Exam III Flashcards
What are the three main eating disorders
Anorexia nervosa,
Bulimia nervosa,
Binge eating
______ _______ is a disorder where the patient refuses to maintain a minimum normal weight for height and expresses an intense fear of normal weight gain.
Anorexia nervosa
_____ ____ can include the restriction of food intake and/or binge eating and purging
Anorexia nervosa
_____ _____ is an eating disorder where the patient engages in repeated episodes of binge eating followed by inappropriate compensatory behaviors, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
Bulimia nervosa
Individuals with _____ _____ disorder engage in repeated episodes of binge eating, after which they experience significant distress. This pattern inevitably causes obesity.
Binge eating
What is the physical criteria for hospitalization of patients with eating disorders?
Weight loss of 30% in 6 months, Heart rate less than 40 bpm, Systolic BP less than 70 mmHg, Arrhythmias, Hypokalemia (less than 3 mEQ/L) or other electrolyte imbalances, Hypothermia or dehydration
What is the psychiatric criteria for hospitalization of patients with eating disorders?
Suicidal ideation, Self-mutilating behavior, Extreme use of laxatives, emetics, diuretics, or street drugs, Non-compliance with treatment contract, Psychosis, Family crisis/dysfunction
What is a common etiology among those with eating disorders?
Childhood trauma,
Sexual abuse,
Physical neglect,
Emotional abuse
What are the biological factors related to eating disorders?
Heritability (poor affect and impulse control), Altered serotonin (causes dysregulation of appetite, mood and impulse control)
______ is an amino acid that is essential to serotonin synthesis and is available thru diet. Temporary drops in the level of this amino acid may relieve symptoms of anxiety and dysphoria and provide a reward for caloric restriction
Tryptophan
What are the signs and symptoms of anorexia nervosa?
Low weight, Amenorrhea, Yellow skin, Lanugo, Cold extremities, Peripheral edema, Muscle weakening, Constipation, Cardiovascular abnormalities (hypotension, bradycardia, heart failure), Impaired renal function. Hypokalemia, Anemic pancytopenia, Decreased bone density, Abnormal lab values (liver function)
A comprehensive nursing assessment of a patient with an eating disorder includes….
Patient perception of problem,
Eating habits,
History of dieting,
Methods of weight control (restricting, purging, exercising),
Determine patient value on specific shape/weight,
Interpersonal/social functioning,
Mental status/physiological parameters
Immediate medical stabilization is required if a patient experiences extreme _____ ______ and/or weighs below ____% of ideal body weight.
Electrolyte imbalance,
75%
A severe shift in electrolytes occurs when a patient consumes a quantity of complex carbohydrates after a prolonged period of deprivation. This causes fluid imbalances that can lead to potentially fatal conditions of Hypophosphatemia (low phosphates in the blood stream) and heart failure
Refeeding syndrome
What is the treatment goal for a patient with an eating disorder?
90% of ideal body weight
This is the weight appropriate to restore and maintain menses
What are appropriate nursing interventions for those with anorexia nervosa?
Provide structured environment with precise meal times,
Adherence to a selected menu,
Observation during and after meals,
Regularly scheduled weighing,
Monitor all trips to bathroom to prevent self-induced vomiting,
Monitor bathroom trips post visitors to monitor for emetic/laxative misuse
What are the signs and symptoms of bulimia nervosa?
Normal/slightly low weight, Dental caries/tooth erosion, Parotid swelling (increased serum amylase levels), Gastric dilation, Hand calluses/scars (Russell's sign), Peripheral edema, Muscle weakening, Abnormal electrolytes, Cardiovascular abnormalities, Cardiac failure (ipecac intoxification)
What is the priority nursing intervention for bulimia nervosa?
Medical stabilization (fluid/electrolyte balance, cardiac function)
What are the laboratory tests that should be run for a patient with bulimia nervosa?
Electrolyte levels, Glucose levels, Thyroid function, CBC, ECG
What are appropriate nursing interventions for those with bulimia nervosa?
Observation during and after meals,
Normalization of eating patterns,
Maintenance of appropriate exercise
What are signs and symptoms of binge eating?
Heartburn,
Dysphasia,
Bloating/abdominal pain,
Diarrhea/urgency/constipation/feeling of anal blockage
What are the typical comorbid emotional/behavioral problems associated with bulimia nervosa?
