w3 Flashcards
This Eating disorder is known as?
epidemiology & comorbidity:
- more common in women
- 25-45 y/o
- May occur with comorbid mood disorder, anxiety disorder, or substance use disorder like alcohol
Bulimia Nervosa
s/s ______ withdrawal
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin
s/s Opioid withdrawal (COWS)
AN treatment:
Hospitalizations, intensive therapy, outpatient partial hospitalization (when stabilized)
- Weight restoration program
- Observation during meals and bathroom
- regularly scheduled weighs
- milieu therapy – focus on eating behavior, anxiety, dysphoria, self esteem, lack of control
Criteria for hospitalization: AN
- Extreme electrolyte imbalance
- Weight below 75% of normal
- < 10% body fat
- Daytime HR < 50
- Systolic BP < 90
- Temp < 96
- Arrhythmias
Goals -
#1 – depends on acuity, nutritional rehab, education
#2 – resolving body image disturbance, coping, assisting family
Biological treatment –
- pharmacotherapy – none, fluoxetine for OCD behaviors
- integrative therapy – yoga, massage, acupuncture, bright light therapy
psychological therapies
- CBT and other therapies for anorexia
0
s/s ______ withdrawal
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual
s/s alcohol withdrawal (CIWA)
Risk factors for ___:
- Female
- Family hx
- Hx of obesity
- Dieting
- Over exercising
- Low self esteem
- Body dissatisfaction
- Lack of assertiveness
- Other ED
- Hx of abuse
- Comorbid conditions
- Distorted body image
- Media
- Fashion industry
- Athlete
Risk factors for ____:
- Binge eating behaviors
- AN hx
- Depression
- Interpersonal relationship problems
- Impulsive, compulsive
- Anxiety
- SUD
AN
BN
s/s or AN or BN?
- Low body weight ( at least 15% below what is expected)
- BMI determines severity
o <15 = extreme
o 15 - 16 = severe
o 16 – 17 = moderate
o >17 = mild
- Amenorrhea
- Lanugo
- Mottled, cool skin on extremities
- Peripheral edema
- Lack of energy, fatigue, muscular weakness
- Constipation
- Low BP, pulse and temp
- Abnormal lab values – more so expected with purging type
- Impaired renal function
- Decreased bone density
- Anemic pancytopenia
AN
Spectrum of ED
1. Normal eating
2. Development of risk factors
- Low self esteem
- Dieting
- Parental attitudes
- Body dissatisfaction
- Media ideal bodies
3. Partial syndrome ED
- Binge eating and serous dieting
4. Full syndrome ED
- Increase in frequency and severity of binge eating, purging, and starvation
5. Treatment
Facts
- All ages, genders, and backgrounds
- Serious but treatable
- 2nd highest mortality rate of any mental illness
- May cause someone to attempt suicide
Comorbidities and dual diagnoses with ED:
- Depression, anxiety
- Alcohol or substance abuse problem
- Personality disorders
Treating ED
- Often don’t seek help
- Not motivated to change
- Leave treatment
- Some recover spontaneously, some have long term problems
0
___________
unconscious feelings that HC workers have toward patient
- occurs unconsciously displaces feelings r/t significant figures from nurses past onto the patient
- overinvolvement or impairs therapeutic relationship
- nurse must examine own attitude, recognize past experiences may impact their perception and influence how they provide care
countertransference
________ NCD – interferes with daily functioning and independence
- Alzheimers
- Dementia
- TBI
- HIV infection
- Parkinsons, huntingtons, prion disease
______ NCD – does not interfere with ADLs, does not progress
Major NCD – interferes with daily functioning and independence
- Alzheimers
- Dementia
- TBI
- HIV infection
- Parkinsons, huntingtons, prion disease
Mild NCD – does not interfere with ADLs, does not progress
s/s Opioid withdrawal (COWS) vs s/s alcohol withdrawal (CIWA)
___________
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual
____________
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin
s/s alcohol withdrawal (CIWA)
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual
s/s Opioid withdrawal (COWS)
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin
are any of these appropriate language to use r/t addiction
- addict
- alcoholic
- drunk
- substance or drug abuser
- drug habit
- dirty
