Quiz 4 Flashcards
What are eating disorders?
several disruptions in normal eating patterns
high levels of anxiety around eating
altered perceptions of body shape and weight
What are examples of eating disorders?
anorexia nervosa
bulimia nervosa
binge-eating disorder
What cognitive distortions do eating disorders have?
overgeneralization
all or nothing
catastrophizing
personalization
emotional reasoning
Define overgeneralization
a single event affects unrelated situations
Define all or nothing thinking
absolute and extreme reasoning
black or white / good or bad
Define catastrophizing
consequences are magnified
ex: “If i gain weight, my weekend will be ruined”
Define personalization
events are overinterpreted as having personal experience
ex: “its all my fault”
Define emotional reasoning
subjective emotions determine reality
ex: “I feel scared - I’m in danger”
What are the causes of eating disorders?
neurobiological/neuroendocrine models
dysfunctional family
trauma
participation in activity requiring thinness
culture/peer pressures
stressful life transitions
comorbid anxiety disorder
What is the hospital admission criteria for someone with an eating disorder?
Physical Criteria
(case by case basis)
30% weight loss over 6 months
inability to gain weight
severe hypothermia
HR < 40
Systolic BP < 70 mmHg
Potassium < 3mEq/L
EKG changes
What is the hospital admission criteria for someone with an eating disorder?
Psychiatric Criteria
suicide or self mutilation
laxatives, emetics, diuretics, street drugs
abusing OTC drugs = danger to self
failure to adhere to tx
severe depression
psychosis
family crisis
What are the signs of anorexia nervosa?
terror of gaining weight
preoccupied with food
views self as fat
handles food peculiarly (pushing pieces around or cutting in small bits)
rigorous exercise regimen
self-induced vomiting
use of laxative or diuretics
cognitive distortions
What are the medical complications of anorexia nervosa?
poor circulation (hypotension/bradycardia)
pallor
palpitations
fainting
dizziness
amenorrhea (no period)
unexplained GI symptoms
cachectic (skin and bones/severely underweight)
lanugo (long peach fuzz - keeps them warm)
What is screening tool is used during the assessment phase of the nursing process for someone with anorexia nervosa?
SCOFF assessment
Sick - do you make yourself sick?
Control - do you fear loss or control over how much you eat?
One stone - has pt lost 14lbs in a 3 month period?
Fat - do you think your fat even if others tell you your too thin?
Food - does food dominate your life?
What happens if a patient with anorexia nervosa answers yes to 2 questions from the SCOFF assessment?
indication of eating disorder
pt sent for further evaluation
What should a nurse do during the assessment phase of the nursing process for someone with anorexia nervosa?
check safety
- risk for falls
check level of insight
- ask pt about feelings of weight/eating disorder
check if pt understands disease
What are the outcomes for someone with anorexia nervosa?
refrain from self harm
eat 75% of 3 meals per day and 2 snacks
achieve 85-90% of ideal body weight
participate in tx
demonstrate one coping behavior
What will the nurse implement for someone with anorexia nervosa?
weight pt regularly (when they first wake up, after voiding, w/ same clothes)
observe pt eating (to prevent hoarding/disposing)
give pt time frame to eat meal (to prevent procrastination)
consult nutritionist for choice of foods
monitor physiological parameters (to prevent life-threatening effects of weight loss)
assess for suicide
work with pt to identify strengths
What are interdisciplinary treatments for anorexia nervosa?
CBT
enhanced CBT
dialectical BT
interpersonal psychotherapy
What are the pharmacological treatments for anorexia nervosa?
olanzapine
fluoxetine
Why would olanzapine be given for anorexia nervosa?
helps with weight gain
changes obsessive thinking
Why would fluoxetine be given for anorexia nervosa?
given when weight is stable
treats depression and OCD symptoms
Can it easily be noted if someone has bulimia nervosa? Why?
no
bc they may not appear ill emotionally or physically
What are signs of bulimia nervosa?
happens in private
binge-eating usually after fasting
compensatory behavior (ex: vomiting)
hx of anorexia nervosa
depression, anxiety, compulsivity
problems with relationships, self, and impulsive behaviors
What are the medical complications of bulimia nervosa?
at or above ideal body weight
enlargement of parotid glands from vomiting
dental erosion from vomiting
skin problems due to dehydration
What is done during the assessment phase of the nursing process for someone with bulimia nervosa?
medical stabilization
physical exam/lab testing
check for the use of medications/herbs/drugs
psych eval
check suicide risk/self harm
What labs should be checked for someone with bulimia nervosa?
electrolytes
glucose
thyroid function
CBC
ECG
What are the outcomes for someone with bulimia nervosa?
maintain normal electrolytes
stable VS
refrain from binge-purge behaviors
be free from self-harm
demonstrate 2 anxiety reduction techniques
name 2 personal strengths
What will the nurse implement for someone with bulimia nervosa?
