Mod. 7 ATI ch. 16, 19

Question 1

Anorexia Nervosa

Answer 1

persistent energy intake restriction leading to extreme low weight

fear of gaining weight

disturbance of self-perceived weight of shape

Question 2

amenorrhea

Answer 2

3 missed cycles as a sign of amenorrhea

Question 3

Anorexia Nervosa types

Answer 3

Restricting type: drastically restricts food and does not binge or purge

Binge-eating/ purging type: engages in binge eating or purging

Question 4

anorexia nervosa characteristics

Answer 4

• 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

Question 5

Bulimia nervosa

Answer 5

-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

Question 6

Bulimia nervosa characteristics

Answer 6

• 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

Question 7

Types of bulimia nervosa

Answer 7

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)

Question 8

Personality Disorder

Cluster A: odd or eccentric traits

Answer 8

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

Question 9

Personality Disorders

Cluster B: dramatic, emotional, erratic traits

Answer 9

• antisocial
• borderline
• histrionic
• narcissistic

Question 10

cluster B

Antisocial

Answer 10

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

Question 11

Cluster B: Borderline

Answer 11

instability of affect, identity, and relationships,
splitting behaviors
manipulation
impulsiveness
fear of abandonment
often self- injurious and potentially suicidal

Question 12

Cluster B: Histrionic

Answer 12

characterized by emotional attention seeking behavior.

Person needs to be the center of attention; often seductive and flirtatious

Question 13

Cluster B: Narcissistic

Answer 13

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

Question 14

Personality Disorders

Cluster C: anxious or fearful traits; insecurity and inadequacy

Answer 14

avoidant
dependent
obsessive- compulsive

Question 15

Cluster C:

Avoidant

Answer 15

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.

Question 16

Cluster C:

Dependent

Answer 16

extreme dependency in a close relationship w/ an urgent search to find a replacement when one relationship ends

Question 17

Cluster C:

Obsessive-Compulsive

Answer 17

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

Question 18

Personality Disorders

Answer 18

pathological personality characteristics including impairments in self-identity/ self-direction and interpersonal functioning.

often co-occur with depression, anxiety, eating and substance disorders

Question 19

Defense mechanisms for personality disorders

Answer 19

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

Question 20

Risk Factors: Personality Disorders

Answer 20

• 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

Question 21

Expected Findings: personality disorders

Answer 21

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

Question 22

Communication Strategies: Personality Disorders

Answer 22

• 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

Question 23

Medications for personality disorders

Answer 23

psychotropic agents

antidepressant

anxiolytic

antipsychotic

mood stabilizer

Question 24

Comorbidities for Eating Disorders

Answer 24

depression
personality disorders
substance use disorder
anxiety

Question 25

Binge eating disorder

Answer 25

• 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

Question 26

Risk Factors for eating disorders

Answer 26

• 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

Question 27

Nursing Assessment for eating disorders

Answer 27

• 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

Question 28

Mental Status in eating disorders

Answer 28

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”

Question 29

Vital Signs, Weight in eating disorders

Answer 29

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

Question 30

Russell’s sign

Answer 30

calluses or scars on hand on clients who self-induce vomiting

Question 31

Criteria care for acute care

eating disorders

Answer 31

!!! 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

Question 32

Labs and Diagnostic Tests
eating disorders (anorexia and bulimia)

Question 33

Medications

Eating Disorders

Answer 33

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

Question 34

Complications

eating disorders

Answer 34

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