Terminally and Chronic

Illness
Learning Object
• Introduction
• Identify term of terminal ill diseases, terminal care, and
end of life diseases
• Identify Chronic Disease
• Characteristic of terminal Illness
• Terminal Illness list and Chronic Illness
• Caused of Terminal Illness
• Pathphysiology Terminal and Chronic Illness
Introduction
 • A clear definition of terminal illness so that almost all individuals may be
classified correctly;
• A reasonable survival period of persons who are categorized as terminally ill
(to make, effect, and be affected by decisions or to receive benefits);
Terminal • A period of terminal illness recognizable for most lethal chronic diseases;
Ill and
• Competence of persons within the category, at least for part of their time as
terminally ill

• firm evidence of progressive disease,

Terminal • Termination of active cancer therapies, and
Care • “death is not far off.”

• Place of care (e.g., hospital to home and vice versa),

Level of care professions providing the care (e.g., oncologists to palliative care teams),
Transitio and
n Care Goals of care (e.g., curative to palliative treatments and no further active treatments)

• In clinical medicine, the ‘end of life’ can be thought of as the period preceding an
End of individual’s natural death from a process that is unlikely to be arrested by medical care
Life
Terminal illness and terminal care
• Refers to active and progressive disease for which
curative treatment is neither possible nor
appropriate and from which death is certain. This
varies from a few days to many months.
• The illness either has no known cure or has
progressed to the point where it cannot be cured;
and
• In the opinion of the attending consultant, the
illness is expected to lead to death within [the
earlier of] 12 months [and the remaining term of
the cover]. (4 to 6 to 12 weeks) even 24 months
Cont’
Summary about meaning
• Based on our literature review, the terms end of
life, terminally ill, and terminal care share similar
meaning: progressive life-limiting disease with a
prognosis of months or less.
• How the terms differ is in their application: end of
life is used to define a particular time frame,
terminally ill is used to describe a patient’s
condition, and terminal care is used to characterize
care delivered for terminally ill patients
Hui el al, 2014, Concepts and Definitions for “Actively Dying,” “End of Life,”
“Terminally Ill,” “Terminal Care,” and “Transition of Care”: A Systematic Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870193/
Causes
• The main of cause of terminal illness is cancer at
around 95 % from all of claims.
• Other causes include severe respiratory conditions,
neurological conditions and Creutzfeld-Jakob
Disease (CJD) (kematian sel saraf otak yang
berkelanjutan, yang dikaitkan dengan
bertambahnya protein prion abnormal)
Characters of Terminal Ill
• Lyn describe some of characteristics of terminal ill
are
1. A clear definition of terminal illness so that almost all
individuals may be classified correctly;
2. A reasonable survival period of persons who are
categorized as terminally ill (to make, effect, and be
affected by decisions or to receive benefits);
3. A period of terminal illness recognizable for most
lethal chronic diseases; and
4. Competence of persons within the category, at least
for part of their time as terminally ill.”
Some changes that is faced by
terminal ill patients
• Physical changes in their body
• Spiritual changes in the way they think about their
future and their spiritual needs
• Social changes and emotional changes
• In their independence
• In their abilities
• In their relationships with others
• When providing personal care, the caregiver should
allow the terminally ill person to maintain a sense
of:
• Dignity
• Privacy
• Control
Terminal Illness List
• Cancer: Most cancers can either
become terminal or be diagnosed as such
including breast cancer and lung cancer.
• Lukemia
• AIDS (Acquired Immune Deficiency Syndrome)
• Lesch-Nyhan Syndrome
• Heart Disease such as Severe Coronary Artery
Disease
• Ebola Hemorrhagic Fever
Chronic Illness
• The term Terminal usually refers to a progressive
disease that is incurable and irreversible, that is it
does not respond to treatment. Furtherore, death
is usually the expected result within a short period
of time.
• A chronic disease is one that lasts 3 months or
longer, according to the definition of the U.S.
National Center for Health Statistics. Chronic
diseases can not be cured and are often,