Same as anorexia
weight pt regularly
observe pt eating and 1-3 hours after
observe for compensatory behavior
encourage pt to keep a journal
assess for suicide
What is the interdisciplinary treatment for someone with bulimia nervosa?
psychotherapy
What is the pharmacological treatment for bulimia nervosa? Why is it used?
fluoxetine
- approved for bulimia
- works best w/ therapy
- decreases behaviors
Describe binge-eating disorder
similar to bulimia nervosa, but no compensatory behaviors used
- no vomiting or exercise
eats large amount of food in short period, feels guilty after
What is done during the evaluation phase of the nursing process for someone with an eating disorder?
disorder can come back due to stress, so it is a constant process of revising goals
What are the cognitive domains?
complex attention (attention span)
executive functioning (ability to do tasks, decisions, plans)
learning and memory
language
perceptual-motor abilities
social cognition
What are examples of neurocognitive disorders?
delirium
mild neurocognitive disorder
major neurocognitive disorder - dementia
(subtype: alzheimer’s)
Describe delirium
secondary to another condition
(ex: delirium caused by UTI)
complete recovery can occur
elderly at greatest risk
How should delirium be treated?
treat primary cause first, if not treated can progress to dementia
What are risk factors for delirium?
MIND SPACES
Medications
Infections/illness
Number of co-occuring conditions
Disorders of substance or alc
Surgery
Pain (uncontrolled)
Age (children/older adults at risk)
Cognitive impairment
Emotional or mental illness
Sleep disturbances
How soon can symptoms develop for delirium?
rapidly and can fluctuate
start to notice in a day or 2
Define sundowning
symptoms of delirium/dementia show @ sunset/evening
What are the cognitive symptoms of delirium?
decreased ability to focus
decreased orientation to environment
memory impairment
unable to calculate
What are the behavioral symptoms of delirium?
restless
anxious
motor agitation
labile (quick mood changes)
What are the perceptual symptoms of delirium?
hallucinations
illusions
decreased visuospatial ability
What is considered to be a medical emergency for someone with delirium?
unstable vital signs
What are the three types of delirium?
hyperactive
hypoactive
mixed
Describe hyperactive delirium
restless
agitated
mood all over the place
Describe hypoactive delirium
lethargic/sleepy
quietness
Describe mixed delirium
switching between hyperactive and hypoactive
What is done during the assessment phase of the nursing process for someone with delirium?
assess:
cognitive and perceptual disturbances (hallucinations/illusions)
mood and behaviors (can change quickly)
safety
- check VS, pulse ox, LOC
- high risk for falls/wandering
What is the outcome for someone with delirium?
reversible diagnosis
What should a nurse implement for someone with delirium?
provide a safe/therapeutic environment
- well lit room
- locks @ top of door where they can’t reach
- room close to nurse’s station
- reality orientation
- have a sitter
What will a nurse evaluate for someone with delirium?
- safety
- oriented to time, place, and person by discharge
- underlying cause of delirium treated
- pt returns to permorid level of functioning
Describe mild neurocognitive disorder
- modest impairment
- symptoms do not interfere w/ independence
- greater time/effort required to perform tasks
Describe major neurocognitive disorder
substantial impairment
symptoms interfere w/ independence
dependent on individuals for tasks
not easily reversible
aka: dementia
How quickly does major neurocognitive disorder (dementia) develop?
- develops more slowly than delirium
- gradual progressive impairment
aka: slow onset
What are the causes of major neurocognitive disorder (dementia)?
key factor: age
65+ @ higher risk
women
familial hx
cardiovascular risk factors
genetics
What is the diagnostic testing for major neurocognitive disorder (dementia)?
no standard single test
only screening tools
What are the defense mechanisms for neurocognitive disorders?
- denial
- confabulation (making up stories to maintain self esteem, not lying )
- preservation (repetition of phrases/behaviors)
- avoidance of questions
What is done during the assessment phase of the nursing process for someone with dementia?
assess:
safety
medical conditions
neglect/abuse
disturbances in executive functioning
cognitive impairment
Describe cognitive impairment
amnesia: loss of memory
aphasia: loss of language ability
apraxia: loss of movement
agnosia: loss of sensory ability to recognize objects
What are the stages of Alzheimer’s disease?
stage 1 (mild)
- forgetfulness - hard time learning new things
stage 2 (moderate)
- confusion - hygiene issues
stage 3 (mod to sev)
- ambulatory dementia - can’t recognize ppl, no selfcare
stage 4 (late)
- end stage - complete regression “infant”
What are the outcomes for someone with dementia?
SAFETY - priority
pt will:
- answer yes or no appropriately to Q’s
- participate in plan of care
- state feeling safe after experiencing delusions
- put on own clothes appropriately
What will a nurse implement for someone with dementia?
validation therapy (focus on emotions instead of facts)
validate the reality
empathize
help pt connect to feelings
reality orientation
reminiscence therapy (get pt to talk about their life memories)
music therapy
sensory interventions
What are the pharmacological interventions for mild to moderate Alzheimer’s?
galantamine hydrobromide
rivastigmine tartrate
donepezil (given @ night)
does not reverse, only slows down
What is the pharmacological intervention for moderate to severe Alzheimer’s?
memantine hydrochloride
benefits are limited and minimal
side effects: dizziness, headache, constipation
