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Exam 3 Flashcards

ATI Ch 7,8,19

1
Q

Types of Eating Disorders

A

Anorexia Nervosa, Bulimia Nervosa, Binge-eating disorder

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2
Q

Risk factors for eating disorders

A

Participation in sports/activities that encourage thinness
Being a picky eater in childhood
History of obesity
Comorbidities: bipolar, depressive, anxiety disorders, OCD, alcohol & substance use disorders
Genetics
Neurobiological
Environmental-bad diets, celebrity role models, social media trends

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3
Q

Consequences of eating disorders

A

Chronic malnutrition
Electrolyte imbalances-low levels
Dehydration
Behaviors-purging, misuse of laxatives/diuretics, excessive exercise
Vitals-hypotension, bradycardia, orthostatic hypotension, rebound tachycardia
Weight
Skin-lanugo(with severe malnutrition), gaunt, muscle wasting, poor skin turgor, cold hands and feet, cold intolerance, skin mottling, acrocyanosis, Russel sign (small cuts over the backs of hands)
Liver damage-jaundice
Head/Neck/Throat-damaged enamel, retinal hemorrhages, enlarged parotid glands from purging
Musculoskeletal-osteoporosis, bony prominence
Easy bruising
Gastrointestinal-ileus, can progress to ostomy due to chronic laxative use
Reproductive-menstrual irregularity, amenorrhea

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4
Q

Refeeding Syndrome

A

Decreased blood glucose>decreased insulin>increased blood glucose after reintroducing carbs>sudden increase insulin>hypophosphate, low thiamine, low sodium, electrolyte imbalances
Leads to massive cardiac dysrhythmias and death
Occurs after long period of malnutrition with sudden reintroduction of food
To avoid refeeding syndrome, must reintroduce food slowly

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5
Q

High Risk for Refeeding Syndrome

A

Body mass index <16
Weight loss >10% past 3-6 months
Little to no intake in the last 5 or more days
Baseline low potassium, phosphate, magnesium before feeding
H/o alcohol or substance use
Long term antacids/diuretics (due to electrolyte imbalances)

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6
Q

Anorexia Nervosa Diagnosis and Subtypes

A

Intense fear weight gain
Distorted body image
Restricted calories w/ low BMI

Subtypes:
Restricting-drastic restriction of food intake, doesn’t binge/purge
Binge-eating/purging

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7
Q

Bulimia Nervosa Diagnosis

A

Normal weight range or higher (BMI 18.5-30)
Recurrent uncontrollable binging
Inappropriate compensatory behaviors: vomiting, laxatives, enemas, diuretics, exercise
Self-image largely influenced by body image

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8
Q

Binge eating disorder

A

Uncontrollable binging without purging

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9
Q

Assessment-anorexia

A

History
MSE: Overgeneralizations-black and white thinking
ask what they eat in a day-very specific calorie counts in answers
All or nothing thinking-if I eat that I will gain 5 pounds
Catastrophizing-“people will hate me”
Physical findings
Labs: CBC, CMP, AST/ALT, Lipid panel, Thyroid, Vitamins/minerals-calcium vitamin D, serum amylase (to tell whether purging or not)
EKG

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10
Q

Assessment Bulimia Nervosa

A

Enlarged parotid
Russel’s sign
Cavities

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11
Q

Criteria for acute care/in patient

A

Rapid weight loss greater than 30% over last 6 months
Unsuccessful weight gain in outpatient, failure to adhere to treatment
ECG changes
Electrolyte disturbances
Low vital signs
Psychiatric criteria-severe depression, SI, psychosis

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12
Q

Interventions

A

Desensitization exercises-putting food on a plate, sitting in front of food, going to the kitchen, etc.
Controlled milieu-no flexibility or choices with meals
6 or small frequent meals/snacks throughout the day
Monitored during meals and post meals (postprandial)
Blind Weight, weekly labs, vitals
Wavy mirrors
Multivitamins

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13
Q

Personality Disorders: Individuals struggle with:

A

Self-identity, self-direction, empathy & intimacy, social relationships

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14
Q

Common findings of personality disorders

A

Inflexibility/maladaptive response to stress
Compulsiveness and lack of social restraint
Inability to emotionally connect in social and professional relationships
Tendency to provoke interpersonal conflict

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15
Q

Risk factors for personality disorders

A

Genetics (hypersensitivity, impulsivity, emotional dysregulation)
Environmental (neglect, trauma, dysfunctional family/social patterns)
Individual (comorbidity substance use disorder, depression, anxiety, eating disorders, h/o nonviolent and violent crimes)

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16
Q

Cluster A Personality Disorder

A

Odd and eccentric:
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder

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17
Q

Cluster B Personality Disorder

A 
dramatic and unpredictable:
antisocial personality disorder
borderline
histrionic
narcissistic
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18
Q

Cluster C Personality Disorder

A

anxious and fearful:
avoidant
dependent
obsessive-compulsive

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19
Q

Paranoid personality disorder

A

Extreme distrust and fear of others-jealousy, controlling behaviors, unwillingness to forgive
Defense mechanism: projection

