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NUR 317 > Exam 3 > Flashcards

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
Q

Narcissistic personality disorders

A

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
Q

Cluster B Nursing Interventions

A

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
Q

Avoidant personality disorder

A

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
Q

Dependent personality disorder

A

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
Q

Obsessive-Compulsive Personality Disorder

A

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
Q

Cluster C Nursing Interventions

A

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
Q

Borderline personality disorder

A

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
Q

Dialectical behavioral therapy

A

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
Q

Disulfiram

A

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
Q

Clonidine

A

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
Q

Risk factors for SUD

A 
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
Q

Diagnosis of SUD

A

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
Q

Physiological consequences alcohol SUD

A

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
Q

Wernicke Korsakoff

A

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
Q

Signs of acute alcohol toxicity

A 
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
Q

Signs of alcohol withdrawal

A 
"STAIRS HD"
Sweating
Tremor
Anxiety
Insomnia
Rapid heart rate
Seizures
Hallucinations
Disorientation
Also abdominal cramping
Vomiting
Restlessness
Increased BP, RR, temp
41
Q

Alcohol withdrawal delirium

A

2-3 days after cessation, medical emergency

severe disorientation, severe HTN, cardiac dysrhythmias, delirium, hallucinations

42
Q

Opioid withdrawal symptoms

A

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
Q

Meds for alcohol withdrawal

A

Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone

44
Q

Meds for alcohol abstinence

A

Disulfiram, naltrexone, acamprosate

45
Q

Meds for opioid withdrawal

A

Methadone, clonidine, buprenorphine, naltrexone, levo-alpha-acetylmethadol

46
Q

Sedatives (benzo) withdrawal symptoms

A

anxiety, insomnia, diaphoresis, HTN, possible psychotic reactions, hand tremors, N/V, hallucinations or illusions, psychomotor agitation, possible seizures

47
Q

Sedative (benzo) toxicity

A 
Slurred speech
Lethargy
Pinpoint pupils
Decreased O2 sat
Shallow respirations
Hallucinations
Respiratory depression
Dysrhythmias
Cardiac or respiratory arrest
Death
48
Q

Methadone

A

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
Q

Buprenorphine

A

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
Q

Other meds given for alcohol withdrawal?

A

Benzos (Diazepam, lorazepam)

NUR 317 (1 decks)

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