Exam 3 Flashcards
What is russells sign?
nondescript dorsal lesions are caused by repeated contact of the incisors to the skin of the hand that occur during self induced vomiting.
What is known as an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness?
repression (defense mechanism)
what may be seen in a client who has developed conversion disorder due to the stress of recently losing a child?
they go blind, deaf, etc.
what are the cues for illness anxiety disorder?
- anxiety that severe illness is present/be acquired
- anxiety is present > 6 months
what may be a likely practice for a client who has illness anxiety disorder with the belief they have breast cancer?
constantly performing breast self-exams
what condition is characterized by the client travelling to a new area and forgetting identity following a traumatic event?
dissociative fugue
what condition is characterized by a client having 2 or more distinct personalities, with the switch being precipitated by a stressful event?
DID (dissociative identity disorder)
what are the cues for derealization?
- patient feels that outside world is not real
- experiences feel dream-like
- objects appear larger/smaller than what they should
what condition is characterized by a feeling that one is observing their own body from a distance?
depersonalization
what are some patient teaching points for conversion disorder?
- participate in individual and group therapy
- attend community support groups
- utilize prescribed meds
- stress management
how can unnecessary medical expenses, procedures, treatments, and operations be prevented in those suspected with factitious order?
openly discuss speculation about factitious disorder; mention to healthcare team (ati EBP)
what condition is lanugo present in?
anorexia nervosa
what eating disorder is characterized by food consumption followed by purging?
bulimia nervosa (vomiting or laxatives)
What are some expected clinical findings consistent with a diagnosis of binge eating disorder?
obesity with health problems consistent with obesity like HTN and diabetes (elevated a1C)
- abdominal pain
what is likely true of the BMI of those with binge eating disorder?
increased (obesity)
why may a client with binge eating disorder experience abdominal pain?
larger than normal amounts of food cause gastrointestinal dilation
- may also have: constipation, diarrhea, urgency and feeling of anal blockage
how can we emotionally support a client with bulimia nervosa?
encourage independent decision making (ati)
why is prazosin given to patients with PTSD who are experiencing nightmares?
prazosin inhibits the brains response to norepinephrine
how does EMDR work?
(eye movement desensitization and reprocessing therapy)
it uses stimuli (tapping, eye movements, audio sounds) combined with verbalization of the traumatic event by the client to change how the client processes the trauma
what diagnosis can the nurse expect for a client who gets anxious when attempting to go out alone and must quickly return and hasn’t been able to leave the house for 10 years?
agoraphobia
what medication may be provided to a patient who is experiencing PTSD following a traumatic event?
paroxetine (SSRI*)
how does trauma effect the hippocampus?
decreased volume, which can lead to memory dysregulation/deficits
what are the biological responses to stress?
increase HR/BP/RR, sweating, pupil dilation, etc.
what are the assessment findings for binge eating disorder?
high BMI (obesity), Hgb A1C 6.5 (elevation)
what type of foods are preferred in those with binge eating disorder?
soft, easily digestible and sugary
identify the likely eating disorder:
- amenorrhea
- BMI 15 (low)
- lanugo
anorexia nervosa
which condition is consistent with the following assessment findings?
- russells sign
- dental erosion
- parotid enlargement
bulimia nervosa
what education should be included for a new prescription of fluoxetine for treatment of an eating disorder?
do not drive for the first few days after starting the medication
what is the hypothalamus responsible for?
regulate appetite, blood pressure, and thirst
which anatomical brain structure is involved in anorexia nervosa?
hypothalamus
what are the nursing interventions for anorexia nervosa?
- assess skin turgor
- sit w/them during meals
- assess for enlarged parotid glands
- begin parenteral fluids and electrolytes
- assess HR and BP
why would someone with OCD apply, remove, then reapply makeup?
attempt to reduce anxiety
what action should the nurse take for a client who is having a panic attack?
stay with the client and remain quiet
- avoid stimuli (turn off TV, dim lights, etc.)
what findings are expected in generalized anxiety disorder?
- restlessness
- sleep disturbances
-procrastination in decision making - muscle tension
what is a statement to make for a client who has severe anxiety?
“tell me about how you are feeling right now?”
what findings may be seen in a client with PTSD?
- difficulty concentrating on tasks
- negative self-image
- recurring nightmares
how can PTSD be prevented in nurses who have been involved in a prolonged mass casualty incident?
- take breaks during incident for food/water
- debrief with others
- take advantage of counseling
what is an indication of derealization?
client states furniture is far away and small
what should be added to the plan of care for dissociative fugue?
work with client on grounding techniques
what should be included in assessment of anorexia nervosa (questions to ask)?
- what is your relationship like with your family?
- describe current eating habits?
- discuss feelings about appearance?
what are expected admission findings for a client with bulimia nervosa?
- hypokalemia
- slightly elevated body weight
what are some risk factors for somatic symptom disorder?
- anxiety disorder
- childhood trauma
what places a client at risk for conversion disorder?
- acute (death of a child 2 months ago)
These findings may be seen in illness anxiety disorder:
- obsessive thoughts about disease
- hx childhood abuse
- avoidance of providers
- depressive disorder
what should be in the plan of care for conversion disorder?
- encourage them to communicate with others
- monitor risk of self harm
- time limit for discussion of manifestations
- discuss alternate coping mechanisms
what is common adverse effect of buspirone?
dizziness
which neurotransmitters are implicated in anxiety disorder?
serotonin, norepinephrine, and gaba
Memories can trigger the release of fight or flight hormones. Which structure heightens fear?
amygdala
which level of anxiety improves awareness and alertness?
mild
Which level of anxiety is the client unable to focus, concentrate, or comprehend simple commands?
panic level
Which interventions are appropriate for panic level anxiety?
- stay with them
- administer lorazepam PRN
- obtain a paper bag
- decrease stimuli
which eating disorder is characterized by restriction?
anorexia nervosa
which eating disorder is characterized by binging with compensation?
bulimia nervosa
which eating disorder is characterized by binging but with NO compensation?
binge eating disorder
what are some of the potential complications of refeeding syndrome?
cardiac dysrhythmia, cardiac collapse, delirium, death
what are some electrolyte imbalances that may occur as a result of refeeding syndrome?
hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemia
what may be found of the levels of endogenous opioids of those with anorexia nervosa?
the levels are increased, which is thought to be associated with denial of hunger
why are some patients with anorexia nervosa given naloxone (opioid antagonist)?
high levels of endogenous opioids are thought to contribute to denial of hunger, so naloxone is given to promote weight gain
what system in prominent in controlling appetite and drives for food?
dopamine reward system
what are maladaptive reactions to stress?
harmful, unhealthy and disrupts the integrity of the individual
why are antianxiolytics given for stress?
GABA is supposed to stop physical stress, but it may not work as it is supposed to
what are some blood dyscrasia manifestations that the nurse should teach the client taking benzodiazepines to report?
sore throat, fever, malaise, bruising, and bleeding
how long does buspirone take to diminish symptoms in anxiety?
2 weeks
what is localized dissociative amnesia?
can’t recall all incidents associated w/stressful event
what is selective dissociative amnesia?
can only recall certain incidents for a specific period
what is generalized dissociative amnesia?
amnesia for his/her identity/total life history