Major depression,
Substance abuse,
OCD
Patients with binge eating disorder are at risk for…
Diabetes,
Hypertension,
Heart disease
This is a result of obesity
What is the primary pharmacological intervention for binge eating disorder related to obesity?
Lorcaserin (Belviq)
Schedule IV drug. Activates serotonin receptors and blocks appetite signals
Must have BMI of 30+ or 27 with a health condition such as hypertension, high cholesterol, or type II diabetes
Side effects include headache, dizziness, fatigue, nausea, dry mouth, constipation
What is the second pharmacological intervention for binge eating disorder related to obesity?
Qsymia (Topiramate/Phentermine combo)
Schedule IV drug. Must have BMI of 30+ or 27 with a health condition such as hypertension, high cholesterol, or type II
Reduces feelings of fullness, reduced taste sensation, and quicker calorie burning
Side effects include tingling of hands and feet, dizziness, altered taste sensation, insomnia, constipation, dry mouth
_____ is unsuccessful bowel control
Copresis
_____ is the voiding of urine
Enuresis
_____ disorder characterizes the rubbing against or touching of another non-consenting person
Frotteuristic
_____ disorder involves the fixation on feces in sexual encounters
Coprophilic
_____ disorder involves sexual activity that incorporates enemas
Klismaphilic
_____ is a disorder with a desire to achieve an altered state of consciousness secondary to hypoxia while experiencing orgasm; a drug such as nitrous oxide may be used to produce hypoxia
Hypoxyphilia
What are the pharmacological interventions for paraphilic disorders?
Antiandrogens and serotonergic antidepressents.
What is the pharmacological treatment for sex offenders?
Testosterone reducing drugs:
Medroxyprogesterone acetate (MPA)
Cyproterone acetate (CPA)Intentional intimidation, abuse, or neglect of children, adults, or elders by a family member, intimate partner, or caregiver in order to gain power and control over the victim is called…
Family violence
What are the social factors that reinforce violence?
Wide acceptance of corporal punishment, Violent movies, Video games, Websites, Comic books, Some music, Pornography
The propensity for violence is rooted in childhood and manifests by…
Lack or self-regard,
Dissatisfaction with life,
Inability to assume adult roles
What are the characteristics of abusive parents?
History of abuse, Low self-esteem, Poor coping skills, Crisis such as unemployment, divorce, Unrealistic expectations, Mental illness, Drug or alcohol abuse, Poor impulse control
What is the cycle of violence?
Tension building stage: minor incidents occur,
Acute battering stage: built up tension released by abuser,
Honeymoon stage: kind and loving behaviors
What are some general symptoms of violence?
Chronic pain,
Insomnia,
Hyperventilation,
Gynecological problems
What should be included in assessment for violence?
Sexual abuse,
Family violence,
Drug use/abuse
This is psychological reaction to a serious trauma, such as witnessing a death, suffering a serious injury, or a sexual violation.
Acute stress disorder
A female sexual assault victim should receive these three services at the hospital
Rape counseling,
Emergency contraceptives,
STD/HIV management
What 5 things does the nurse assess in a sexual assault victim ?
Level of anxiety, Coping mechanisms, Available support systems, Signs/symptoms of emotional trauma, Signs/symptoms of physical trauma
When collecting evidence for a sexual assault victim, what are the 5 steps of the exam?
HTT exam, Detailed genital exam, Evidence collection and preservation, Documentation of physical findings, Treatment, discharge planning, follow-up care
This is the sustained and maladaptive response to a forced, violent penetration against the victim’s will and consent
Rape-trauma syndrome
_____ is an emotional response to frustration of desires, a threat to ones needs (emotional or physical), or a challenge.
Anger
____ is an action or behavior that results in a verbal or physical attack.
Aggression
_____ is an objectionable act that involves intentional use of force that results in, or has the potential to result in injury to another person.
Violence
______ has been shown to increase the rate of major cardiac events
Suppression of anger
_____ has been shown to increase a person’s perception of pain
Anger
Biological factors such as brain tumors, Alzheimer’s disease, temporal lobe epilepsy, and traumatic injury result in charges to personality that include _______
Increased violence
What is the area of the brain associated with aggression?
