ACTIVITY BASED ASSESSMENT

(HEALTH PSYCHOLOGY)

SUBMITTED TO SUBMITTED BY
Ms. DEVIKA BALAKRISHNAN ALBY ABRAHAM
ASSISTANT PROFESSOR ROLL NO : 04
DEPARTMENT OF PSYCHOLOGY 1ST YEAR MSc PSYCHOLOGY
TOPIC: TO VISIT PATIENT WITH CHRONIC ILLNESS/PAIN AND
PALLIATIVE CENTRE AND PREPARE HEALTH PROFILES AND
INTERVENTION PLAN

INTRODUCTION

CHRONIC ILLNESS

Chronic illnesses are defined as long-term health conditions that endure for a year or longer,
necessitating continuous medical care or imposing limitations on daily activities. In contrast
to acute illnesses, which are typically short-lived and often amenable to treatment, chronic
diseases can have a lasting impact on an individual's health throughout their lifetime.
Common examples of chronic illnesses include diabetes, heart disease, arthritis, asthma, and
chronic obstructive pulmonary disease (COPD). The onset of these conditions is frequently
attributed to a complex interplay of genetic predispositions, environmental influences, and
lifestyle choices. Effective management of chronic illnesses generally requires a multifaceted
approach that encompasses lifestyle modifications, pharmacological interventions,
therapeutic support, and consistent medical oversight to alleviate symptoms and avert
potential complications.

The ramifications of chronic illnesses extend beyond the individual, significantly affecting
both personal well-being and societal structures. Individuals grappling with chronic
conditions often face a reduced quality of life, characterized by ongoing symptoms, persistent
pain, or functional limitations. Furthermore, emotional and psychological challenges,
including depression and anxiety, are prevalent among those living with chronic illnesses.
The financial implications are also considerable, as the costs associated with treatment,
medications, and long-term care can impose a heavy burden on both patients and healthcare
systems. To mitigate these effects, early detection and preventive strategies, such as adhering
to a balanced diet, engaging in regular physical activity, and participating in routine health
screenings, are essential in managing chronic illnesses and lowering the associated risks.

CHARACTERISTICS OF CHRONIC ILLNESS

Chronic illnesses are characterized by their long-lasting nature, often persisting for years or
even for the entirety of a person’s life. Unlike acute illnesses that come on suddenly and tend
to resolve quickly, chronic conditions develop gradually and remain with the individual
indefinitely. While these conditions cannot always be cured, they can usually be managed
through a combination of medication, lifestyle adjustments, and other forms of intervention.
The goal of management is to control symptoms, prevent further complications, and enhance
the overall quality of life. The symptoms of chronic illnesses can vary greatly, ranging from
mild to severe, and may change over time. For example, someone with rheumatoid arthritis
may experience times when their symptoms are less intense (remission), followed by flare-
ups marked by increased inflammation and pain. Chronic illnesses can also have a profound
effect on a person's daily routine, affecting their ability to work, engage in social activities, or
perform daily tasks. As a result, individuals may need to adjust their lifestyle, which might
involve dietary changes, physical therapy, or the use of assistive devices to maintain their
independence.

EFFECTS OF CHRONIC ILLNESS

Chronic illness impacts nearly every aspect of a person's life, affecting both their physical
and emotional well-being. Physically, individuals living with chronic conditions often
experience persistent pain, fatigue, and limited mobility, which can hinder their ability to
perform daily tasks and enjoy activities they once did. These physical limitations may also
contribute to a decline in overall health, leading to additional complications or medical
issues. Emotionally, the constant need to manage symptoms and the uncertainty of the future
can result in heightened stress, anxiety, and even depression. The psychological toll of
managing a long-term illness can be overwhelming, especially when there is no clear
resolution in sight. This ongoing emotional strain can diminish a person’s mental health,
making it harder for them to stay positive and engaged with life.

Socially, chronic illness often leads to isolation, as people may withdraw from social events
or activities due to their condition. They may feel self-conscious or reluctant to engage in
conversations, fearing that others won’t understand their struggles. Additionally, relationships
can be strained as loved ones may have difficulty coping with the challenges of caregiving or
supporting someone with a long-term illness. Financially, managing a chronic condition can
be expensive, especially when ongoing treatments, medications, or specialized care are
required. This financial burden can strain family resources and impact employment, as
individuals may need to reduce working hours or even stop working altogether. Ultimately,
living with a chronic illness requires significant adjustments to one’s daily life, as individuals
navigate a range of physical, emotional, and financial challenges that can affect their overall
quality of life.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized
by long-term airflow limitation, making it difficult to breathe. It encompasses conditions such
as chronic bronchitis and emphysema, which involve damage to the lungs and respiratory
system. COPD is primarily caused by long-term exposure to harmful particles or gases,
particularly cigarette smoke, but other factors such as environmental pollution and genetic
factors can contribute. If not properly managed, COPD can lead to severe respiratory failure
and significant limitations in physical activity.

