ILLNESS AND DISEASE MANAGEMENT ACROSS LIFE SPAN:
QUESTION:
Consider a 12-year-old and 75-year-old have one of the following illnesses:
- COPD
- Asthma
- Heart Failure
- Cancer
- Describe the chronic illness trajectory for the selected illness based on the patient’s age.
- How does the chronically ill patient’s illness trajectory influence the plan of care?
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Introduction:
Chronic illnesses are a prevalent occurrence across all age groups. Understanding the chronic illness trajectory of a patient, based on their age, is crucial in developing an appropriate plan of care. In this answer, we will explore the chronic illness trajectory of four common illnesses – COPD, asthma, heart failure, and cancer. We will also discuss how the illness trajectory influences the plan of care for the patient.
Answer:
COPD:
For a 12-year-old with COPD, the chronic illness trajectory is relatively stable for the first few years after diagnosis. However, as the child grows, the trajectory becomes more severe, leading to an increased frequency of exacerbations and hospitalizations. Their lung function declines rapidly due to increased exposure to pulmonary irritants, infections, and environmental toxins. The patient becomes more susceptible to respiratory infections, which can lead to acute exacerbations of COPD. The chronic nature of COPD affects the quality of life and results in a decline in activities of daily living.
On the other hand, for a 75-year-old with COPD, the chronic illness trajectory is different. The exacerbations will typically come with a much more significant impact as the older patient’s immune system is not as effective. The long-term effects of the illness, including lung function decline, metabolic disturbances, and cardiorespiratory dysfunction, have a greater impact on the older patient’s quality of life. The older COPD patient is at higher risk of comorbidities such as cardiovascular events, strokes, and pneumonia.
Plan of Care:
The care plan for a COPD patient should incorporate management of acute exacerbations and routine care. Monitoring of oxygenation, respiratory rate, and assessment of breath sounds will ensure early identification and management of exacerbations.
Asthma:
The chronic illness trajectory for a 12-year-old with asthma is a fluctuating pattern of exacerbations, hospitalizations, and symptom-free periods. Asthma presentation at puberty often leads to higher levels of exacerbations and impacts the patient’s quality of life more severely than in younger children. The teenage years constitute a time of considerable emotional and physical stress, and this may influence the illness trajectory of the patient.
Similarly, the chronic illness trajectory for a 75-year-old patient with asthma will be more severe than for a younger asthma patient because the aging body will be less effective at handling stress and infection. Therefore, the asthma patient’s lung function will decline more rapidly, leading to decreased activity levels, more frequent hospitalization, and lower quality of life.
Plan of Care:
The asthma patient’s plan of care should include education on self-management, including symptom recognition, medication use, and action plans for exacerbations. Regular monitoring and review of the patient’s medication regimen will optimize the plan of care for the asthma patient.
Heart Failure:
The chronic illness trajectory of heart failure for a 12-year-old patient will likely be a steady decline in cardiac function due to congenital deformities. The patient may suffer from congenital heart disease, and according to the severity, may require cardiac surgeries. As the patient grows, they may develop chronic heart failure, leading to pulmonary edema and shortness of breath.
However, for a 75-year-old patient with heart failure, the chronic illness trajectory will be different, with multiple factors contributing to the development of the condition. These factors include genetic predisposition, poor lifestyle choices, and comorbidities such as hypertension, diabetes, and atherosclerosis, all of which worsen with age.
Plan of Care:
The plan of care for a heart failure patient should focus on managing symptoms such as edema, fatigue, and shortness of breath. Care should also include education on diet and lifestyle changes, cardiac rehabilitation, and medication management.
Cancer:
The chronic illness trajectory for cancer varies depending on the type, stage, and aggressiveness of cancer. For a 12-year-old with cancer, the trajectory may be more aggressive, depending on the type of cancer, and the treatment regimen may be more intensive to achieve a cure. However, the side effects of the treatment may impact the child’s growth and development, leaving them prone to emotional and psychological disturbances.
In contrast, a 75-year-old patient with cancer may experience a chronic illness trajectory with medical interventions aimed at palliative care to improve the quality of life rather than a cure. At this age, the immune system is less effective and may not eliminate tumor cells effectively.
Plan of Care:
The plan of care for a cancer patient aims to treat the cancer and manage side effects. The care plan may include surgery, radiation therapy, chemotherapy, or a combination of these depending on the type, stage, and aggressiveness of the cancer. Symptom management, supportive care, and psychosocial support must incorporate in the plan of care.