No, stigmatizing language
reasons for continued use: the addicted brain
- repeated use leads to tolerance and withdrawal r/t changes in neurotransmitters, decreased D2 receptors, and decreased dopamine release
- this results in – compulsive behaviors, decreased inhibitory control, increased impulsivity, impaired regulation of intentional action
- alcohol and nicotine metabolize into ______
reasons for continued use: the addicted brain
- repeated use leads to tolerance and withdrawal r/t changes in neurotransmitters, decreased D2 receptors, and decreased dopamine release
- this results in – compulsive behaviors, decreased inhibitory control, increased impulsivity, impaired regulation of intentional action
- alcohol and nicotine metabolize into acetate
_________ – occurs when a person no longer responds to the substance in the way that the person initially responded
- Using increasing amounts of substance overtime to achieve the same level of response and a diminished effect occurs with continued use
- Some substances cause rapid physiological tolerance (cocaine) and some cause tolerance after weeks or months of use (rx pain meds)
- Increased tolerance may result in a person being able to tolerate a higher Blood alcohol level (BAC) while exhibiting fewer symptoms
Tolerance
AN vs BN?
_________
An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain
_________
Life threatening eating disorder
- Intense fear of weight gain
- Severely distorted body image
- Restriction of calories relative to requirements with significantly low BMI
- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise
- Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)
Bulimia nervosa (BN)
An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain
Anorexia nervosa (AN)
Life threatening eating disorder
- Intense fear of weight gain
- Severely distorted body image
- Restriction of calories relative to requirements with significantly low BMI
- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise
- Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)
risk factors: addiction
- genetic
- neurotransmitters
- environmental – chronic stressors, anxiety, abuse, trauma, addiction in family or peers, access to substances, ineffective coping strategies
- starting certain substances at _____ age
risk factors: addiction
- genetic
- neurotransmitters
- environmental – chronic stressors, anxiety, abuse, trauma, addiction in family or peers, access to substances, ineffective coping strategies
- starting certain substances at an early age
biology and addiction
- genetic predisposition
- __creased dopamine
- immature brain development
- acetate function
- males
- depression, ADHD, PTSD, increase potential to self-medicate with substances
dopamine and drug use
- dopamine (feel good neurotransmitters) __crease with substance use = feeling high
- relapse is common
increase
increase
off label meds for behavioral symptoms of AD
- antipsychotics
- antidepressants
- antianxiety
- anticonvulsants
0
Neurotransmitters in AD - too much or too little?
- ____ Acetylcholine produced
- _____ glutamate
Neurotransmitters in AD
- Less Acetylcholine produced (med- cholinesterase inhibitors keep enzyme from breaking down acetylcholine)
- Excessive glutamate (med – NMDA antagonists reduce excess calcium by blocking some NMDA receptors)
Bulimia nervosa vs anorexia nervosa
_______ is
- more prevelant
- older at onset
- normal weight
- not life threatening
- outpatient treatment
- better outcomes
- lower mortality rates
- effective medications
BN
_________ – a comprehensive integrated public health approach to the delivery of early intervention and treatment services for person with SUD and those at risk
Goal: reduce and prevent related health consequences, disease, accidents, injuries, costs and healthcare utilization
SBIRT
Screening, brief intervention, and referral to treatment
emergency treatment:________ kits
- drug (injection or nasal mist) can quickly reverse effects of heroin OD
naloxone
___________
Food avoidance
- May be r/t strong dislikes from sensory of food, appearance, color, smell, texture, temp, and tase