Types of Chronic Obstructive Pulmonary Disease

1. Chronic Bronchitis
Chronic bronchitis is characterized by chronic inflammation of the bronchial tubes,
which carry air to and from the lungs. The inflammation causes the airways to narrow
and produce excessive mucus, making breathing difficult. A key symptom is a
persistent cough that produces sputum (mucus) for at least three months in two
 consecutive years. This type of COPD can lead to further complications such as
frequent respiratory infections and reduced oxygen levels in the blood.
2. Emphysema
Emphysema involves the destruction of the alveoli (tiny air sacs in the lungs where
gas exchange occurs), leading to reduced surface area for oxygen absorption and the
elimination of carbon dioxide. The alveoli lose their elasticity, which impairs airflow,
making it harder to exhale. Over time, the lungs become hyperinflated, leading to
difficulty in breathing. People with emphysema often have a "barrel chest"
appearance due to lung over-expansion.
3. Chronic Obstructive Asthma (Mixed COPD/Asthma)
Some individuals may experience a combination of both asthma and COPD, which is
termed chronic obstructive asthma. This condition features symptoms of both asthma
and COPD, such as wheezing, shortness of breath, and chronic coughing. It is marked
by airway inflammation, which causes narrowing and obstructed airflow, similar to
asthma. However, unlike asthma, the airway changes in COPD are permanent.

Pathophysiology of COPD
COPD primarily results from long-term exposure to irritants like cigarette smoke or industrial
pollutants, which trigger chronic inflammation in the lungs. Over time, this inflammation
damages the airways and alveoli.

1. Chronic Inflammation
Inhaled irritants such as smoke stimulate the immune system to produce inflammatory
mediators that lead to swelling of the airways, increased mucus production, and
damage to lung tissue. In the case of chronic bronchitis, the inflammation leads to
thickening of the airways and mucus secretion. In emphysema, it leads to the
destruction of the alveolar walls, reducing the lungs' ability to oxygenate the blood
and eliminate carbon dioxide.
2. Airflow Limitation
In COPD, the airways become constricted, reducing airflow into and out of the lungs.
This is due to a combination of inflammation, mucus production, and damage to the
structural components of the lungs, leading to airflow obstruction. The lungs' ability
to fully expel air becomes impaired, leading to the sensation of breathlessness,
particularly during physical exertion.
 3. Impaired Gas Exchange
The damage to the alveoli (air sacs) in emphysema and the narrowing of the airways
in chronic bronchitis limit the lungs' ability to efficiently exchange gases—
specifically, oxygen and carbon dioxide. This results in lower oxygen levels in the
blood and an accumulation of carbon dioxide. Over time, this can cause significant
strain on the heart, leading to complications such as pulmonary hypertension and
right-sided heart failure (cor pulmonale).

Symptoms of COPD
The symptoms of COPD tend to worsen over time and may include:

 Chronic Cough: A persistent cough that often produces mucus or phlegm, especially
in the morning.
 Sputum Production: Excessive mucus production is a common symptom,
particularly in chronic bronchitis.
 Shortness of Breath (Dyspnea): Difficulty breathing, especially during physical
activity, due to narrowed airways and impaired lung function.
 Wheezing: A whistling sound when breathing, especially during exhalation, caused
by airflow obstruction.
 Fatigue: Chronic fatigue results from the body working harder to breathe and from
reduced oxygen levels in the blood.
 Chest Tightness: A feeling of tightness or heaviness in the chest due to airflow
obstruction.
 Frequent Respiratory Infections: People with COPD are at a higher risk of
respiratory infections, such as pneumonia, due to the impaired ability to clear mucus
from the lungs.

Complications of COPD
COPD can lead to a range of complications that further impact an individual's health:

1. Respiratory Infections
People with COPD are more susceptible to respiratory infections, such as pneumonia
and the flu, due to weakened lung function and impaired immune response.
2. Pulmonary Hypertension
Over time, reduced oxygen levels in the blood can cause increased pressure in the
 pulmonary arteries (pulmonary hypertension), which strains the right side of the heart,
potentially leading to right-sided heart failure (cor pulmonale).
3. Lung Cancer
COPD increases the risk of developing lung cancer, particularly in smokers, due to
long-term inflammation and cellular damage in the lungs.
4. Osteoporosis
Chronic use of corticosteroids to manage COPD symptoms can lead to decreased
bone density, increasing the risk of fractures and osteoporosis.
5. Depression and Anxiety
COPD can significantly impact an individual’s quality of life, leading to emotional
and psychological complications like depression and anxiety due to the chronic nature
of the illness and limitations it imposes on daily activities.
6. Weight Loss and Muscle Wasting
Severe COPD may lead to unintentional weight loss and muscle wasting (cachexia)
due to increased energy expenditure from labored breathing and reduced physical
activity.