The limbic system
Specifically, the Amygdala
Which neurotransmitter is associated with impulsive aggression?
Serotonin (low levels)
What are the signs and symptoms that usually proceed violence?
Hyperactivity, Increased anxiety/tension, Verbal abuse, Loud voice, change of pitch, Intense eye contact, Silence, Alcohol or drug intoxication, Possession of a weapon, Isolation that is new
What milieu characteristics are conducive to violence?
Overcrowding, Staff inexperience, Provocative or controlling staff, Poor limit setting, Arbitrary revocation of privileges
What assessments are done to predict violent behavior ?
History of violence,
Delusions, hyperactivity, impulsive,
Assess for triggers,
Assess person sense of competence during conflict
What type of medications are used for patients with anger/aggression problems?
Antianxiety,
Antipsychotics
Body temperature below 36.2c/97f is called …
Hypothermia
Body temperature above 37.6c/100f is called…
Hyperthermia
Extremely high body temperature is called…
Hyperpyrexia
The thermostat center of the body is the _____
Hypothalamus
The transfer of heat from one surface to another is called…
Conduction
The loss of heat by air currents moving across the body is called…
Convection
Electromagnetic waves emit heat from the skin surface to the air is called…
Radiation
What process takes place to cause vasoconstriction when body temperature drops?
Hypothalamus secretes TSH-RH ->stimulates anterior pituitary,
Anterior pituitary secretes TSH ->activates adrenal medulla,
Adrenal medulla ->causes release of epinephrine into blood,
Epinephrine ->increases heat production by increasing metabolic rate, stimulating glycolysis, and causing vasoconstriction.
What process takes place to cause shivering when body temperature drops?
Hypothalamus ->stimulates sympathetic nervous system,
Sympathetic nervous system->triggers adrenal cortex,
Adrenal cortex->increases muscle tone and initiates shivering and vasoconstriction
What is the physical result of excess body temperature over time?
Hypotension, Tachycardia, Decreased cardiac output, Reduced perfusion, Reduced coagulation, cardiovascular collapse
What is the physical result of reduced body temperature over time?
Reduced cognition, Peripheral tissue edema, Increased blood viscosity, Reduced blood flow, Coagulation
What is NMS?
Neuroleptic Malignant Syndrome
Reduced consciousness, muscle rigidity, Autonamic dysfunction (Hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis and drooling)m
Which condition is characterized by reduced consciousness, muscle rigidity, Autonamic dysfunction (Hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis and drooling)m
NMS
What causes NMS?
Excessive dopamine receptor blockage
This is due to use of first generation antipsychotic drugs
What is the treatment for NMS?
Discontinue antipsychotics,
Manage fluid balance,
Rapid temperature reduction (cooling blankets, ice bath),
Monitor for deep vein thrombosis and rhabdomyolysis
What are the pharmacological treatments for NMS?
Mild case: bromocriptine (Parlodel)
Severe case: dantrolene (Dantrium)
Which cardiac drug causes hypothyroidism?
Amiodarone (Cordarone)
What is an example of a maturational crisis?
Going to college
What is an example of situational crisis?
Loss of job, death.
What is an example of adventitious crisis?
Flood, tornado, earthquake.
What are priority nursing interventions for crisis management?
Safety and anxiety reduction
What are the four stages of human sexual response?
Excitement,
Plateau,
Orgasmic,
Resolution
What eight things are asked when recording a sexual history?
Menstrual history, parity/pregnancies, Safe sex practices, Number of partners, Frequency/type sexual activity, Sexual satisfaction, Knowledge of sexual function, Perceived problems, STIs, drug use, tattoos
How long must someone partake in a paraphilic activity before it’s considered a disorder?
6 months
What are the three primary date rape drugs?
GHB,
Rohypnol (Flunitrazepam),
Ketamine
What are first line drugs for acute aggressive episodes?
Benzodiazepines (i.e. Lorazepam)
Atypical antipsychotics (Risperidone) and Typical Neuroleptics (haloperidol) are used for acute aggression and psychosis induced violence
What body temperature signifies hypothermia?
Below 36.2 c/97 f
What body temperature signifies hyperthermia?
Above 37.6 c/99.6 f
What body temperature signifies hyperplexia?
Above 41.5 c/106.7 f