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20
Q

Schizoid personality disorder

A

emotional detachment, disinterest in close relationships, indifference fo praise or criticism, uncooperative.
“loners”; lifelong social withdrawal, expressionless, restricted range emotional expression
Does not seek out or enjoy relationships

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21
Q

Schizotypal personality disorder

A

both personality disorder and schizophrenia spectrum disorder
odd beliefs and magical thinking leading to interpersonal difficulties, eccentric appearance, perceptual distortions that aren’t clear delusions/hallucinations
can be made aware of delusions with evidence
strange and unusual beliefs, speech patterns, inappropriate affect
severe anxiety in social situations

22
Q

Cluster A Nursing Considerations

A

odd eccentric: schizoid, paranoid, schizotypal
High degree of mistrust-adhere to promises, appointments, schedules
Give straightforward explanations-avoid being “too nice”
Simple language
Limit setting
Don’t try to increase socialization, respect need for social isolation
Interventions appropriate for suspicion
Strange beliefs and activities may be part of their life

23
Q

Antisocial personality disorder

A

disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility
evidence of conduct disorder before age 15
entitled, manipulative, impulsive, seductive behaviors
verbally charming and engaging
little to no capacity for intimacy, concerned with gaining personal power or pleasure, other’s needs do not matter
1.1% more common in men
risk factors: genetic predisposition, childhood maltreatment, inconsistent parenting/discipline, abuse neglect, history of impulse control or conduct disorder (severe rule breaking, fire setting, abuse of animals)

24
Q

Histrionic personality disorder

A

Emotional, attention-seeing. Person needs to be the center of attention.
Dramatic, seductive, and flirtatious
Extroverted, colorful personalities, excitable, struggle developing meaningful relationships
No insight in role of impaired relationships, can make partners feel smothered, exaggerate symptoms
Behaviors stem from distress