- Can result in significant weight loss, nutritional deficiency, dependence on supplements/enteral feeding, functioning
- Infancy and early childhood
- Males and females equally
- Risk factors – personal or family anxiety
Treatment
- Behavioral modification
- Family support and education
- Treat anxiety and depression
Feeding disorders
Avoidant/restrictive food intake disorder (ARFID)
Complications d/t weight loss and starvation: AN
- Musculoskeletal – muscle and fat loss, osteoporosis early onset
- Metabolic – hypothyroidism, hypoglycemia, electrolyte issues
- Cardiac – bradycardia, hypotension, cardiac muscle loss, small heart, arrhythmias, chest pain, sudden death
- GI – delayed emptying, bloating, constipation, abd pain, gas, diarrhea, GERD, hemorrhoids
- Reproductive – amenorrhea, irregular periods, loss of libido, infertility
- Dermatologic – dry skin, brittle nails, lanugo, edema, acrocyanosis (blue hands/feet), thinning hair, yellow skin, poor wound healing
- Hematologic – leukopenia, anemia, thrombocytopenia, hypercholesterolemia, hypercarotenemia
- Neuropsychiatric – abnormal taste sensation, apathetic depression, mental symptoms, sleep issues, fatigue
0
Epidemiology & comorbidity: BED
- Most common ED
- More common in females
- Equal in racial groups
- Normal, overweight, or obese individuals
- May be genetic
- May have another psychiatric disorder – phobia, social issues, PTSD, alcohol abuse or dependence
- Impulsive and reward sensitive
- Low self esteem
- Body dissatisfaction
- Difficulty coping with feeling
- Hx of trauma or adverse child events
- Hx of food insecurity
0
Epidemiology of AN:
- More common in female
- Adolescence or young adult
- Athletes
- LGBTQ
- Less common than bulimia nervosa
- Comorbid with bipolar disorder, anxiety, OCD, depression, PTSD, trauma, alcohol or substance use disorder
Etiology of AN:
Biological
- Genetic
- Glucose and lipid metabolism
- Neurobiological – serotonin
Physical and cognitive
- Ego-syntonic disorder – knows actions are harmful but believes benefits outweigh harm
- Emotional identification, regulation, and processing issues
- Low distress tolerance and deficits in behavioral control in response to stress
Environmental
- Internalization of a thin body idea
- Associated with cultures that value thinness
0
______– co-ocurring mental illness and substance use or addictive disorder
Dual diagnosis
Alzheimer’s meds
Class = acetylcholinesterase inhibitors (AChEI)
Drugs = donepezil, rivastigmine, galantamine
or
Class = NMDA antagonists
Drug = memantine
- 2nd line or combo
- restore function of damaged nerve cells and reduce abnormal excitatory signals of glutamate
- s/e = dizzy, confusion, h/a, constipation
Class = NMDA antagonists
Drug = memantine
substance _________
- Specific substances (alcohol, caffeine, opioids, etc.) have their own disorder
- chronic medical condition with roots in enviro, NT, genetics, and life experiences
- strong craving of a substance
- persistent desire to cut down without success
- impacts life, unable to fulfill role obligations
- increased social isolation
- hazardous activity
- continuation despite potential harmful consequences
- excessive time spent trying to get the substance or recover from use
- tolerance or withdrawal
addiction
Warning signs and s/s of _____:
- Present as overwhelmed, overly committed social butterflies, difficulty setting limits/boundaries
- Rules about food
- Shame, guilt, disgust regarding binge/purge
- Compulsive, impulsive
- Binge eating – large amounts of food disappear in a short amount of time, finding a bunch of wrappers
- Purging – frequent trips to bathroom after meals, signs/smell of vomit, wrappers/packages of laxatives, diuretics.
- Excessive, rigid exercise regimen – feel the need to burn off calories taken in
- Schedules to make time for binge/purge session
- Withdrawal socially
- Behavior showing weight is primary concern
- Parotid gland swelling – unusual swelling of cheeks or jaw area
- Russells sign – calluses, scars on back of hands/knuckles from self-induced vomiting
- Dental caries, tooth erosion, discoloration/staining
Warning signs of ____:
- Dramatic weight loss
- Preoccupation with weight, food, calories, etc.