Diagnosis of COPD
COPD is diagnosed through a combination of clinical evaluation and diagnostic tests:

1. Spirometry:
Spirometry is the primary test used to diagnose COPD. It measures lung function by
assessing how much air a person can exhale and how quickly. A reduced forced
expiratory volume in one second (FEV1) and a low FEV1/FVC ratio are indicative of
obstructed airflow typical in COPD.
2. Chest X-ray or CT Scan
These imaging tests can help identify lung damage, emphysema, or other
abnormalities such as tumors or infections.
3. Arterial Blood Gas (ABG) Test
An ABG test measures the levels of oxygen and carbon dioxide in the blood,
providing insights into how well the lungs are functioning.
4. Alpha-1 Antitrypsin Deficiency Test
This test is used to detect a rare genetic disorder that can cause COPD in non-
smokers, known as alpha-1 antitrypsin deficiency.
 5. Pulse Oximetry
A simple test to measure oxygen levels in the blood, which can be lower in
individuals with COPD.

Treatment of COPD
While there is no cure for COPD, treatment focuses on managing symptoms, improving
quality of life, and slowing disease progression:

1. Medications
o Bronchodilators: These medications help open the airways and make
breathing easier. They are often prescribed as inhalers.
o Steroids: Inhaled corticosteroids reduce inflammation in the airways and can
be used alongside bronchodilators.
o Phosphodiesterase-4 Inhibitors: These medications help reduce
inflammation and relax the airways in severe COPD cases.
2. Oxygen Therapy
For individuals with low blood oxygen levels, supplemental oxygen can improve
oxygenation and reduce strain on the heart.
3. Pulmonary Rehabilitation
Pulmonary rehabilitation programs involve exercise training, education, and support
to help people manage their COPD and improve physical endurance.
4. Lifestyle Modifications
o Smoking Cessation: The most important step in managing COPD is quitting
smoking.
o Nutritional Support: Maintaining a healthy weight and muscle strength is
essential, as malnutrition can exacerbate symptoms.
o Physical Activity: Regular exercise helps strengthen respiratory muscles and
improve overall well-being.
5. Surgical Treatment
In severe cases, surgery may be necessary, including options like lung volume
reduction surgery or a lung transplant.

Prevention of COPD
The most effective way to prevent COPD is to avoid smoking and exposure to lung irritants.
Vaccinations against flu and pneumonia can also help prevent respiratory infections, which
are particularly dangerous for individuals with COPD.

Report on Visit to Peacefully Person Care Centre (20/03/2025)

Patient Profile
I visited the Peacefully Person Care Centre on 20th March 2025, where I conducted an
interview with a patient diagnosed with Chronic Obstructive Pulmonary Disease (COPD).
The patient is a 60-year-old male who has been living with COPD for over ten years. He has
a history of long-term smoking (approximately 30 years) and was diagnosed with COPD after
experiencing a gradual decline in his lung function. His occupation involved heavy physical
labor, which contributed to prolonged exposure to dust and industrial fumes, further
exacerbating his respiratory condition.

Patient’s Medical Background

The patient has been managing his COPD through a combination of medical treatment,
lifestyle modifications, and respiratory therapy. However, his condition has progressively
worsened over the years, and he now experiences frequent shortness of breath, chronic cough,
and fatigue. He shared that his symptoms were particularly exacerbated during cold weather
or after exposure to respiratory infections, which has led to multiple hospitalizations.

Symptoms and Current Health Status

The patient's primary complaints include:

 Persistent Cough: He describes the cough as frequent, especially during the early
morning hours, often producing yellowish mucus.
 Shortness of Breath: He experiences difficulty breathing even with minimal
exertion, and his ability to perform daily activities, such as walking or climbing stairs,
has significantly decreased.
  Wheezing: The patient has a wheezing sound while exhaling, especially in the
evening, which is indicative of bronchial constriction and airway inflammation.
 Fatigue: He reports feeling constantly tired, which is likely due to reduced oxygen
levels in the blood and the increased energy expenditure required for breathing.
 Increased Sputum Production: The patient mentioned that he produces a significant
amount of mucus, especially during respiratory flare-ups.