progressive.
Chronic Illness List
• A list of some Chronic Diseases
• Addison’s disease
• Asthma
• Cardiac failure
• Cardiomyopathy
• Chronic obstructive pulmonary
disorder
• Chronic renal disease
• Coronary artery disease
• Crohn’s disease
• Diabetes
• Glaucoma
• Haemophilia
• Hypertension
• Hypothyroidism
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Schizophrenia
• Systemic lupus erythematosus
• Ulcerative colitis
• Bipolar Mood Disorder
Heart Failure
• Heart failure develops when the heart, via an
abnormality of cardiac function (detectable or not),
fails to pump blood at a rate commensurate with
the requirements of the metabolizing tissues or is
able to do so only with an elevated diastolic filling
pressure. (Dumitru and Backer, 2018)
• The most common symptoms and comorbidities
among patients with end-stage heart failure include
dyspnea, pain, depression, fatigue, and edema
(Adler, Goldfinger et al. 2009).
Pain
• Pain is common and often undertreated in end-stage
heart failure.Pharmacological agents that treat the
underlying cause of pain, such as bisphosphonates for
fractures1 and antianginals for angina, should be used
when appropriate.
• Fearing addiction, providers and patients are often
wary of opioids. Although opioids will predictably
induce tolerance and physical dependence, studies
suggest true addiction in terminally ill patients is
rare. Manipulative behavior or dramatic demands for
opioids should initially be assumed to be a result of
undertreatment and will generally respond to
appropriate analgesia
Depression
• Depression occurs in 21% to 36% of patients with
heart failure.84,85 More severe heart failure
correlates with increased rates of depression.
Patients who report severe depression have
increased rates of clinical events and
rehospitalization and incur a higher death rate and
economic cost
• When pharmacotherapy is begun, it is important to
strike a balance between relieving symptoms of
depression without adding onerous side effects.
Fatique
• The foundation for treatment of fatigue is the
identification and treatment of secondary causes
such as anemia, infection, dehydration, electrolyte
abnormalities, thyroid dysfunction, and depression.
Pharmacological options for primary fatigue include
stimulants, such as methylphenidate, as well as
nonpharmacological techniques, such as training in
energy conservation and aerobic exercise
Edema
• Edema can be a significant cause of discomfort in
patients. As with dyspnea, it is treated principally
with diuretics. Compression stockings may be
effective for lower-extremity edema. Patients with
refractory ascites may benefit from paracentesis,
which also may improve renal function in patients
with elevated intra-abdominal pressure
Palliative Care
Who said
• Palliative care is an approach that improves the
quality of life of patients and their families facing
the problem associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification and
impeccable assessment and treatment of pain and
other problems, physical, psychosocial and
spiritual.
What should we do in Paliative
Care?
• rovides relief from pain and other distressing
symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• integrates the psychological and spiritual aspects of
patient care;
• offers a support system to help patients live as
actively as possible until death;
Cont
• Offers a support system to help the family cope during
the patients illness and in their own bereavement;
• Uses a team approach to address the needs of patients
and their families, including bereavement counselling,
if indicated;
• Will enhance quality of life, and may also positively
influence the course of illness;
• is applicable early in the course of illness, in
conjunction with other therapies that are intended to
prolong life, such as chemotherapy or radiation
therapy, and includes those investigations needed to
better understand and manage distressing clinical
complications.
WHO, WHO Definition of Palliative Care
http://www.who.int/cancer/palliative/definition/en/, Accessed at 2018
Conclusion
• Penyakit kronis dan terminal mengalami penurunan
kualitas hidup (fisik, mental, dan sosial). Ada
beberapa tanda dan gejala yang harus diketahui
oleh profesi kesehatan yang mana merupakan
beban bagi pasien penyakit terebut seperti nyeri,
kelemahan, depressis, sesak, dan gangguan sosial.
• Pengetahuan mengenai patofisilogi dapat
membantu tenaga kesehatan untuk memberikan
intervensi yang tepat bagi pasien.