CONCEPT OF ILLNESS

People may view illness and disease as the same entity, health professionals view them as completely separate.

Illness is a personal state in which the person feels unhealthy or ill. Illness may or may not be related to disease. Illness is a state in which a person’s physical, emotional, intellectual, social,

developmental or spiritual functioning is diminished or impairment compared with previous experience.

Although nurses must be familiar with different kinds of diseases and their treatments, they are concerned more with illness, which may include disease.

Disease is used to describe as an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span.

Etiology – causation of the disease. Etiologic description includes identification of all factors that act together to bring a disease condition.

Risk Factors of a Disease

1. Genetic and Physiological Factors Heredity, or genetic predisposition to specific illness, is a major physical risk factor.

2. Age increases or decreases susceptibility to certain illnesses (the risk of heart diseases

Age increases with age for both sexes) The risk of birth defects and complications of pregnancy increase in

women bearing children after age 35.

3. Environment The physical environment in which a person works or lives can increase

the likelihood that certain illnesses will occur. 4. Lifestyle

Many activities, habits and practices involve risk factors. Lifestyle practices and behaviors have positive or negative effects on health.

Stress can be a lifestyle risk factor if it is severe or prolonged, or if the person is unable to cope.

Stress can threaten mental health & physical well-being

Common Causes of Disease

1. Biologic Agents 2. Inherited Generic Defects 3. Physical Agents 4. Chemical Agents 5. Tissue response to irritation/injury (fever, inflammation) 6. Faulty chemical or metabolic process 7. Emotional or physical reaction to stress

Classification of Disease

According to Etiologic Factors

1. Hereditary. Due to defect in the genes of one or other parent which is transmitted to the offspring.

2. Congenital. Due to a defect in the development, hereditary factors, or prenatal infection; present at birth. (e.g. cleft lip, cleft palate)

3. Metabolic. Due to disturbances or abnormality in the intricate processes of metabolism.

4. Deficiency. Results from inadequate intake of absorption of essential dietary factors.

5. Traumatic. Due to injury. 6. Allergic. Due to abnormal response of the body to chemical or protein

substances or to physical stimuli. 7. Neoplastic. Due to abnormal or uncontrolled growth of cells. 8. Idiopathic. Cause is unknown; Self-originated; of spontaneous origin. 9. Degenerative. Results from the degenerative changes that occur in tissue and

organs. 10. Iatrogenic. Results from the treatment of a disease.

According to Duration or Onset

1. Acute Illness. Usually has a short duration and severe. The signs and symptoms appear abruptly, are intense and often subside after a

relatively short period. Following an acute illness a person may return to normal level of wellness

2. Chronic Illness. Slow onset. Persists, usually longer than 6 months and can also affect functioning in any dimension.

Chronically ill person have long term disease process The client fluctuate between maximal functioning and serious relapses

that may be life threatening.

Characterized by: Remission - Period during which the disease is controlled

symptoms are not obvious Exacerbation - The disease becomes more active again at a future

time, recurrence of pronounced symptoms.

Other classification of disease may be described as:

Organic – results from changes in the normal structure, from recognizable anatomical changes in an organ or tissue of the body

Functional – no anatomical changes are observed to account for the symptoms, present may result from abnormal response to stimuli.

Occupational – results from factors associated with the occupation engaged in by the patient (e.g. cancer among chemical factory workers.

Familial – occurs in several individuals of the same family (e.g. hypertension, cancer)

Venereal – Usually acquired through sexual relation (AIDS, gonorrhea) Epidemic. Attacks a large number of individuals in a community at the same time (SARS)

Endemic. Present more or less continuously or recurs in the community. Pandemic. Epidemic diseases which is extremely widespread involving an entire

country or continent. Sporadic. A disease in which only occasional cases occur.

Terminologies

Disease. Disturbance of structure or of function of the body or its constituent parts.

Lack of or inadequate adaptation of the organism to his environment. Failure of the adaptive mechanism to adequately counteract the stimuli or

stresses to which it is subject resulting in disturbances in function and structure of any part, organ or system of the body.

Morbidity. Condition of being diseased.

Morbidity Rate. The proportion of disease to health in a community.

Mortality. Condition or quality of being subject to death.

Epidemiology. Study of the patterns of health and disease, its occurrence and distribution in man, for the purpose of control and prevention of disease.

Susceptibility. The degree of resistance the potential host has against the pathogen.

Etiologic Agent. One that possesses the potential for producing injury or disease. (e.g. Streptococcus, Staphylococcus)

Virulence. Relative power or the degree of pathogenicity of the invading microorganism, the ability to produce poisons that repel or destroy phagocytes.

Symptomatology. Study of symptoms.

Symptom. Any disorder of appearance, sensation or function experienced by the patient indicative of a certain phase of a disease. Manifestation of perceptible changes in the body which indicate the presence of a disease or disorder.

Sign. An objective symptom or objective evidence or physical manifestation made apparent by special methods of examination or use of sense.

Syndrome. A set of symptom, the sum of which constituents a disease.

A group of symptoms which commonly occurs together A group of signs and symptoms which when considered together characterize a

disease.

Pathology. The branch of medicine which deals with the cause, nature, treatment and resultant structural and functional changes of disease.

Diagnosis. Art or act of determining the nature of a disease, recognition of a diseased state.

Complication. A condition that occurs during or after the course of an illness.

Prognosis. Prediction of the course and of a disease, medical opinion as to the outcome of a disease process. Good prognosis means that there is great possibility to recover from the disease and poor prognosis means that there is great risk for morbidity or mortality.