Treatment and Management Plan

The patient is currently receiving pharmacological treatment, including inhaled

bronchodilators and steroids, which help open his airways and reduce inflammation. His
treatment plan includes the following interventions:

1. Medications
o Inhaled bronchodilators: These help in widening the airways, making it
easier to breathe.
o Inhaled corticosteroids: These are used to reduce airway inflammation and
manage flare-ups.
o Antibiotics (when necessary): Prescribed during infections to manage
exacerbations.
2. Oxygen Therapy
Due to the patient’s low oxygen saturation levels, especially during physical exertion,
oxygen therapy has been introduced. He uses supplemental oxygen at night and
during strenuous activities to maintain adequate oxygen levels.
3. Pulmonary Rehabilitation
The patient attends a pulmonary rehabilitation program aimed at improving his
exercise tolerance, muscle strength, and overall respiratory function. This program
includes structured exercise routines, breathing exercises, and education on managing
COPD symptoms.
4. Lifestyle Modifications
o Smoking Cessation: The patient has quit smoking after being diagnosed with
COPD. However, the long-term damage from smoking continues to affect his
lung function.
 o Dietary Changes: He has been advised to maintain a nutritious diet, rich in
antioxidants and low in processed foods, to support his immune system and
lung health.
o Exercise Routine: He has started a light exercise regimen consisting of daily
walks to improve cardiovascular and pulmonary health.

Psychological and Social Support

The patient expressed feelings of isolation and anxiety due to his restricted lifestyle and
inability to engage in activities he once enjoyed. This emotional distress is compounded by
the fear of further deterioration of his lung function and frequent hospital visits. The
healthcare team at the center has provided psychological support, encouraging him to join
support groups for individuals with COPD. These groups offer emotional support, share
coping strategies, and promote a sense of community.

Family and Caregiver Support

The patient lives with his spouse, who has been his primary caregiver. His spouse expressed
concern over the patient’s physical limitations and the emotional toll COPD has had on their
relationship. They both attended counseling sessions to help manage stress, improve
communication, and enhance their understanding of the disease. Additionally, the healthcare
team provided information on advanced directives and end-of-life planning, ensuring that
both the patient and his family are prepared for future health challenges.

Prognosis

Despite the patient’s adherence to treatment and lifestyle changes, his COPD remains a
progressive condition. His symptoms, although somewhat controlled with medications and
oxygen therapy, are unlikely to improve significantly. However, with ongoing management
and continued support from his healthcare team, the patient can maintain a relatively stable
quality of life. His prognosis will depend heavily on his ability to avoid respiratory infections,
further exposure to pollutants, and his adherence to treatment plans.
The patient is also aware of the potential complications of COPD, such as respiratory
infections, pulmonary hypertension, heart failure, and lung cancer, and continues to
monitor his condition closely with regular follow-up visits.

Psychological Interventions in COPD Management

Given the impact of COPD on both physical and emotional well-being, psychological
interventions have been incorporated into the patient's treatment plan. These include:

 Stress Management Techniques: The patient was introduced to relaxation methods,

such as deep breathing exercises and mindfulness-based stress reduction (MBSR),
to alleviate stress and enhance emotional well-being.
 Cognitive-Behavioral Therapy (CBT): This therapy helps the patient manage
negative thought patterns related to his chronic illness, such as fear of exacerbations
or death. It also encourages more adaptive behaviors for managing stress and anxiety.
 Support Groups: The patient participates in a support group where he can meet
others who understand the challenges of living with COPD. These groups provide a
sense of community and offer shared experiences for coping strategies.

Final Observations

During the interview, the patient demonstrated an optimistic attitude despite his challenging
diagnosis. His awareness of the severity of COPD and his proactive approach to managing
the disease have significantly improved his quality of life. However, the patient emphasized
the importance of continued medical support and lifestyle changes in managing his condition
effectively.

Recommendations

 Regular Monitoring: It is essential to continue regular monitoring of lung function,

blood oxygen levels, and overall health.
 Pulmonary Rehabilitation: Ongoing participation in pulmonary rehabilitation
programs will continue to benefit the patient’s exercise capacity and overall
respiratory health.
  Psychological Support: Continued psychological support is recommended to help
manage stress, anxiety, and feelings of isolation.
 Vaccination: The patient should receive annual flu and pneumococcal vaccinations to
reduce the risk of infections, which can exacerbate COPD symptoms.

Conclusion

This visit to the Peacefully Person Care Centre provided valuable insight into the
complexities of managing COPD in a real-life setting. The patient's progress is a testament to
the importance of comprehensive care, including medical management, lifestyle changes,
and psychological support. These interventions, when combined, can help improve not only
the physical aspects of COPD but also the emotional well-being of the patient, leading to
better overall health outcomes.