- Refusal to eat certain foods and restrictions
- Frequent comments about feeling fat despite weight loss
- Anxiety about gaining weight
- Denial of hunger
- Development of food rituals
- Consistent excuses to avoid mealtimes
- Excessive rigid exercise regimen, the need to burn off calories taken in
- Withdrawal socially
- Behaviors indicating weight is primary concern
BN
AN
_______
ED characterized by recurrent episodes of binge eating, with accompanying distress and impaired control over such behavior
Binge eating disorder (BED)
treatment:
reduce cravings and controls withdrawal symptoms for opioid addiction
- methadone – ceiling effect?, monitor closely
- buprenorphine + naloxone
- buprenorphine – ceiling effect?, limits OD potential
- methadone – no ceiling effect, monitor closely
- buprenorphine + naloxone
- buprenorphine – ceiling effect, limits OD potential
s/s of what alcohol withdrawal complication?
- agitation
- increased anxiety
- confusion
- tremors
- seizures
- delusions
- hallucinations
- paranoia
- autonomic hyperactivity – tachycardia, diaphoresis, fever, anxiety, insomnia and HTN
delirium tremens (DTS)
alcohol craving and acetate
- alcohol breaks down into ______
- acetate triggers craving for more acetate
- normal drinker = acetate moves through system _______
- in addiction = acetate accumulates in their body with only one drink bc it is barely processed out (r/t slow filtering of pancreas and liver) so by staying in the body it triggers craving for more acetate
- control is lost and the craving cycle begins
alcohol craving and acetate
- alcohol breaks down into acetate
- acetate triggers craving for more acetate
- normal drinker = acetate moves through system quickly
- in addiction = acetate accumulates in their body with only one drink bc it is barely processed out (r/t slow filtering of pancreas and liver) so by staying in the body it triggers craving for more acetate
- control is lost and the craving cycle begins
Timing of withdrawal symptoms following alcohol intake
__-__ hours
- Minor withdrawal s/s
- Insomnia
- Tremors
- Mild anxiety
- GI upset
- h/a
- diaphoresis
- palpitations
- anorexia
__-__ hours
- hallucinations – visual, auditory, tactile
__-__ hours
- seizures – generalized, tonic-clonic
__-__ hours
- delirium tremens
- hallucinations – visual usually
- disorientation
- tachycardia
- hypertension
- low grade fever
- agitation
- diaphoresis
Timing of withdrawal symptoms following alcohol intake
6-12 hours
- Minor withdrawal s/s
- Insomnia
- Tremors
- Mild anxiety
- GI upset
- h/a
- diaphoresis
- palpitations
- anorexia
12-24 hours
- hallucinations – visual, auditory, tactile
24-48 hours
- seizures – generalized, tonic-clonic
48-72 hours
- delirium tremens
- hallucinations – visual usually
- disorientation
- tachycardia
- hypertension
- low grade fever
- agitation
- diaphoresis
________ – caused by excessive consumption of alcohol followed by episodes of amnesia
- During episode a person actively engages in behaviors, can perform tasks, and appears normal
- No the same as passing out
Blackouts
Factors contributing to ED:
- Genetics
- Onset of puberty
- Vulnerable person
- Female
- History of obesity
- Uncontrollable dieting
- Major life changes or stressors
- Family functioning style
- Sociocultural emphasis on slimness
- Perfectionism
- Impulsivity
What causes ED:
Psychological factors
- Low self esteem
- Feeling inadequate
- Lack of control in life
- Depression, anxiety, stress, loneliness, trauma
Interpersonal factors
- Troubled relationships
- Difficulty expressing emotion
- History of being teased about weight, physical/sexual abuse
Social factors
- Cultural pressure to be thin and value perfect body
- Narrow definition of beauty
- Cultural norms that value physical appearance
Biological factors
- Irregular hormone functions
- Genetics
Neurobiology
- Altered brain serotonin which contributes to dysregulation of appetite, mood, and impulse control
Environmental
- Childhood trauma
- Sexual abuse
0
immature brain development
- early experiences affect brain development
- early stress/trauma change brain response
- brain continues to develop until 24+
- brain matures from back (emotion, memory, impulse, psychomotor) to front (executive functioning, planning, problem solving, judgements, impulse control, organization)
- pathways and patters are being established
- when making decisions – adults rely on frontal cortex and teens rely on amygdala
0
treatment: DTS
- _________!!!
