Mod. 7 ATI ch. 16, 19 Flashcards
Anorexia Nervosa
persistent energy intake restriction leading to extreme low weight
fear of gaining weight
disturbance of self-perceived weight of shape
amenorrhea
3 missed cycles as a sign of amenorrhea
Anorexia Nervosa types
Restricting type: drastically restricts food and does not binge or purge
Binge-eating/ purging type: engages in binge eating or purging
anorexia nervosa characteristics
- preoccupied with food and rituals of eating & refusal to eat
- most often in female from adolescence to young adulthood
- onset can be due to stress
- restricting type: binge-eating/ purging type have higher rates of impulsivity, more likely to abuse drugs/ alcohol
Bulimia nervosa
-eat large amounts of food (binge eating)
followed by compensatory behaviors such as: purging
-binge eating and compensatory behavior occur on average once per week for at least 3 mo.
-binge eating happens usually in less than 2 hours
Bulimia nervosa characteristics
- most maintain a weight within normal range or slightly higher BMI is 18.5 to 30
- average age on onset in females is late adolescence or early adulthood
- occurs more in females
- between binges, clients typically restrict caloric intake and select low-calorie “diet” foods
Types of bulimia nervosa
Purging type: client uses self-induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight.
Non-purging type: client can compensate for binge eating through other means (excessive exercise and the misuse of laxatives, diuretics, and/or enemas)
Personality Disorder
Cluster A: odd or eccentric traits
Paranoid: distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person
Schizoid: emotional detachment, disinterest in close relationships, and indifference to praise or criticism, often uncooperative
Schizotypal: odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations
may be argumentative, sometimes grandiosity behavior
Personality Disorders
Cluster B: dramatic, emotional, erratic traits
- antisocial
- borderline
- histrionic
- narcissistic
cluster B
Antisocial
disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility, evidence of conduct disorder before age 15
- sense of entitlement
- manipulative
- impulsive
- seductive behaviors: nonadherence to traditional morals
- verbally charming and engaging
Cluster B: Borderline
instability of affect, identity, and relationships,
splitting behaviors
manipulation
impulsiveness
fear of abandonment
often self- injurious and potentially suicidal
Cluster B: Histrionic
characterized by emotional attention seeking behavior.
Person needs to be the center of attention; often seductive and flirtatious
Cluster B: Narcissistic
characterized by arrogance, grandiose, views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism
Personality Disorders
Cluster C: anxious or fearful traits; insecurity and inadequacy
avoidant
dependent
obsessive- compulsive
Cluster C:
Avoidant
social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; feelings of inadequacy and are anxious in social situations.
Cluster C:
Dependent
extreme dependency in a close relationship w/ an urgent search to find a replacement when one relationship ends
Cluster C:
Obsessive-Compulsive
characterized by indecisiveness and perfectionism w/ a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task
Personality Disorders
pathological personality characteristics including impairments in self-identity/ self-direction and interpersonal functioning.
often co-occur with depression, anxiety, eating and substance disorders
Defense mechanisms for personality disorders
repression, suppression, regression, undoing, splitting
splitting commonly associated w/ borderline personality disorder
- go from thinking all is good to all is bad or vise versa
Risk Factors: Personality Disorders
- substance use, history of non-violent and violent crimes including sex offenses
- psychosocial influences (childhood abuse or trauma) and developmental factors w/ a direct link to parenting
- genetic and biochemical influences
Expected Findings: personality disorders
one or more of the following;
- inflexibility/ maladaptive responses to stress
- compulsiveness and lack of social restraint
- inability to emotionally connect in social and professional relationships
- tendency to provoke interpersonal conflict
Communication Strategies: Personality Disorders
- firm yet supportive approach and consistent care
- offer realistic choices to enhance client’s sense of control
- for manipulative clients, borderline or antisocial personality disorders– limit-setting and be consistent
- dependent and histrionic personality disorders– benefit from assertiveness training, modeling, psychotherapy
- schizoid/ schizotypal personality tend to isolate themselves and nurse should respect this. Psychotherapy can help identify social cues
- histrionic– nurse should maintain professional boundaries and communication
- for dependent behavior– self assess for countertransference reactions
Medications for personality disorders
psychotropic agents
antidepressant
anxiolytic
antipsychotic
mood stabilizer
Comorbidities for Eating Disorders
depression
personality disorders
substance use disorder
anxiety
Binge eating disorder
- excessive food consumption must be accompanied by a sense of lack of control
- at least once per week for 3 months
- affects men and women all ages, but mainly adults age 46 - 55
- weight gain associated with binge eating disorder ^risk for type 2 diabetes, htn, and cancer
- severity depends on number of binge eating per week
Risk Factors for eating disorders
- occupational choices that encourage thinness (modeling)
- history of “picky” eater as a child
- participation in athletics, especially elite level or thin body build (bicycling) (wrestling)
- history of obesity
~ Family genetics
~ biological: serotonin pathways implicated
~ interpersonal relationships: parental pressure
~ psychological influences: ritualism (enmeshment)
~ environmental factors: media and societal pressure
~ temperamental: anxiety/ obsessional traits in childhood
Nursing Assessment for eating disorders
- perception of issue
- eating habits
- Hx of dieting
- methods of weight control
- value to specific weight or shape
- interpersonal or social functioning
- difficulty w/ impulsivity, or compulsivity
- family and interpersonal relationships ( troublesome, lack of nurture)
- high interest in preparing foods but not eating
- terrified of weight gain
- client sees severe overweight
- low self-esteem, impulsivity, difficulty w/ interpersonal relationship
- intense physical regimen
- guilt or shame from binge eating
- obsessive-compulsive behavior
Mental Status in eating disorders
cognitive distortions include;
- overgeneralization: “other people don’t like me because i’m fat”
- “All-or-Nothing” thinking:
- Catastrophizing: “my life is over if I gain weight”
- Personalization: “i know everyone is looking at me”
- Emotional reasoning: “IK I look bad because i feel bloated”
Vital Signs, Weight in eating disorders
Vital Signs
low blood pressure, possible orthostatic hypotension
decreased pulse and body temp.
HTN can be present for binge eaters
Weight
- anorexia nervosa- body weight is less than 85% of expected normal
- bulimia nervosa- normal range or slightly higher
- clients who have binge eating disorder are typically overweight/ obese
Russell’s sign
calluses or scars on hand on clients who self-induce vomiting
Criteria care for acute care
eating disorders
!!! rapid weight loss/ weight loss of greater than 30% of body weight over 6 months
!!! unsuccessful weight gain in outpatient Tx, failure to adhere to Tx contract
!!! VS demonstrating HR less than 40/ min, systolic BP less than 70 mm HG, body temp. less than 36 C (96.8 F)
!!! ECG changes
!!! electrolyte disturbances
!!! psychiatric criteria: severe depression, suicidal behavior, family crisis, psychosis
Labs and Diagnostic Tests eating disorders (anorexia and bulimia)
Medications
Eating Disorders
SSRI: fluoxetine
- can take 1 to 3 weeks for initial response, up to 2 mo. for maximal response
- avoid hazardous activities
- notify if sexual dysfunction occurs and is intolerable
Complications
eating disorders
Refeeding syndrome
(potentially fatal complication when fluids, electrolytes, and carbs. are introduced to a severely malnourished client.)
- care for client in a hospital setting
- consult with provider and dietician
- monitor electrolytes and fluid replacement therapy
Cardiac dysrhythmias, severe bradycardia, and hypotension
- place on continuous cardiac monitoring
- monitor VS frequently
