Exam 4 Flashcards
somatic d/o examples (4)
-somatic symptom d/o
-illness anxiety d/o
-functional neurological symptom d/o
-factitious d/o (Munchausen’s)
somatic symptom d/o pathway
1) anxiety leads to
2) chest pain leads to
3) thinking that they are having a heart attack
somatic d/o nursing role
-take somatic complaints seriously
-pursue tx until medical issues are ruled out
illness anxiety d/o pathway
- saw a man cough at the grocery store
- and I am deathly afraid of ebola
- therefore, no more grocery store for me
functional neurological symptom d/o (aka conversion d/o)
-neurological d/o w/unknown etiology
-symptoms manifest that affect nervous system
factitious d/o / Munchausen
-symptom deception
-convincing others of illness or injury
-exaggerating sx
-making up hx
-faking sx
-self harm
Munchausen by proxy
-projecting sx onto another
-usually children or family member
-identify potential for child abuse
dissociative disorders
-disconnecting from reality
-re-experiencing trauma
-unconscious protection from the trauma
dissociative d/o diagnoses examples (4)
-depersonalization
-derealization
-dissociative amnesia
-dissociative identity d/o
dissociative amnesia (3)
-no recollection of traumatic event
-missing memories
-“blacked out”
dissociative identity d/o
-protective mechanism
-belief of multiple people living in same body
-switching to different identities
How dissociative identity d/o is protective
-individual is traumatized
-individual struggles w/ sx
-individual develops new identity that never experienced the trauma
-individual switches to new identity as coping mechanism
depersonalization / derealization
- trauma-related
-detachment from physical body
-out-of-body expereinces
-emotional disconnection
Tx for somatic d/o
-psychotherapy
-psychopharm
-CBT/DBT
What to focus on as a nurse
-ensure safety
-sx presentation
-differentiation of diagnoses
-therapeutic communication
-client education
healthy eating (4)
-variety of foods
-response to hunger
-stop when full
-no guilt or anxiety
eating d/o (5)
-disruption to any component of healthy eating
-binge eating
-not eating enough
-only eating certain foods
-experiencing guilt or anxiety related to eating
warning signs for eating d/o (6)
-unexplained obvious weight loss/gain
-lying about food/eating
-secret eating/bingeing
-excessive exercise
-pre-occupation with weight and body image
-fear of fat
major classes of eating d/o (3)
-anorexia nervosa
-bulimia nervosa
-binge eating d/o
other eating d/o related d/o
-pica
-avoidant restrictive food intake d/o
-orthorexia
-rumination
-diabulimia
eating d/o risk factors
-anxiety, depression, SUD, OCD
-avoidant personality d/o, borderline personality d/o
-family hx
-culture, occupation, abuse
populations that tend to have eating d/o more often
-mostly female (10:1 female to male)
-transgender
-veterans
eating d/o complications
-diabetes
-DKA
-electrolyte disruptions
-osteoporosis
-dental problems
-kidney failure
-cardiac dysfunction
-skin issues
-menstrual disruption
anorexia nervosa characterized by:
-intentional starvation
-restriction of calorie intake relative to need
-decreased weight/BMI
anorexia: mental components
-fear of weight gain
-aversion to high calories foods
-body image issues
-inability to recognize low body weight
anorexia presentation
-thin
-emaciated
-hypotension
-bradycardia
-dysrhythmias
-dehydration
-dry skin
-decreased bone density
-muscle weakness
-menstrual irregularity or absence
anorexia lab expectations
-electrolyte imbalance
-anemia
-neutropenia
-hypoglycemia
psych presentation of anorexia (7)
-negative, self-defeating patterns
-polarized thinking
-emotional reasoning
-catastrophizing
-control fallacies
-mind reading
-trouble concentrating
bulimia nervosa characteized by:
episodes of purging
-vomiting
-use of laxatives
-use of medications
-excessive exercise
on average at least once a week for 3 months
bulimia presentation
-can have normal weight
-GI issues
-dental issues
-lab values off
-enlarged parotid gland
-Russell’s sign
bulimia lab results (2)
-electrolyte imbalance
-acid/base disturbance
bulimia psych expectations
-secretive food practices
-going straight to the bathroom after meals
Binge Eating d/o characterized by:
-episodes of binge eating
-at least once per week for 3 months
-not associated with purging
binge eating criteria (need 3 or more)
-eating much more rapidly than normal
-eating until feeling uncomfortably full
-eating large amounts of food when not feeling physically hungry
-eating alone because of feeling embarrassed by how much one is eating
-feeling disgusted with oneself, depressed, or very guilty afterwards
-marked distress regarding binge-eating is present
binge eating assessment
-nutritional deficiencies
-GI disturbances
-Weight gain/obesity
-bowel issues
-HTN
-heart disease
psych expectations with binge eating
-depression
-anxiety
-feelings of guilt, shame, and embarrassment
-low self-esteem
-global cognitive impairments
-decreased inhibitory control
-addictive style of thinking
nurse considerations
-trust building
-careful monitoring
-consider physical manifestations
nursing priorities for binge eating
-safety (risk for SI/SA)
-medical stability
-cardiac, neuro, etc.
-psychosocial (mood, affect, socialization)
-education (treatment options, meds, nutrition, resources)
refeeding syndrome
-massive shift in electrolytes
-CV decompensation
-deadly
eating d/o tx (6)
-typically specialized units
-extended stay (30+ days)
-specific to eating d/o
-group meals
-careful monitoring
-special training to identify patterns in behavior
monitoring meals
-meals must be eaten within a specific time frame
-everything on tray should be eaten
-supplements may be provided
-strict calorie count
-watch for smearing, hiding of food
other behavior monitoring for eating d/o
-remain visible for 1-2 hrs after meals
-daily weights
therapy options for eating d/o
-CBT
-DBT
-Acceptance Commitment Therapy (ACT)
