week 6 Flashcards
What are the cognitive distortions of eating disorders?
- overgeneralization
- all or nothing
- catastrophizing
- personalization
- emotional reasoning
Explain overgeneralization in eating disorders?
a single event affects unrelated situations
all cats have four legs and I have four legs therefore I am a cat
Explain all-or-nothing thinking in eating disorders.
absolute and extreme reasoning
black or white; good or bad
if you eat a pastry your entire diet is RUINEDDDDDD
explain catastrophizing in eating disorders
consequences are magnified
explain personalization in eating disorders
events are over interpreted as having personal significance
people won’t like me unless I’m thin
explain emotional reasoning in eating disorders
subjective emotions determine reality
I know I’m fat because I feel fat
what causes eating disorders?
- neuro biological/endocrine
- dysfunctional family
- trauma
- participation in activity requiring thinness
- culture/peer pressure
- stressful life transitions
- comorbid anxiety disorder
what do those with anorexia usually have a difficulty with?
a difficult time with boundaries and with family
What do those with bulimia usually experience with family?
chaotic families
What criteria would show the need for hospitalization for someone with an eating disorder?
- 30% weight loss over 6 months
- inability to gain weight outpatient
- severe hypothermia
- HR below 40
- SBP less than 70
- K+ less than 3
- EKG changes
What is a BIG physiological concern for those with an eating disorder?
Potassium below 3
What is the psychiatric criteria for hospital admission with an eating disorder?
- suicide or self mutilation
- laxatives, emetics, diuretics, street drugs
- failure to adhere to tx
- severe depression
- psychosis
- family crisis
what psychiatric criteria can be an indication they may want to harm themselves?
laxative, emetic, diuretic, street drug use
what are some indications of anorexia nervosa?
- terror or gaining weight
- preoccupied with food
- views self as fat
- handles food peculiarly
- rigorous exercise regimen
- self induced vomiting, laxatives, diuretics
- cognitive distortions
What do those with anorexia nervosa physically experience?
- poor circulation
- pallor
- palpitations
- fainting
- dizziness
- menstrual disturbances
- unexplained GI symptoms
- Cachectic
- lanugo
What does cachectic look like?
like someone is wasting away ;(
what is lanugo?
long peach fuzz, keeps the body warm
In an assessment for eating disorders what does the nurse ask?
series of SCOFF questions
sick
control
one stone
fat
food
how many SCOFF questions does someone need to answer yes to in order to be considered for further eval?
2
What are the SCOFF questions?
- Do you make yourself SICK or vomit after a meal because you feel uncomfortable full?
- Do you fear loss or CONTROL over how much you eat?
- Has the pt lost 14lb in a 3 month period?
4.Do you believe you are FAT even when others tell you you’re thin? - Does FOOD dominate your life?
what are some expected outcomes for someone with an eating disorder?
- pt refrains from self harm
- pt will eat 75% pf 3 meals per day + snackiessss
- pt will achieve 85-90% of IBW
- pt will participate in tx
- pt will identify one coping behavior
What are some implementations for someone with an eating disorder?
- weight pt regularly (everyday)
- Observe pt while AND after eating to prevent procrastination
- give pt time frame to eat each meal
- consult nutritionist for choice of foods
- monitor physiological chambers
- assess for suicide
- work with pt to identify strengths
What are some interdisciplinary txs for eating disorders?
- CBT
- enhanced CBT
- dialectal behavior therapy
- interpersonal psychotherapy
What are the pharmacological txs for eating disorders?
- olanzipine
- fluoxetine
what is the pahrmacolocial tx of choice?
olanzapine, helps with obsessive thinking and cognitive distortions
What are some characteristics of bulimia nervosa?
- binge eating
- binging occurs after fasting
- compensatory behavior
- Hx of anorexia
- depression, anxiety, compulsivity
- problems with interpersonal relationships, self concept, impulsive behaviors
What are some physiological changes in someone with bulimia?
- at or above IBW
- enlargement of parotid glands
- dental erosion
- skin problems
what do we assess for in someone with bulimia?
- medical stabilization
- physical exam and lab testing
- use of meds, herbs, and drugs
- psychiatric eval
- suicide risk
what are some outcomes for someone with bulimia?
- pt will obtain and maintain normal electrolytes and stable VS
- pt will refrain from binge-purge behaviors
- pt will be free from self harm
- pt will demonstrate 2 anxiety reduction techniques
- pt will name 2 personal strengths
what is involved in the implementation process for someone with bulimia?
- weigh pt regularly
- observe pt while eating AND 1-3 hours after
- observe for compensatory behavior
- encourage pt to keep a journal
- assess for suicide
what is an interdisciplinary tx for someone with bulimia?
psychotherapy
what is a pharmacological therapy for someone with bulimia?
fluoxetine
approved for bulimia. but best p[aired with therapy
describe binge eating disorder
- similar to bulimia BUT NO COMPENSATORY MECHANISMS USED
- eat large amounts in a short period
- feel guilty after binge eating
meaning they don’t vomit pr exercise
what do we evaluate for in binge eating disorder?
constant process of revising goals
What are the neurocognitive disorder domains?
