Phases of Chronic

Illness/Conditions
Asst. Prof. Rochie Cagara
Chronic Illness/Conditions

• As medical conditions or health problems with associated symptoms or

disabilities that require long-term management (3 months or longer).
• Management: is learning to live with symptoms and to prevent
complications.
• People with chronic conditions do not consider themselves to be sick or ill
and try to live a normal life as possible.
• They only think they are ill when complications develop & symptoms
interfere with ADLs.
Causes of Chronic Illness/Conditions

• Decreased mortality from CD

• Longer life span: advances in health technology & pharmacology,
improved nutrition, safer working conditions & greater access to
health care.
• Improved screening & diagnostic procedures
• Prompt & aggressive management of acute conditions
• The tendency to develop chronic illness with advancing age
• Lifestyle factors: smoking, chronic stress, & sedentary lifestyle
Characteristics of Chronic Illness/Conditions

• It involves more than managing medical problems.

• It usually involves many different phases over a course of a lifetime.
• Keeping it under control requires persistent adherence to the therapeutic
regimen.
• One chronic disease leads to the development of another chronic disease.
• It affects the entire family,
• Day-to-day management of illness is largely the responsibility of the person
involve and their families.
Characteristics of Chronic Illness/Conditions

• Management is a process of discovery.

• Management must be a collaborative process that involves many
different health care professionals working together with the patient
& families . . . full range of services. . .
• Management is expensive.
• It raise difficult ethical issues for patients, health care professionals
and society..
• Living with chronic illness, means living with uncertainty.
Living with Chronic Conditions include the
need to accomplish the following:

• Alleviate and manage symptoms

• Psychologically adjust to and physically accommodate disabilities
• Prevent & manage crisis and complications
• Carry out regimens as prescribed
• Validate individual self-worth & family functioning
• Mange threats to identity
Living with Chronic Conditions include the
need to accomplish the following:

• Normalize family life as much as possible

• Live with altered time, social isolation, & loneliness
• Establish the networks of support and resources that can enhance
quality of life
• Return to satisfactory way of life after an acute debilitating episode
• Die with dignity and comfort
Phases of Chronic Conditions
• Pre-trajectory
• Trajectory
• Stable
• Unstable
• Acute
• Crisis
• Comeback
• Downward
• Dying
Phases of Chronic Conditions
1. Pre-trajectory Phase

• Initial or pretrajectory phase - occurs before any signs and symptoms

are present.

• Focus of Nrsg. Care:

• Refer for genetic testing and counseling, if needed.
• Provide education for prevention of modifiable factors and behaviors
Phases of Chronic Conditions
2. Trajectory Phase

• Trajectory onset phase- occurs with the first onset of signs and
symptoms and includes the diagnostic period.

• Focus of Nrsg. Care:

• Provide explanation of diagnostic tests and procedures & reinforce information
given by the primary care provider
• Provide emotional support to patient and family
Phases of Chronic Conditions
3. Stable Phase

• This phase starts once illness course and the symptoms are controlled.
• Everyday life activities are being managed within limitations.

• Focus of Nrsg. Care:

• Reinforce positive behaviors and offer ongoing monitoring
• Provide education about health promotion
• Encourage participation in health promoting activities and
health screening
Phases of Chronic Conditions
4. Unstable Phase

• When the patient's symptoms are uncontrolled by the previously

adopted regimen.
• This is characterized by exacerbation of illness symptoms; development
of complications or reactivation of illness
• Period of inability to keep symptoms under control and difficulty in
carrying out everyday life activities.
• May require more diagnostic testing and trial of new treatment regimen
or adjustment of current regimens
Phases of Chronic Conditions
4. Unstable Phase

• Focus of Nrsg. Care:

• Provide guidance and support
• Reinforce previous teaching
Phases of Chronic Conditions
5. Acute Phase

• Severe and unrelieved symptoms or development of illness

complications necessitating hospitalization, bed rest or interruption of
person’s usual activities to bring illness course under control.

• Focus of Nrsg. Care:

• Provide direct care and emotional support to patient and family members.
Phases of Chronic Conditions
6. Crisis Phase

• Critical or life-threatening situation requiring emergency treatment or

care and suspension of everyday life activities until the crisis has
passed.

• Focus of Nrsg. Care:

• Provide direct care, collaborate with
other health care team members to
stabilize patient’s condition.
Phases of Chronic Conditions
7. Comeback Phase
• It marks the recovery from an acute period and learning to live with or to
overcome disabilities and return to an acceptable way of life within the
limitations imposed by the chronic condition or disability.
• Involves physical healing, limitations stretching through rehabilitative
procedures, psychosocial coming-to-terms and biological management
with adjustments in daily life activities.
Phases of Chronic Conditions
7. Comeback Phase
• Focus of Nrsg. Care:
• Assist in the coordination of care.
• Rehabilitative focus may require care from other health care providers.
• Provide positive reinforcement of goals identified and accomplished.
Phases of Chronic Conditions
8. Downward Phase

• Illness characterized by rapid or gradual worsening of a condition;

• Physical decline accompanied by increasing disability or difficulty
in controlling symptoms;
• Requires biographical adjustments and alterations in everyday life
activities with each major downward step.
Phases of Chronic Conditions
8. Downward Phase

• Focus of Nrsg. Care:

• Provide home care and other community-based care to help patient and family
adjust to changes and comes to terms with this changes;
• Assist patient and family to integrate new treatment and management strategies;
• Encourage identification of end-of-life preferences and planning.
Phases of Chronic Conditions
9. Dying Phase

• Final days or weeks before death;

• Characterized by gradual or rapid shutting
down of body processes, biographical disengagement or closure,
and relinquishment of everyday life interests and activities.

• Focus of Nrsg. Care:

• Provide direct and supportive care to patient and family through hospice programs.
References

Smeltzer, S. C. (2008). Brunner and Suddarth’s Textbook of medical

-surgical nursing. 11th ed. USA: Lippincott Williams & Wilkins.

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