- medicate adequately
- monitor closely
- listen and respond to patients subjective symptoms
- treat complications
- give thiamine and other meds
- life support as indicated
- labs – electrolytes
- hydration
- vitals
- anticonvulsants (phenytoin or phenobarbital) to treat seizures
- oral diazepam to treat symptoms of acute agitation, tremors, impending or acute DTS, hallucinations
- IV lorazepam to treat severe symptoms when delirium appears
- Antipsychotics (haloperidol) prn
- Clonidine to treat HTN
- Oral or IV fluids to treat dehydration exacerbated by diaphoresis and fever
treatment: DTS
- prevention
- medicate adequately
- monitor closely
- listen and respond to patients subjective symptoms
- treat complications
- give thiamine and other meds
- life support as indicated
- labs – electrolytes
- hydration
- vitals
- anticonvulsants (phenytoin or phenobarbital) to treat seizures
- oral diazepam to treat symptoms of acute agitation, tremors, impending or acute DTS, hallucinations
- IV lorazepam to treat severe symptoms when delirium appears
- Antipsychotics (haloperidol) prn
- Clonidine to treat HTN
- Oral or IV fluids to treat dehydration exacerbated by diaphoresis and fever
_________
An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain
Bulimia nervosa (BN)
BN
Etiology:
Biological
- Neuropathological – eating dysregulation may cause changes in brain
- Genetics
- Genes
- Lower brain serotonin
Psychological & cognitive
- Anxiety, low self esteem
- Impulsive, compulsive
- Chaotic, non-nurturing family
- Difficult interpersonal relationship
- Triggers – stress, poor body image, food, restrictive dieting, boredom
Environmental
- Thin body idea, weight bullying
- Sexual or physical abuse, trauma, stress
Clinical course:
- Few outward s/s, doesn’t appear physically ill
- Normal weight
- Binge/purge in secret
- Delayed treatment
- Treatment started when eating is uncontrollable
- After treatment, complete recovery of ED, mood disorders may remain
0
________ disorders
- Consistently below/above person’s caloric needs to maintain a healthy weight
- Can have anxiety and guilt
- Occurs without hunger or without satiety
- Results in physiologic imbalances or medical complications
eating d/o
treatment: alcohol withdrawal
goals
- control agitation
- decrease seizure risk
- decrease morbidity and mortality
meds
- chlordiazepoxide
- diazepam
- lorazepam
- ________ - daily replacement critical, give prior to IV dextrose, helps prevent wernickes syndrome
- schedule and PRN dosing for breakthrough autonomic symptoms
- clonidine – HTN
treatment: alcohol withdrawal
goals
- control agitation
- decrease seizure risk
- decrease morbidity and mortality
meds
- chlordiazepoxide
- diazepam
- lorazepam
- thiamine - daily replacement critical, give prior to IV dextrose, helps prevent wernickes syndrome
- schedule and PRN dosing for breakthrough autonomic symptoms
- clonidine – HTN
_________
Ingestion of substance with no nutritional value (ex: Dirt, Paint)
- May begin in early childhood, adolescence or adulthood
- Males and females equal
- Treatment – monitor eating, reward appropriate eating
Feeding disorders
Pica
___________ – a set of physiological symptoms that occur when a person stops using a substance
- Specific to each substance
- Mild to life threatening
- The more intense the symptoms = the more likely the person is to start using again
Substance withdrawal
Alzheimer’s meds
Class = acetylcholinesterase inhibitors (AChEI)
Drugs = donepezil, rivastigmine, galantamine
or
Class = NMDA antagonists
Drug = memantine
- 1st line
- Indication = mild to moderate AD
- Delays cognitive decline
- s/e = n/v
- peaks in 3 mos, then continues to decline
- rivastigmine route – PO and patch
Class = acetylcholinesterase inhibitors (AChEI)
Drugs = donepezil, rivastigmine, galantamine
treatment: substance use disorder
medication assisted treatment
- combo medication, counseling, and behavioral therapies
pharmacotherapy
- naltrexone
- disulfiram
- clonidine
- acamprosate
