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Med-Surg · chapter 9 · Management of Chronic Illness

Chronic Disease and Illness (Prevalence and Etiology)

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.

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Key points

  1. Slow onset and duration

    Chronic diseases and illnesses are disorders that have a slower onset and are long-lasting.

  2. Chronic disorder prevalence

    Chronic disorders affect more than half of the US population and are the leading causes of death and disability in the United States (Centers for Disease Control and Prevention [CDC], 2022a).

  3. National cost burden

    They cost the US health care system nearly $3.7 trillion annually, accounting for 90% of the nation’s total health care costs (CDC, 2023b).

  4. Prevention and health promotion

    The significance of chronic diseases and illnesses on the health of the population, coupled with associated economic costs, has shifted the focus of health care and research to disease prevention and health promotion (Healthy People 2030, n.d.).

  5. Subjective illness experience

    This definition encompasses the pathophysiological causes of the health problem and the disorder itself but does not address the subjective feelings and experiences of the patient who is living with the illness.

  6. Disease and illness distinction

    Many people use chronic disease and chronic illness interchangeably, but it is useful to distinguish between the terms.

  7. Variation in experiences

    The feelings and experiences associated with living with chronic illness vary significantly from person to person and can change frequently depending on factors such as age, the presence (or lack) of social support, and other social and demographic characteristics.

  8. Different coping responses

    As a nurse, it is important to understand that not all patients experiencing chronic illness will successfully cope with their condition in the same way.

  9. Patient beliefs and values

    Nurses must be able to communicate effectively and implement treatment and support strategies that are reflective of the patient’s beliefs and values as they relate to their chronic conditions.

  10. Demographic factors

    Age, gender, and culture are three demographic factors that can have a significant impact on chronic disease and illness.

  11. Age and outlook

    For example, a child or adolescent experiencing a chronic disease is likely to have a completely different outlook on life than an older adult, due to differences in their respective lived experiences.

  12. Gender prevalence differences

    Specifically, osteoporosis, depression, and arthritis are all more commonly seen in females than in males (Temkin et al., 2023).

  13. Patient-centered care

    Regardless of the factors in any given case, it is imperative that the nurse provide patient-centered care that considers the specific preferences and needs of the patient.

  14. Cultural treatment preferences

    Traditional healing practices, such as herbal medicine or spiritual rituals, may be preferred over Western medical interventions in some cultures.

Terms to know

acute disease
In comparison, acute disease refers to an illness that develops quickly and lasts a relatively short time, typically days or weeks (National Council on Aging, 2024).
chronic disease
We define chronic disease is defined as a medical or health problem that lasts at least 1 year and requires ongoing medical attention or limits activities of daily living (ADLs) (CDC, 2022c).
chronic illness
Although the definition of chronic disease refers to the disorder itself, chronic illness is defined as the human experience of living with a chronic disease (Martin, 2007).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. At 0900, a nurse reviews a patient’s history before completing the assessment. The patient has had hypertension for 18 months, requires ongoing medical attention, and reports no limitations in activities of daily living (ADLs). Which assessment entry best applies the section’s definition of chronic disease?

    1. Chronic disease requiring ongoing medical attention, with no reported ADL limitations.
    2. Chronic disease classification deferred until the patient’s emotional response is assessed.
    3. Chronic illness rather than chronic disease because the patient remains independent in ADLs.
    4. Chronic disease classification deferred because ADL limitations have not been established.

    Answer: Chronic disease requiring ongoing medical attention, with no reported ADL limitations.

    The condition has lasted at least 1 year and requires ongoing medical attention, so ADL limitations are not also required. Preserved independence neither prevents classification as chronic disease nor makes chronic illness a replacement classification. Emotional responses describe the experience of chronic illness but are not required to identify chronic disease.

  2. During a 1300 assessment, a patient diagnosed with arthritis 2 years ago reports frustration, difficulty completing daily activities, and a belief that the condition is a test of faith. The nurse is documenting the patient’s experience of chronic illness. Which entries capture that lived experience rather than simply identify or describe the underlying disease? Select all that apply.

    1. Reports that arthritis makes daily activities difficult.
    2. Duration of diagnosed condition: 2 years.
    3. Describes the condition as a test of faith.
    4. Reports frustration about living with arthritis.
    5. Medical diagnosis: arthritis.

    Answer: Reports that arthritis makes daily activities difficult., Describes the condition as a test of faith., Reports frustration about living with arthritis.

    Chronic illness includes the patient’s emotions, beliefs, and the condition’s effects on daily life, so frustration, difficulty with activities, and the test-of-faith belief belong in this description. The diagnosis and duration describe the disease itself rather than how this patient experiences living with it.

  3. At 1600, a patient with chronic disease says, “Spiritual rituals help me cope. I want that considered when we discuss treatment.” The nurse is preparing a handoff note. Which entry best reflects the section’s approach to cultural beliefs and patient-centered care?

    1. Patient’s spiritual beliefs may interfere with participation in treatment.
    2. Patient’s spiritual preferences noted for support discussions, separate from treatment planning.
    3. Patient values spiritual rituals for coping and wants this preference considered in treatment discussions.
    4. Patient prefers spiritual rituals instead of medical treatment.

    Answer: Patient values spiritual rituals for coping and wants this preference considered in treatment discussions.

    The correct entry reflects the patient’s stated preference without judgment and keeps that preference relevant to treatment discussions. The patient has not said that rituals replace medical treatment or interfere with participation. Separating the preference from treatment planning overlooks the section’s emphasis on care that considers the individual’s beliefs and needs.

Where every quote comes from

Section 9.1 Chronic Disease and Illness (Prevalence and Etiology) of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.

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