25
Narcissistic personality disorders
arrogance, grandiose view of self-importance, need for consistent admiration, lack of empathy for others=strained relationships sensitive to criticism behaviors stem from weak self-esteem, shame, fear of abandonment
26
Cluster B Nursing Interventions
Limit setting objectively document behaviors Be aware that preventing desires may result in aggression All staff needs to be consistent! Understand seductive behavior is result of distress Assess for SI Avoid engaging in power struggles, becoming defensive Provide exercises to enhance new social skills-use with caution, failure can increase feelings of poor self worth
27
Avoidant personality disorder
social inhibition, avoidance of all situations that require interpersonal contact despite wanting close relationships due to extreme fear of rejection feelings of inadequacy, anxious in social situations Low self-esteem, feelings of inferiority, reluctance to engage in unfamiliar activities with new people
28
Dependent personality disorder
extreme dependency in a close relationship with urgent search to find a replacement when one relationship ends submissive and clinging behavior overwhelming need to be cared for intense fear of separation/abandonment, intense anxiety when left alone may manipulate others to assume their responsibilities; may act like they need more help than they do Stem from lack of confidence in own abilities or judgment vulnerable to exploitation
29
Obsessive-Compulsive Personality Disorder
Obsessed with perfection in what they do and what others do Struggle to start and finish tasks because "they have to be perfect" in every situation Want relationships but may struggle if they don't meet expectations May also drop away from relationships to hyperfocus on work/tasks but never actually complete Limited emotional expression Stubborn, indecisive Rigid, inflexible standard of self and others
30
Cluster C Nursing Interventions
Friendly, accepting, reassuring approach Remember being pushed into social situations can induce severe anxiety Convey attitude of acceptance toward fears Assertiveness training (dependent personality) Provide exercises to enhance social skills, use with caution Beware clients may struggle with sudden change in routine Identify ineffective coping and develop effective coping
31
Borderline personality disorder
Difficulty with empathy and intimacy Emotional lability Huge fear of rejection (will see massive behavioral reaction if pt feels rejected) Impulsive and reactive, risk taking behaviors May act out and hurt themselves in order to get people to be there for them History of self harm-usually low risk, suicidal behaviors to get attention High mortality rate: 10% 85% meet criteria for another disorder (SUD, MDD, anxiety, antisocial) Risk factors: five times more common with 1st degree relatives, genetic hypersensitivity, impulsivity, emotional dysregulation Defense mechanisms: Splitting (if they feel rejected will take drastic actions in the opposite mindset), undoing, regressing
32
Dialectical behavioral therapy
Mindfulness techniques, distress tolerance, emotion regulation, interpersonal effectiveness Long term treatment for borderline personality disorder Teaches patients to manage their own distress; try to avoid admitting when possible because it reinforces attention seeking behaviors Only admit if serious safety risk
33
Disulfiram
Aversion therapy for alcohol use disorder; acetaldehyde syndrome if taken concurrently with alcohol causes N/V, sweating, weakness, palpitations, respiratory depression, hypotension, seizures, death, hepatotoxicity, metallic aftertaste Inhibit breakdown of acetaldehyde, increases alcohol metabolites Contraindications/Precautions: liver/kidney dysfunction, pregnancy, heart disease, psychosis Education: drinking alcohol is dangerous, avoid vanilla, aftershave, mouth wash, hand sanitizer, cough syrup, some perfumes Risk lasts up to two weeks after d/c Wear med alert bracelet Use in conjunction with therapy, 12 step programs
34
Clonidine
Reduce effect of opioid withdrawal, hypertension Centrally acting alpha 2 agonist, suppress fight or flight, decrease norepinephrine, vasodilation (decreased BP), decrease HR Adverse reactions: drowsiness, dizziness, dry mouth, anticholinergic effects, rebound hypertension if not tapered Interactions: intensifies benzos, cocaine, and opioids euphoria, sedation, and hallucinations with high doses Nursing interventions: take BP before administering
35
Risk factors for SUD
``` Family history chronic stress-socioeconomic factors History of trauma-abuse, combat experience Low self esteem Low tolerance for pain/frustration Few meaningful personal relationships Few life successes Risk-taking tendencies Burnout Drug availability Co-occurring mental health disorders ```
36
Diagnosis of SUD
2 of the 11 within 12 months: increased use over time, desire to or unsuccessful attempts to stop, cravings, continued use despite consequences, tolerance, withdrawal, impact to relationships, job, housing mild=2 moderate=4 severe=6 +
37
Physiological consequences alcohol SUD
Cardiovascular-HTN, A fib, cardiomyopathy, stroke, CAD, sudden cardiac death GI-GERD, gastritis, peptic ulcer, esophageal varices, pancreatitis, oropharyngeal and colorectal cancer Hematologic-bone marrow suppression, anemia, leukopenia, thrombocytopenia, blood clotting disorders Hepatic-cirrhosis, hepatitis, liver cancer Integumentary-palmar erythema, spider angiomas, rhinophyma, rosacea Musc-myopathy, osteoporosis, gout Neuro-insomnia, alcohol dementia, Wernicke kors syndrome, impaired cognitive, psychomotor and abstract thinking. depression, anxiety, attention deficit, labile effect, seizures, insomnia, peripheral neuropathy, chronic headache Repro-testicular atrophy, breast cancer, decreased beard growth, decreased libido, decreased sperm count, gynecomastia Urinary-diuretic effect from inhibition ADH
38
Wernicke Korsakoff
Wernicke-acute lack of thiamine: mental confusion, vision problems, hypothermia, ataxia, memory issues Korsakoff-chronic lack of thiamine: irreversible brain damage, same symptoms, permanent memory loss, inability to form new memories or retrieve previous memories
39
Signs of acute alcohol toxicity
``` Unintentional overdose Slurred speech Nystagmus Memory impairment Altered judgment Decreased motor skills Decreased LOC Respiratory arrest Peripheral collapse-abnormally low BP leads to collapsed arteries and veins Death ```
40
Signs of alcohol withdrawal
``` "STAIRS HD" Sweating Tremor Anxiety Insomnia Rapid heart rate Seizures Hallucinations Disorientation Also abdominal cramping Vomiting Restlessness Increased BP, RR, temp ```
41
Alcohol withdrawal delirium
2-3 days after cessation, medical emergency | severe disorientation, severe HTN, cardiac dysrhythmias, delirium, hallucinations
42
Opioid withdrawal symptoms
Sweating & rhinorrhea progressing to piloerection, tremors, and irritability followed by severe weakness, diarrhea, fever, insomnia, pupil dilation, N/V, pain in the muscles and bones and muscle spasms
43
Meds for alcohol withdrawal
Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone
44
Meds for alcohol abstinence
Disulfiram, naltrexone, acamprosate
45
Meds for opioid withdrawal
Methadone, clonidine, buprenorphine, naltrexone, levo-alpha-acetylmethadol
46
Sedatives (benzo) withdrawal symptoms
anxiety, insomnia, diaphoresis, HTN, possible psychotic reactions, hand tremors, N/V, hallucinations or illusions, psychomotor agitation, possible seizures
47
Sedative (benzo) toxicity
``` Slurred speech Lethargy Pinpoint pupils Decreased O2 sat Shallow respirations Hallucinations Respiratory depression Dysrhythmias Cardiac or respiratory arrest Death ```
48
Methadone
Use: used for withdrawal and long term maintenance, reduce effect of opioid withdrawal, prevent relapse, Mu receptor agonist Contraindications/Precautions: GI obstruction, ileus, pregnant, elderly, cardiac/liver/renal impairment Adverse reactions: drowsiness, dizziness, respiratory depression, hypotension, cardiac arrest, dependency withdrawal (if not tapered)
49
Buprenorphine
Use: opioid agonist-antagonist for withdrawal and maintenance, decrease craving, relapse prevention Interactions: increase anticholinergic effect, CNS depressants Contraindications/Precautions: GI obstruction, ileus, asthma, liver dysfunction Adverse reactions: respiratory depression, hypotension, constipation, dependency, angioedema, abrupt cessation, precipitated withdrawal Administer sublingually
50
Other meds given for alcohol withdrawal?
Benzos (Diazepam, lorazepam)

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