reduce cravings and controls withdrawal symptoms for specifically _____ addiction
- methadone – no ceiling effect, monitor closely
- buprenorphine + naloxone
- buprenorphine – ceiling effect, limits OD potential
treatment: substance use disorder
medication assisted treatment
- combo medication, counseling, and behavioral therapies
pharmacotherapy
- naltrexone
- disulfiram
- clonidine
- acamprosate
reduce cravings and controls withdrawal symptoms for opioid addiction
- methadone – no ceiling effect, monitor closely
- buprenorphine + naloxone
- buprenorphine – ceiling effect, limits OD potential
Wernickes encephalopathy: treatment
- _________ replacement
- Improve nutrition
Wernickes encephalopathy: treatment
- Thiamine replacement
- Improve nutrition
alzheimer’s Stages
Mild – priority care is delay ________
- Forgetful
- Misplaces things
- Decreased recall
- Social withdrawal
- Frustrated with self
- Changes may not be apparent to others
Moderate - priority care is ______
- Decreased self care, way finding
- Disoriented to time and place
- Wandering, pacing
- Hallucinations or delusions
- Decreased visual perception
- Required supervision
- Emotional lability
- Symptoms noticeable
Severe - priority care is _______ needs
- Cant care for self
- Loss of language
- Minimal long term memory
- Constant complete care
Stages
Mild – priority care is delay cognitive decline
- Forgetful
- Misplaces things
- Decreased recall
- Social withdrawal
- Frustrated with self
- Changes may not be apparent to others
Moderate - priority care is safety
- Decreased self care, way finding
- Disoriented to time and place
- Wandering, pacing
- Hallucinations or delusions
- Decreased visual perception
- Required supervision
- Emotional lability
- Symptoms noticeable
Severe - priority care is physical needs
- Cant care for self
- Loss of language
- Minimal long term memory
- Constant complete care
(wernicke’s)
Aphasia
Hyperorality
Confabulation
(broca’s area)
Apraxia
Preservation
Agnosia
_______– loss of language
Expressive aphasia _________ – cant find words to express ideas
Receptive aphasia _______– cant interpret what is said
________– loss of purposeful movement
_______ – loss of ability to recognize objects
__________ – unconscious creation of stories/answers in place of actual memories (not done intentionally, maintains self esteem)
_________ – persistent repetition of a word, phrase, or gesture
________– tendency to put things in mouth to taste or chew
Aphasia – loss of language
Expressive aphasia (broca’s area) – cant find words to express ideas
Receptive aphasia (wernicke’s) – cant interpret what is said
Apraxia – loss of purposeful movement
Agnosia – loss of ability to recognize objects
Confabulation – unconscious creation of stories/answers in place of actual memories (not done intentionally, maintains self esteem)
Preservation – persistent repetition of a word, phrase, or gesture
Hyperorality – tendency to put things in mouth to taste or chew
________ disorders
- Progressive deterioration of cognitive functioning and global impairment of intellect
- No change in consciousness
- Acquired condition, not developmental
- Difficulty with memory, problem solving, complex attention
- Affects orientation, attention, memory, vocabulary, calculation ability, abstract thinking
Neurocognitive
__________
- most severe form of alcohol withdrawal
- can result in death
- can occur in 48-72 hours after cessation of heavy drinking
- hepatitis or pancreatitis can increase risk
- rare in individuals with good physical health
- risk of being misdiagnosed as a psychiatric disorder
delirium tremens (DTS)
Clinical course of AN:
- Chronic condition, with relapses
- May continue to be preoccupied with food
- May develop bulimia nervosa
- May die by suicide
- Poor outcome r/t lower initial weight, purging, earlier onset
- Difficult to treat, but recovery is possible
0
Consequences of ____:
- HTN
- High cholesterol
- Heart disease
- DM
- GI disease
- Gallbladder issue
- Musculoskeletal problems
