Chapter 17
Providing Care for People with Specific Illnesses

Key Terms

Providing Care for People with Acute and Chronic Illnesses

Acute conditions occur suddenly and last a short time (e.g., cold, appendicitis). Chronic conditions develop slowly and last a long time (e.g., heart disease, diabetes, arthritis). Chronic illnesses may have acute flare‑ups requiring treatment before returning to baseline. Chronic conditions affect daily living and emotional health; your care focuses on helping the person live the fullest life possible and supporting family/caregivers.

Chronic Conditions of the Skeletal System

Arthritis — Characteristics & Plan of Care

Inflamed, swollen, stiff, painful joints; roughened cartilage causes friction. Stiffness makes movement difficult; even simple tasks hurt.

• Acknowledge pain; ask what eases movement.
• Time morning care after pain medication; warm tub baths (check temp).
• Warm clothing over affected joints; gentle ROM to prevent contractures (never move painful/red/swollen joints); support above/below joint when moving.
• Encourage exercise of affected joints and joint‑protection techniques (drawer loops, push doors with side of arm, use palms to lift, use carts).

Osteoporosis — Characteristics & Plan of Care

Gradual bone mineral loss (esp. calcium); common in older women; fractures, height loss, rounded upper back, stooped posture; pain, fatigue, fear of falling.

• Safety first: gentle exercise as tolerated; use safety belt if ordered; clear paths, proper chair height, install grab bars.
• Choose clothing that de‑emphasizes posture changes.

Chronic Conditions of the Cardiovascular System

Angina Pectoris — Characteristics & Plan of Care

Chest pain from inadequate oxygen to heart; triggered by activity/stress; relieved by nitroglycerin (tablet under tongue or skin patch).

• Provide relaxed, unhurried care.
• Coach slow breathing during pain; stop activity at any chest discomfort.
• Encourage smoking cessation.

Congestive Heart Failure — Characteristics & Plan of Care

Weak pumping → fluid buildup, dyspnea, weight gain, edema; anxiety/restlessness; fluctuating severity.

• Frequent rest periods; position for easier breathing (Fowler’s), elevate legs for edema.
• Special mouth care (dry mouth from O₂), frequent toileting (diuretics), track I&O and daily weight; possible fluid restriction.

Chronic Conditions of the Endocrine System

Diabetes — Characteristics & Plan of Care

Type 1: too little/no insulin. Type 2: regulation/release problem. Managed by diet, exercise, medications (oral agents/insulin). Symptoms include thirst, frequent urination, weight change, fatigue, nausea, numbness, slow healing, blurred vision.

• Skin care to prevent pressure ulcers; keep skin clean/dry.
• Foot care daily; report cuts; only qualified clinician trims nails.
• Report diet non‑adherence; perform urine/blood tests as ordered.
• Report changes in activity/stress; encourage exercise for circulation and mood.

Chronic Conditions of the Respiratory System

Influenza & Pneumonia

Flu: contagious viral respiratory infection; prevention via annual vaccination (esp. older adults). Pneumonia: inflammation with fluid‑filled air sacs; serious in older adults; bacterial cases treated with antibiotics; aspiration risk in coma/feeding‑tube residents.

• Turn/position diligently; encourage vaccinations, fluids, rest and coughing.

COPD — Characteristics & Plan of Care

Includes chronic bronchitis, emphysema, asthma. Symptoms: excessive mucus, fatigue, poor appetite, bent posture with pursed‑lip breathing, tachycardia, barrel chest, confusion, cyanosis.

• Frequent deep breathing; relaxation and slow, deep breaths.
• Special mouth care; check O₂ tubing/cannula and skin; provide bedside commode; small frequent meals; no smoking (never around oxygen); encourage coughing; elevate head of bed.
• Let the person set the pace; promote control and independence.

Chronic Conditions of the Urinary System

Kidney Failure — Characteristics & Plan of Care

Renal failure/ESRD: kidneys can’t remove wastes; symptoms include fatigue, swelling, kidney‑area pain, cramps, nausea/vomiting, poor nutrition, itching, hypertension, muscle wasting. Dialysis (peritoneal or hemodialysis) removes wastes; may bridge to transplant.

• Encourage rest; monitor/record food and fluids per diet plan.
• Plan ADLs to conserve energy; prevent infection; keep dialysis access site clean/dry; maintain skin integrity.
• Support independence and encourage expression of concerns.

Chronic Conditions of the Nervous System

Multiple Sclerosis (MS)

Chronic demyelination; symptoms come and go (remissions). Symptoms: numbness/tingling/burning, constant fatigue, vision/sleep/speech problems, bowel/bladder issues, mood swings/anxiety, paralysis, cognitive slowing, edema/cold feet.

• Passive/active ROM to prevent contractures; encourage participation.
• High‑fiber diet; laxatives PRN; high fluids for urinary and bowel health.
• Warm (not hot) tub baths for spasms; pace activities; encourage social connection; support emotions.

Stroke (CVA)

May cause hemiplegia/hemiparesis; decreased sensation on affected side; bowel/bladder incontinence; aphasia.

• ROM for affected limbs; encourage unaffected side to assist exercises.
• Supervise meals; place food on unaffected side; check for pocketed food; upright posture.
• Protect skin (drooling side); supervise shaving; assist ADLs as needed; follow PT for gait devices; elevate/support paralyzed limbs; place needed items and call signal on unaffected side; promote independence.

Paraplegia / Quadriplegia

Paralysis from brain/spinal injury; losses include sensation, motor control, temperature regulation, balance, continence, and sometimes breathing.

• Skin care and pressure sore prevention; reposition q2h; alignment aids; elevate affected hand; prevent external rotation; footboards/boots as needed.
• Teach use of self‑help devices; bladder/bowel training; promote independence; provide emotional support.

Parkinson’s Disease

Progressive movement disorder: stiffness, bradykinesia, tremors, gait disturbance; fatigue/frustration.

• Frequent rest; avoid rushing (anxiety worsens tremors); warm tub baths.
• Assistive devices for ADLs; cue posture/arm swing/heel‑to‑toe gait.
• Elevated toilet seat; cue through swallow mechanics; small frequent meals; support self‑esteem.

Mental Depression

Persistent sadness; can mimic physical illness; suicide risk. Signs: crying, memory/concentration issues, low energy, sleep/eating changes, isolation/irritability/helplessness/hopelessness, somatic complaints.

• Safety first; build self‑esteem with positive feedback, strengths focus, simple goals with praise; listen and allow tears; schedule rest; monitor nutrition/fluids; report pain complaints; encourage use of glasses/hearing aids; promote social/physical activity; foster independence.

Cancer

Abnormal cell growth; benign vs malignant; potential to metastasize. Early cancers may be painless; detection improves outcomes. Treatments include surgery, chemotherapy and radiation (often combined).

Plan of Care During Treatment

• Be present, listen, support; maintain positive, hopeful outlook.
• Strict infection control (hand hygiene, Standard Precautions); immune suppression is common.
• Mouth care q2h; observe for redness/irritation; antibacterial rinses as prescribed.
• Maintain nutrition and rest: anticipate nausea/diarrhea and taste changes; use small frequent meals, appealing foods, nutritious fluids, snacks; make mealtime pleasant.
• Avoid providing care if you are ill (cold/flu).
• Support self‑image: hair loss is common with chemo/radiation; suggest scarves/wigs/hats; reassure hair regrowth post‑therapy.
• Explain fatigue as treatment‑related; encourage naps/early bedtime; assist with comfortable alignment; frequent skin checks/backrub (avoid massaging irradiated area; preserve radiation field markings).