- complex attention
- executive functioning
- learning and memory
- language
- perceptual motor abilities
- social cognition
Describe delirium
- secondary to another condition
- complete recovery can occur
- elderly at greatest risk
can delirium progress to dementia?
yes, if not tx it can progress
what are the risk factors for delirium?
- medications
- infections/illness
- number of co-ocurring conditions
- disorders of substance or alcohol
- surgery
- pain
- cognitive impairment
- emotional or mental illness
- sleep disturbances
who is at higher risk for developing delirium?
children and older adults
how fast can delirium occur?
symptoms develop rapidly and fluctuate.
Happens in a day or 2
How does delirium affect cognition?
- decreased ability to focus
- Decreased orientation to environment (may not know the date)
- memory impairment
- unable to calculate
how does delirium affect behavior?
- restless
- anxious
- motor agitation
- labile
How does delirium affect perception?
- hallucinations
- illusions
- decreased visuospatial ability
(may reach for coffee and not grab it and miss it)
How can delirium affect physiological aspects?
- medical emergency!!!!!
VS ARE UNSTABLE
What are the different types of delirium?
- hyperactive
- Hypoactive
- Mixed
Describe hyperactive delirium
restless
agitated
describe hypoactive delirium
sleepier
lethargic
difficult to identify
What do we assess for in a pt with delirium?
- cognitive and perceptual disturbances
- safety
- mood and behaviors
they wander, forget they can’t walk, labile, crying uncontrollably
What are the outcomes for someone with delirium?
reversible diagnosis
UNO REVERSE THAT SHID
Are the interventions the same for dementia and delirium?
YUHHHHSSS SIR
What are the interventions for someone with delirium?
provide a safe and therapeutic environment
- non skid socks
- good lighting in room
- room close to nursing station
- a lot of reality orientation
- have clocks and calendars
- I.D bracelet
Describe mild neurocognitive disorder
- modest impairment
- symptoms do not interfere
describe major neurocognitive disorder
- substantial impairment
- symptoms interfere with independence
What is major neurocognitive disorder also known as?
dementia
which is a gradual progressive impairment
what is the difference between primary and secondary major neurocognitive disorder?
primary is irreversible
secondary id the type of dementia where delirium does untreated
what are risk factors for developing Alzheimers
- 65 years or older
- women
- familial hx
- Cardiovascular risk factors
- genetics
Is alzheimers a normal part of aging?
NO
What is the primary risk of Alzheimers?
over age 65, chances DOUBLE
What is used as a neurocognitive test?
Mini-mental state exam MMSE
What are some neurocognitive defense mechanism?
- Denial
- Confabulation
- Perservation
- avoidance of questions
What do we assess for in a pt with dementia?
- disturbances in executive functioning
- cognitive impairment
What cognitive impairment issues does someone with dementia experience?
- amnesia
- aphasia
- Apraxia
- Agnosia
what is aphasia
difficulty understanding words, speech
what is apraxia?
loss of movement
what is agnosia?
hard time interpreting sensations, can’t tell if something is hot or smell
What do we assess for in a pt with dementia
- cognition
- identify any general medical conditions
- safety
- neglect or abuse
- family
What are the stages of Alzheimers disease?
- Stage 1:mild
- Stage 2: moderate
- Stage 3: mod to severe
- Stage 4: end stage
What are some characteristics of mild Alzheimers?
forgetfulness
hard time learning new things
What are some characteristics of moderate Alzheimers?
confusion
harder time compensating
hygiene issues
start to see labile mood
What are some characteristics of mod to severe Alzheimers?
ambulatory dementia
can’t recognize their loved ones
What are some characteristics of late Alzheimers?
end stage
complete regression
can’t walk
can’t talk
need to touch everything
What are some outcomes for someone with Alzheimers?
- Pt will remain safe in all environments
- pt will answer yes or no appropriately to questions
- pt will participate in plan of care
- Pt will state feeling safe after experiencing delusions
- Pt will put on own clothes appropriately
What will we implement with a pt with dementia?
- validation therapy
- Validate the reality
- Empathize
- help person to connect to feelings
- reality orientation
- Reminiscience therapy
What is validation therapy?
focuses on emotions rather than the facts
What can we implement as interventions for someone with dementia?
music therapy
sensory interventions
What are the pharmacological therapies for mild to moderate AD?
- Galantamine hydrobromide
- Rivastigmine tartrate
- Donepezil hydrochloride
What do the pharmacological therapies for mild to moderate AD target to do?
Slow down AD progression for limited time
What are the side effects of the medications given fir mild to moderate AD?
GI side effects
When do you give Donepezil?
give at night
Do the meds for mild to moderate AD reverse AD?
DOES NOT REVERSE only buys them time.
What is the medication given for moderate to severe AD?
- Memantine hydrochloride
What is the mechanism of action for Memantine?
slow down progression
What are the side effects of Memantine?
- Dizziness
- Headache
- Constipation
