Med-Surg · chapter 9 · Management of Chronic Illness
Care of the Chronically Ill Patient
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Patient-centered chronic care
The nurse must provide patient-centered care and focus management and treatment strategies specific to the patient’s needs and preferences.
Focused subjective history
The assessment of a patient with a suspected or diagnosed chronic illness begins with obtaining a full subjective history and patient interview. This interview is like a typical patient history but with questions that are more focused on the specific chronic illness.
Symptom questions guide follow-up
Questions during the subjective interview should focus on common symptoms associated with chronic illness. Asking these questions can help indicate whether the individual may have the illness and whether further testing and follow-up are necessary.
Knowledge deficits assessment
For patients admitted with acute exacerbations of the underlying chronic disease, it is important for the nurse to assess for any knowledge deficits the patient may have about their condition.
Home management resources
In these cases, the nurse should ask the patient questions about what they know about their condition, what treatment (if any) that they are currently receiving, and what resources they have available for managing their condition.
Interprofessional collaboration benefits
Collaboration between members of the health care team has been shown to improve patient outcomes and ensure that the patient receives thorough, high-quality care (Pannick et al., 2015).
Recognizing cues
One of the most important aspects of nursing care for a patient with a chronic illness relates to assessment and recognizing cues.
Worsening or improvement signs
If the patient has already been diagnosed with a chronic condition, the nurse should be able to recognize symptoms that would indicate the condition is worsening or improving.
Diagnostic testing after assessment
Often, this involves suggesting further diagnostic testing to confirm the suspected diagnosis. Chronic disease progression is often identified in this step of the clinical judgement measurement model.
Analyzing cues purpose
By analyzing cues, the nurse is linking the patient’s medical history with the cues initially identified.
Life-threatening priorities
If the patient’s chronic condition has become life-threatening, implementing life-saving measures is the top priority.
Collaborative outcome planning
The nurse collaborates with the care team—which includes the family and support team—to determine appropriate outcomes for the patient based on their needs.
Individualized evidence-based interventions
When taking action, nursing interventions are individualized for the patient and supported by evidence-based practice.
Outcome reevaluation
The nurse should assess not only whether the outcomes have been met but also which priorities of care need further intervention. If it is determined that the outcomes were not met, the nurse is tasked with coordinating revisions to the plan of care to address the unmet outcomes.
Terms to know
- acute exacerbation
- For example, inpatient admissions may be required due to an acute exacerbation, or sudden worsening of symptoms, of a chronic disease (e.g., acute-on-chronic heart failure).
- subjective data
- A comprehensive interview incorporating subjective data (e.g., patient- or family-reported data) and objective data (e.g., changes in vital signs) lends itself to using multiple recognized cues in understanding the impact of chronic disease.
- objective data
- A comprehensive interview incorporating subjective data (e.g., patient- or family-reported data) and objective data (e.g., changes in vital signs) lends itself to using multiple recognized cues in understanding the impact of chronic disease.
- Prioritizing hypotheses
- Prioritizing hypotheses involves organizing the assessment data collected previously and determining what the priority issues are that require intervention.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At 0900, a nurse is documenting a teaching plan for a patient with diabetes. The goal is for the patient to monitor blood glucose correctly. Which planned outcome best measures achievement of this goal?
- By the end of today's teaching session, the patient will competently perform a blood glucose check as a return demonstration.
- By the end of today's teaching session, the nurse will have completed blood glucose monitoring education.
- By the end of today's teaching session, the patient will explain the complications of untreated diabetes.
- By the end of today's teaching session, the patient will report confidence in checking blood glucose at home.
Answer: By the end of today's teaching session, the patient will competently perform a blood glucose check as a return demonstration.
A return demonstration directly shows whether the patient can perform the monitoring skill, and the deadline makes the outcome timed. Explaining complications or reporting confidence does not demonstrate the skill, while completing education measures the nurse's activity rather than the patient's competence.
At 1000, a nurse is documenting assessment findings for a patient with a chronic illness and identifying interprofessional follow-up needs. Which entries most directly support involving the social worker? Select all that apply.
- The patient's financial resources for managing the chronic condition need review.
- The patient's prescriptions need review to ensure correct medications and dosages.
- The patient needs counseling and a dietary plan to support healthy eating habits.
- The patient's access to community resources for managing the chronic condition needs review.
- The patient needs support to improve performance of activities of daily living.
Answer: The patient's financial resources for managing the chronic condition need review., The patient's access to community resources for managing the chronic condition needs review.
Financial and community resources fall within the social worker's role. Dietary planning belongs to the dietitian, support for activities of daily living to physical and/or occupational therapy, and prescription and dosage coordination to the pharmacist.
At 1600, a nurse evaluates a patient with diabetes and documents that the goal of competent blood glucose self-monitoring has not been met. Which plan-of-care update best follows this finding?
- Outcome not met; continue the existing plan and defer decisions about changes until the next scheduled evaluation.
- Outcome not met; extend the goal deadline while retaining the current priorities and interventions.
- Outcome not met; repeat the current teaching while keeping the established care plan unchanged.
- Outcome not met; coordinate revisions with the interdisciplinary team to address the patient's unmet needs.
Answer: Outcome not met; coordinate revisions with the interdisciplinary team to address the patient's unmet needs.
Unmet outcomes call for coordinated care-plan revisions that address the patient's needs, often involving the interdisciplinary team again. Deferring changes, repeating unchanged teaching, or only extending the deadline does not establish how the plan will address the unmet outcome.
Where every quote comes from
Section 9.7 Care of the Chronically Ill Patient of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.