneumothorax.
● In the adult population with hypertension, between
90% and 95% have essential (primary) hypertension, DIABETES
which has no identifiable medical cause; it appears
● Diabetes mellitus is a group of metabolic disorders
to be a multifactorial, polygenic condition.
characterized by elevated levels of blood glucose
● For high blood pressure to occur, an increase in
(hyperglycemia) resulting from defects in insulin
peripheral resistance and/or cardiac output must
secretion, insulin action, or both.
occur secondary to increased sympathetic
● Three major acute complications of diabetes related
stimulation, increased renal sodium reabsorption,
to short-term imbalances in blood glucose levels are
increased renin–angiotensin–aldosterone system
hypoglycemia, diabetic ketoacidosis (DKA), and
activity, decreased vasodilation of the arterioles, or
hyperglycemic hyperosmolar nonketotic syndrome
resistance to insulin action.
(HHNS).
● Hypertensive emergencies and urgencies may occur
● Long-term hyperglycemia may contribute to chronic
in patients whose hypertension has been poorly
microvascular complications (kidney and eye
controlled, whose hypertension has been
disease) and neuropathic complications. Diabetes is
undiagnosed, or in those who have abruptly
also associated with an increased occurrence of
discontinued their medication.
macrovascular diseases, including coronary artery
Secondary Hypertension disease (myocardial infarction), cerebrovascular
disease (stroke), and peripheral vascular disease.
● Secondary hypertension is characterized by
elevations in blood pressure with a specific cause,
such as narrowing of the renal arteries, renal
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Diabetes Type I
● About 5% to 10% of patients with diabetes have type
1 diabetes. It is characterized by destruction of the
pancreatic beta-cells due to genetic, immunologic,
and possibly environmental (eg, viral) factors.
● Insulin injections are needed to control the blood
glucose levels.
● Type 1 diabetes has a sudden onset, usually before
the age of 30 years.
Diabetes Type II
● About 90% to 95% of patients with diabetes have
type 2 diabetes. It results from a decreased
sensitivity to insulin (insulin resistance) or from a
decreased amount of insulin production.
● Type 2 diabetes is first treated with diet and
exercise, and then with oral hypoglycemic agents as
needed.
● Type 2 diabetes occurs most frequently in patients
older than 30 years and in patients with obesity.
Gestational Diabetes Mellitus
● Gestational diabetes is characterized by any degree
of glucose intolerance with onset during pregnancy
(second or third trimester).
● Risks for gestational diabetes include marked
obesity, a personal history of gestational diabetes,
glycosuria, or a strong family history of diabetes.
● High-risk ethnic groups include Hispanic Americans,
Native Americans, Asian Americans, African
Americans, and Pacific Islanders. It increases their
risk for hypertensive disorders of pregnancy.
CANCER
● Cancer is a disease process that begins when an
abnormal cell is transformed by the genetic
mutation of the cellular DNA.
● The abnormal cell forms a clone and begins to
proliferate abnormally, ignoring growth-regulating
signals in the environment surrounding the cell.
● The cells acquire invasive characteristics, and
changes occur in surrounding tissues. The cells
infiltrate these tissues and gain access to lymph and
blood vessels, which carry the cells to other areas of
the body.
● This phenomenon is called metastasis (cancer
spread to other parts of the body).
● Cancerous cells are described as malignant
neoplasms and are classified and named by tissue
of origin. The failure of the immune system to
promptly destroy abnormal cells permits these cells
to grow too large to be managed by normal immune
mechanisms. Certain categories of agents or factors
implicated in carcinogenesis (malignant
transformation) include viruses and bacteria,
physical agents, chemical agents, genetic or familial
factors, dietary factors, and hormonal agents.
● Cancer is the second leading cause of death in the
United States, with most cancers occurring in men
and in people older than 65 years. Cancer also has a
higher incidence in industrialized sectors and
nations.
ALZHEIMER’S DISEASE
● Alzheimer’s disease (AD) is a progressive,
irreversible, degenerative neurologic disease that
begins insidiously and is characterized by gradual
losses of cognitive function and disturbances in
behavior and affect. It is important to note that AD is
not a normal part of aging.
● Although the greatest risk factor for AD is increasing
age, many environmental, dietary, and inflammatory
factors also may determine whether a person
suffers from this cognitive disease. AD is a complex
brain disorder caused by a combination of various
factors that may include genetics, neurotransmitter
changes, vascular abnormalities, stress hormones,
circadian changes, head trauma, and the presence of
seizure disorders.
● AD can be classified into two types: familial or
early-onset AD (which is rare, and accounts for less
than 10% of cases) and sporadic or late-onset AD.
STROKE (CEREBROVASCULAR ACCIDENT)
● A cerebrovascular accident (CVA), an ischemic
stroke or “brain attack,” is a sudden loss of brain
function resulting from a disruption of the blood
supply to a part of the brain.
● Stroke is the primary cerebrovascular disorder in the
United States.
● Strokes are usually hemorrhagic (15%) or
ischemic/nonhemorrhagic (85%). Ischemic strokes
are categorized according to their cause: large artery
thrombotic strokes (20%), small penetrating artery
thrombotic strokes (25%), cardiogenic embolic
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strokes (20%), cryptogenic strokes (30%), and other
(5%).
● Cryptogenic strokes have no known cause, and other
strokes result from causes such as illicit drug use,
coagulopathies, migraine, and spontaneous dis-
section of the carotid or vertebral arteries.
● The result is an interruption in the blood supply to
the brain, causing temporary or permanent loss of
movement, thought, memory, speech, or sensation.

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