Treatment of ___:
- Outpatient treatment
- Education
- Pharmacotherapy – SSRIs, lisdexamfetamine dimesylate
- Psychological – CBT, DBT, group or support therapy
BED
_________ – excessive use of substance that results in reversible substance specific syndrome
- judgement impaired, inappropriate and maladaptive behaviors, impaired functioning
- CNS changes, disruption in pshysiological and psychological functioning
- Can happen with one time use of substance
- Ex: alcohol – physiological symptoms (slurred speech, poor coordination, impaired memory, stupor, coma) and behavioral symptoms (inappropriate behavior)
substance intoxication
Treatment: BN
- If life threatening complications or suicide risk – hospitalization
- Otherwise, outpatient
- Stabilize eating, interrupt binge/purge
- Restructure thoughts about eating
- Healthy boundary setting
- Nutrition counsel
- Behavioral techniques
Pharmacotherapy
- SSRIs
- Fluoxetine (in combo with CBT)
Psychological
- CBT – 1st line
- DBT
- Group therapy
- Family therapy not used d/t age
0
Wernicke encephalopathy vs Korsakoff syndrome
- Acute and reversible
- May clear up within a few weeks of may progress (more severe, and chronic)
Korsakoff syndrome
- Chronic and debilitating
- Not reversible
Wernicke encephalopathy
Korsakoff syndrome
Life threatening eating disorder
- Intense fear of weight gain
- Severely distorted body image
- Restriction of calories relative to requirements with significantly low BMI
Anorexia nervosa (AN)
__________
Undigested food being returned to the mouth, rechewed, reswallowed or spit out
- Dx after 1 month of s/s
- Can begin at any age, usually 3-12 mos
- More common with intellectual disabilities
- Predisposing factor – childhood neglect
Interventions:
- Reposition during feeding
- Improve interactions between caregiver and child
- Making mealtime a pleasant experience
- Distracting child when behavior starts
- Family therapy
Feeding disorders
Rumination disorder
________ – recurrence of alcohol/drug dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detoxification
Relapse
long-term medication management: methadone maintenance for pregnant women
- decreases variability of drugs on fetus
- newborns have more predictable outcomes
- limits exposure to health risk for mom and fetus – unknown toxic additives, dirty needles
- dosages may need to be adjusted upward as pregnancy progresses
- dosing options – smaller 2x per day dose or 1 large dose per day
- dosage titrated depending on opioid withdrawal scoring
- maintained until delivery then withdrawn
- fetus withdrawal symptoms may be 2-3x as intense as moms
0
neurocog d/o: Medications
____________
- Donepezil
- Rivastigmine – PO and transdermal
- Galantamine
__________
- Memantine
Medications
Acetyl/cholinesterase inhibitors (AChEI)
- Donepezil
- Rivastigmine – PO and transdermal
- Galantamine
NMDA antagonists
- Memantine
Wernicke encephalopathy vs Korsakoff syndrome
_________
- Confusion
- Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors
- Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping
_________
- Confusion
- Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors
- Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping
- Severe, irreversible persistent memory impairments – problems forming and recalling memories
- Confabulation – unknowingly lying
- Hallucinations
- Repetitious speech and actions
- Problems with decision making
Wernicke encephalopathy
Korsakoff syndrome
Treatment: opioid withdrawal
- Give scheduled _________ on time
Nonpharmacological interventions done before prn meds
- Nausea – crackers, ginger ale, tea, flat warm cola
- Muscle aches – hot shower, warm compress
- Anxiety reduction – distraction, relaxation, talk therapy
Pharmacologic interventions for:
- n/v (Must see emesis before giving) – ondansetron, promethazine PO or rectal suppository (avoid giving IM r/t rush effect)
- anxiety, lacrimation (watery eyes), rhinorrhea – hydroxyzine, avoid benzodiazepines
- insomnia – trazadone
