Psych Study Guide Exam 2

Anorexia nervosa (AN)

restricting food eating disorder

Bulimia nervosa (BN)

binge eating and compensatory behaviors like vomiting, fasting, or excessive exercise to prevent weight gain

Anorexia nervosa (AN) treatment goals:

Nutrition rehab, resolving body-image conflicts, effective coping, address underlying issue

Bulimia nervosa (BN) treatment goals:

Normalize eating and break the binge-purge cycle, correct electrolytes, change faulty thinking and perceptions, improve self-worth

Anorexia nervosa (AN) nursing interventions:

Use nonjudgemental but firm approach, give rationale for every intervention, supervise bathroom for purging, privileges linked to weight gain

Bulimia nervosa (BN) nursing interventions:

Monitor all meals and intake, supervise the bathroom, monitor sleep, use CBT

Anorexia nervosa (AN) medications:

-Fluoxetine(Prozac) is used only AFTER the person reaches maintenance weight, to reduce obsessive symptoms and perfectionism

-Olanzapine (Zyprexa) or chlorpromazine (Thorazine) can reduce obsessional behavior and resistance to weight gain

-        Medications are NOT EFFECTIVE IN ACUTE PHASE.

Bulimia nervosa (BN) medications:

-        SSRIs and TCAs decrease symptoms short-term

o   Bupropion (Wellbutrin) is contraindicated because of seizure risk

-        BED: lisdexamfetamine (Vyvanse), CBT and SSRIs

Anorexia nervosa (AN) priority assessments and interventions for MORE severe and medically unstable:

-        Refeeding syndrome: a dangerous fluid/electrolyte shift when nutrition restarts in a starved patient

Assessments/interventions for suicidality in youth:

-        Assess for level of understanding of suicide and death, history of threats, recent behavior change, substance use, hopelessness

What is different in how youth understand death?

-Death concept: young children often don’t grasp that death is PERMANENT. They may see it as temporary, so self-harm can seem like a way to escape and come back

-Interventions need to be concrete, plus close supervision and safety. Don’t assume a child understands the finality

Black box warning for use of SSRIs in youth:

- SSRIs carry a warning for increased suicidal thinking and behavior in children and young adults, especially in early treatment or after dose changes.

- Side effects to watch for: decreased sleep, sudden mood or behavior change, suicidal ideation and self-injury.
Treatment: CBT plus an SSRI is the best combination!

Youth VS adult disorders:

- Anxiety: separation anxiety, and school phobia. Meds are not effective; use CBT and consider SSRIs

- Depression: children express it as sleep, appetite and activity changes, and behavior problems because they are less able to name sadness

- OCD: starts in childhood and often occurs with tics

- Psychosis: childhood schizophrenia is rare, has poorer premorbid functioning and is more severe than the adult form-NOT autism

Therapeutic range for lithium therapy:

-0.6-1.2 mEq/L

-Toxicity begins above 1.5

-Toxicity signs: coarse tremor, vomiting, ataxia, and confusion

Electrolyte imbalances:

-Potassium: Low (under 3.5) causes weakness, cramping, constipation, arrhythmias and prolonged QT. Under about 4.0 needs URGENT intervention

-Sodium: low causes confusion, headache, and seizures. Under about 120 is an emergency

- Magnesium: low causes tremor, cramps, arrythmias, and seizures

- Phosphorus: Low is the key REFEEDING risk

- Purging pattern: Low K, low Cl, high bicarbonate (alkolosis)

Refeeding syndrome:

-Dangerous fluid/electrolyte shift when nutrition restarts in a starved patient

-Phosphate, potassium, and magnesium LOW -> can cause arrythmias and cardiac failure, edema, delirium, and seizures

What refeeding syndrome means for care of youth with AN or BN:

For youth, calories are advanced slowly. Monitor vital signs, labs, and I/O, and edema (privileges linked to weight gain for treatment!)

ADHD/ADD (attention deficit hyperactivity disorder/attention deficit disorder)

- Neurodevelopmental disorder characterized by difficulty paying attention, impulsivity, and/or hyperactivity

o   ADD is an older term for ADHD that primarily describes difficulty paying attention without hyperactivity

ADHD/ADD medications:

- Stimulants (1^st line): dextroamphetamine (Dexedrine), Adderall, Vyvanse; methylphenidate (Ritalin, concerta, Focalin, daytrana patch)

- Non-stimulants: atomoxetine (Strattera, first line), guanfacine (intuniv, tenex), clonidine, and bupropion or TCAs as second line

Psychostimulant medications vs nonstimulant for focus

-Stimulant: 1st line, works quickly

-Non-stimulant: strattera has less abuse potential, long-acting forms have less abuse potential

Nursing considerations for psychostimulants:

- Monitor height, weight, BP, and pulse

-Stimulants do NOT increase risk of later substance abuse

-Give after meals for nausea or appetite loss

-Give last dose at least 6 hours before bedtime

- Watch for anxiety, mood changes

Diversion risk of psychostimulants: (stolen/transferred)

Warning signs are early refill requests, “lost” prescriptions, pills missing on counts, a household member with substance abuse, and a teen sharing or selling. Use locked storage, count pills, single prescriber, etc.

Nursing interventions for youth with TIC disorders:

- Do full assessment of tic type, frequency, and interference

- Teach family, school, and daycare that tics are involuntary and worsen with stress

Nursing treatment for youth with TIC disorders:

-Medications: haloperidol or pimozide, risperidone, apriprazole, and clonidine or guanfacine

-Goal: reduce tic frequency, improve quality of life and manage symptoms

Anti-craving medications for opiates

-Methadone: clinic-dispensed, monitor respiratory depression and QT

- Buprenorphine (Subutex/suboxone): start when in withdrawal to avoid precipitated withdrawal, monitor liver function

- Naltrexone (Revia/vivitrol)-ALSO used in alcohol: decreases cravings, monitor liver function, contraindicated with concurrent opioid use-person MUST BE OPIOID FREE

Anti-craving medications for alcohol

-Disulfiram (Antabuse): aversive reaction (flushing, vomiting, hypotension) if alcohol is consumed, including hidden alcohol. Monitor liver function

- Acamprosate: monitor kidney function, diarrhea is common. Start AFTER detox

- Naltrexone (Revia/vivitrol)-ALSO used in opioids: decreases cravings, monitor liver function, contraindicated with concurrent opioid use-person MUST BE OPIOID FREE

Delirium tremens:

SEVERE alcohol withdrawal delirium with disorientation, vivid hallucinations, extreme agitation, fever, and autonomic instability

Treatment for delirium tremens:

- Benzodiazepines (symptom-triggered, using the CIWA scale), thiamine and multivitamins/folate, IV fluids and electrolytes, seizure precautions, and a quiet, low-stimulation environment with close monitoring.

-        Benzodiazepines, anticonvulsants, thiamine, and multivitamin therapy