Recovery. Implies that the person has no observable or known after effects from his illness; there is apparent restoration to the pre-illness state.

Precursor of Illness

These are the factors which impose on the individuals to lead towards illness spectrum.

1 Heredity. e.g. family history for diabetes mellitus, hypertension, cancer.

2 Behavioral factors. e.g. cigarette smoking, alcohol abuse, high animal fat intake.

3. Environmental factors. e.g. overcrowding, poor sanitation, poor supply of potable water.

Stages of Illness

1. Symptom Experience Transition stage. The person experience believes something is wrong. Experience some symptoms. 3 aspects:

- physical (fever, muscles aches, malaise, headaches) - cognitive (perception of “having flu”) - emotional (worry on consequences of illness)

2. Assumption of Sick Role

Acceptance of the illness. Seeks advice, support for decision to give up some activities.

3. Medical Care Contact

Seeks advice to health professionals for the following reasons:

- validation of real illness - explanation of symptoms - reassurance or prediction of outcome

4. Dependent Patient Role The person becomes a client dependently on the health professional for

help. Accepts/rejects health professional’s suggestions. Becomes more passive and accepting. May regress to an earlier behavioral stage.

Four aspects of sick role:

1. Clients are not responsible for their condition 2. Clients are excused from certain social roles and tasks 3. Clients are obliged to try to get well as quickly as possible 4. Clients or their families are obliged to seek competent help

Three distinct criteria to determine if a person is ill

1. The presence of symptoms 2. The perception of how they feel 3. Their ability to carry out daily activities

Effects of Illness

Privacy Autonomy Financial burden Life-style Family and significant others

Factors that determine the extent of effect of illness:

The member of the family who is ill The seriousness and length of the illness Cultural and social customs the family follows

The changes that can occur in the family:

Role changes Tasks reassignments and increase demands on time Increase

stress due to anxiety about the outcome of the illness Financial problems Loneliness resulting from separation and pending loss Change in

social customs

Promoting Health and Wellness

Health Promotion – an activity undertaken for the purpose of achieving higher level of health and wellness.

Three Levels of Prevention

1. Primary Prevention: Wellness activities. To encourage optimal health and to increase the person’s resistance to illness. Seeks to prevent a disease or condition at a prepathologic state; to stop something from ever happening.

It precedes disease Applied generally for health individuals Health promotion 2. Secondary Prevention: It is also known as health maintenance (for individuals

experiencing health problem). Seeks to identify specific illnesses or conditions at an early stage with prompt intervention to prevent or limit disability.

Early diagnosis/detention/screening Prompt treatment to limit disability Prevention of complication

3. Tertiary Prevention: Begins after an illness. To support the client's achievement of successful adaptation to known risks, and or establishment of high-level wellness. It focus to rehabilitate individual s and restore them to an optimum level of functioning within the constraint of their disability.

Rehabilitation

Behaviors Associated with the Levels of Prevention

Primary Prevention

Quit smoking Avoid or limit alcohol intake Exercise regularly Eat well-balanced diet Reduce fat and increase fiber in diet Take adequate fluids Avoid over exposure to sunlight Maintain ideal body weight Wear hazard devices in work site Complete Immunization program

Secondary Prevention

Have annual physical examination. Regular Pap’s test for women. Monthly BSE for women who are 20 years – above. Sputum examination for Tuberculosis. Annual stool guaiac test and rectal examination for clients over age 50 years.

Tertiary Prevention

Self-monitoring of blood glucose among diabetics. Attending self-management education for diabetes. Physical therapy after CVA; participation in cardiac rehabilitation after MI Undergoing speech therapy after laryngectomy.

Types of Health Promotion Program

1. Information Dissemination Use of variety of media to offer information to the public about the particular

lifestyles choices and personal behavior, the benefits of changing that behavior and improving the quality of life.

2. Health Appraisal and Wellness Assessment Programs Appraise individuals of their own risk factors that are inherent in their lives in

order to motivate them to reduce specific risk and develop positive health habits. Wellness assessment programs are focused on more positive methods of

enhancement.

3. Lifestyle and Behavior Change Programs Basis for changing health behavior. Geared toward enhancing the quality of life and extending the life span.

4. Worksite Wellness Programs Include programs that serve the needs of persons in their workplace.

5. Environmental Control Programs Developed to address the growing problem of environment pollution-air, land,

water, etc.

Activities to Promote Health and Prevent Illness

1. Have regular (yearly) physical examination. Women: Regular Pap test; Monthly BSE (breast self-examination) Men: regular testicular self examination.

2. Annual dental examination and prophylaxis. 3. Regular eye exam (every 1-2 years) 4. Exercise regularly at least 3x per week for 30 minutes. 5. Do not smoke: avoid second hand smoke. 6. Avoid alcohol and “recreational drugs”.

7. Reduce fat and increase fiber in diet. 8. Sleep regularly 7-8 hours/night. 9. Eat breakfast. 10.Eat regularly meals with few snacks. 11.Maintain Ideal Body Weight.

Key Problem Areas Experienced By Patients With Chronic Illness

1. Prevention of medical crisis and and the management of problems once they occur

2. Control of symptoms3. Carrying out prescribed regimens and the management of problems attendant

with adhering to self-care4. Prevention of, or living with, social isolation that decreases contact with others5. Adjustment to changes in the course of the disease, whether it exacerbates or

enters remissions6. Normalizing both interactions with others and one’s lifestyles7. Funding (finding the necessary money to pay for treatments or to survive

despite partial or complete loss of employment8. Confronting attendant psychological, marital and family problems