- pain – acetaminophen (long term alcohol use pt may have esophageal varices or gastric ulcers), NSAIDS
- diarrhea – kaopectate (first line), avoid loperamide b/c sedation effect
Treatment: opioid withdrawal
- Give scheduled methadone on time
Nonpharmacological interventions done before prn meds
- Nausea – crackers, ginger ale, tea, flat warm cola
- Muscle aches – hot shower, warm compress
- Anxiety reduction – distraction, relaxation, talk therapy
Pharmacologic interventions
- n/v (Must see emesis before giving) – ondansetron, promethazine PO or rectal suppository (avoid giving IM r/t rush effect)
- anxiety, lacrimation (watery eyes), rhinorrhea – hydroxyzine, avoid benzodiazepines
- insomnia – trazadone
- pain – acetaminophen (long term alcohol use pt may have esophageal varices or gastric ulcers), NSAIDS
- diarrhea – kaopectate (first line), avoid loperamide b/c sedation effect
Anorexia nervosa (AN)
Types:
- ________ type – weight loss accomplished through dieting, fasting, or excessive exercise
- ________ type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)
- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise
- Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)
____ complications –
- refeeding syndrome – sudden shifts in electrolytes can be fatal
Complications from ____:
- Erosion of dental enamel, xerostomia – dry mouth, tooth decay
- Neuro issues – seizures, fatigue, weak, mild mental symptoms
- Cardiac – cardiomyopathy, arrhythmias
- Russells sign
complications –
- refeeding syndrome – sudden shifts in electrolytes, can be fatal
BN (purging)
_________ – ACUTE cognitive impairment with rapid onset, caused by medical condition or direct physiological cause
________ – CHRONIC cognitive impairment, differentiated by cause not symptoms, Degenerative progressive
- emotional, and behavioral changes, physical and functional decline, ultimately death
Delirium – ACUTE cognitive impairment with rapid onset, caused by medical condition or direct physiological cause
Dementia – CHRONIC cognitive impairment, differentiated by cause not symptoms, Degenerative progressive
- emotional, and behavioral changes, physical and functional decline, ultimately death
s/s of _________
- Disturbance in executive functioning
- Aphasia – loss of language
- Apraxia
- Agnosia
- MMSE – cant name things
- Sundowning
- Memory impairment – confabulation
- Preservation
- Hyperorality
- Hoarding
Alzheimers
Most common dementia
__________
Neurological disorder caused by lack of thiamine (vitamin B1)
- requires immediate treatment
Develops most often in people with Alcohol use d/o or malnutrition
- Chronic alcoholism decreases intestinal absorption of thiamine
- Must r/o other causes of thiamine deficiency – malnutrition, ED, chronic infections, surgery
Wernicke-korsakoff syndrome
AN or BN?
Parotid gland swelling
Russells sign
BN
- Parotid gland swelling – unusual swelling of cheeks or jaw area
- Russells sign – calluses, scars on back of hands/knuckles from self-induced vomiting
Risk factors for ________
- Age, family hx
- CV disease
- Social engagement
- Diet
- TBI
- HTN and dyslipidemia
- Neuronal degeneration
- Genetics
Etiology of _____
- Tau proteins and beta amyloid plaques (sticky clumps between nerve cells) create neurofibrillary tangles (abnormal collections of protein threads inside nerve cells)
- Oxidative stress and free radicals
- Inflammation
- Brain atrophy
alzheimer’s
2 stages: Wernicke-korsakoff syndrome
- _________ – acute
- _________ – chronic
- Wernicke encephalopathy – acute
- Korsakoff syndrome – chronic
- ½ of people with Wernicke encephalopathy eventually develop korsakoff syndrome
s/s of ______:
- Frequent episodes of eating large amoutns of food in shorts time periods
- Feeling out of control overeating during episode
- Feeling depressed, guilty, disgusted
- Eating when not hungry
- Eating alone b/c of embarrassment of quantity eating
- Eating until uncomfortably full
- Upper and lower GI problems that bring them to HCP
BED
