EXAM 4 MENTAL HEALTH

what are our eating disorders (3)

- anorexia nervosa

- bulimia nervosa

- binge-eating disorder

what are eating behaviors (2)

- eating behaviors influenced by culture, family, and social influence

- habits when it comes to eating (either healthy or unhealthy)

what are healthy eating behaviors (4)

- eats when hungry

- eats intentionally and with purpose

- stops eating when satisfied/full

- positive body image

what are unhealthy eating behaviors

habits that lead to our ED diagnoses

what else to know about eating behaviors (2)

- influenced by culture, family, and social influence

- eating disorders represent a multidimensional set of sx and behaviors occurring along a spectrum

what are the dx criteria for anorexia nervosa (5)

- restriction of calorie intake leading to SIGNIFICANTLY LOW BODY WEIGHT (LOW BMI!!)

- body weight has a huge influence on self-evaluation for the client

- disturbance in how body weight/shape is experienced

- intense fear of gaining weight

- denial of the seriousness of low body weight

what are the two subcategories for anorexia nervosa (2)

restricting type: does not engage in binge-purge episodes

- weight loss through fasting and/or excessive exercise

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

- self-induced vomiting, laxatives, diuretics, enemas to lose weight

what are some S/S of anorexia nervosa (11)

- low weight

- distorted body image

- cold extremities/lanugo

- peripheral edema

- muscle weakening

- amenorrhea

- hypothermia

- bradycardia/hypoTN

- constipation

- metabolic changes

- abnormal lab values

what is the nursing process for anorexia nervosa (5)

establishing more adaptive eating patterns

- weight restoration: daily meal plan and caloric intake

- highly structured, precise meal times

- observation before and after meals; monitoring bathroom trips

- monitor weight: weigh in gown, check urine specific gravity

- monitor movement: parameters for exercise

what is the dx criteria for bulimia nervosa (5)

BMI is typically in the normal range

- eating, in a discrete period (2-hour period), a large amount of food

- sense of lack of control, overeating during the episode

- recurrent, inappropriate, compensatory behaviors to prevent weight gain

- binge eating & compensatory behaviors occur at least once a week for 3 months

- self-evaluation is influenced by body shape and weight

what are the S/S of bulimia nervosa (9)

- normal BMI / slightly low weight

- dental caries, tooth erosion

- parotid swelling

- calluses (russell sign)

- muscle weakening

- peripheral edema

- electrolyte imbalance (hypokalemia/natremia

- cardiovascular abnormalities

- seizure (vomiting lowers threshold)

what is the nursing process for bulimia nervosa (4)

same for anorexia nervosa

- highly structured, precise meal times

- observation before and after meals; monitoring bathroom trips

- monitor weight: weigh in gown, check urine specific gravity

- monitor movement: parameters for exercise

what is the dx criteria for binge eating disorder (5)

BMI is usually high

- eating, in a discrete period (2 hours), a large amount of food

- sense of lack of control; over-eating

- binge eating occurs at least once a week for 3 months

- marked distress regarding binge eating

- no recurrent, inappropriate, or compensatory behaviors

what else is binge episodes associated with (6)

- eating more rapidly than normal

- eating large amount of food when not hungry

- eating until uncomfy full

- eating when not hungry

- eating alone, embarrassed by how much one is eating

- feeling disgusted, depressed, or very guilty

what is the nursing process with binge eating disorder (5)

- binge eating is not about food; more with emotional coping

- binge eating can cause gastrointestinal problems (heartburn, dysphagia, abdominal pain)

- care plan = focus on rebuilding daily intake, balancing frequency and volume

- focus on healthy movement and physical activity at slow pace

- obesity = risk for DM, HTN, heart disease

what are nursing dx for eating disorders (8)

- imbalanced nutrition

- fluid imbalance

- impaired body image

- electrolyte imbalance

- anxiety

- ineffective denial

- low self-esteem

- impaired coping

what are the interventions for the management of eating disorders (8)

- VS & daily weight

- monitor intake, exercise, purging

- structured meals, observation after eating

- hospitalization, nutritional therapy as needed

- establish a healthy dietary plan, avoid caffeine

- teach relaxation techniques

- cognitive restructuring

- pharmacotherapy

what is the pharmacotherapy for eating disorders (3)

- no FDA approved medication for anorexia

- fluoxetine (Prozac) SSRI = only FDA approved for bulimia

- lisdexamfetamine (Vyvanse) = stimulant approved for binge-eating disorder

what medication is contraindicated with eating disorders

buproprion (Wellbutrin) contraindicated with bulimia!!

--> increased seizure risk!

what are the psychological therapies for eating disorders (3)

- family-based treatment: more effective than individual therapy for anorexia

- CBT: first-line treatment for bulimia

- CBT, DBT, and IPT are all associated with reducing binge frequency

what is the evaluation for eating disorders (7)

- VS, BP, and labs within normal limits

- verbalizes importance of adequate nutrition & fluid intake

- demonstrates techniques for anxiety reduction

- verbalizes ways to reduce feelings of powerlessness

- express less preoccupation w/ own appearance

- demonstrates adaptive eating behaviors

- established a healthy pattern of eating for weight control

what are the overviews of feeding disorders (3)

- multiple etiologies, often associated with developmental delays of childhood

- may result in significant nutritional deficiencies; can be fatal

- treatment: behavioral intervention, aimed to increase appropriate food consumption

what are the three feeding disorders

- Pica

- Rumination disorder

- avoidant/restrictive food intake disorder

what is Pica

Ingestion of substances that have no nutritional value, like dirt or paint

what is rumination disorder

undigested food being returned to the mouth; it is then rechewed and re-swallowed, or spit out

what is avoidant/restrictive food intake disorder

food avoidance; may be related to strong dislikes related to the sensory qualities of food

neurocognitive

cognitive functions linked to areas of the brain that have to do with thinking, reasoning, memory, learning and speaking

neurocognitive disorders (NCDs)

clinically significant deficit in cognition or memory, representing a notable change from a previous level of functioning

delirium

affects lower-level functioning, and is acute and reversible

mild neurocognitive disorders

characterized by a decline in higher level cognitive functioning

major neurocognitive disorders

referred to as dementia, are progressive and irreversible

delirium (6)

- medical emergency; requires immediate attention to prevent irreversible and serious damage

- begins abruptly

- usually brief

- common in hospitalized pts (older!!)

- associated with a high mortality rate

- may shift into a more permanent cognitive disorder

what are the 7 risk factors for delirium

- serious medical, surgical, or neurological conditions

- older than 65

- depression, falls, elder abuse

- substance intoxication delirium

- substance withdrawal delirium

- medication-induced delirium

- delirium due to another medical condition

what is the nursing process for delirium (5)

perform mental and neurological status examination AND physical examination

- determine underlying cause

- remain with patient

- SAFETY!!! (avoid restraints)

- quiet environment, lighted room

- fluid balance and adequate nutrition

mild neurocognitive disorder

Deficits do not interfere with independence in everyday activities

major neurocognitive disorder

Cognitive deficits are sufficient to interfere with independence in everyday activities

dementia

broad term used to describe the deterioration of cognitive functioning and global impairment of cognitive functioning

- alzheimer's disease = MOST common cause of dementia

alzheimer's disease (7)

- decreased ACh results in cognitive process disturbances

- excess glutamate = overstimulation NMDA receptors

- plaques (beta peptides clump together)

- tangles (tai protein tangle; interferes w/ neuronal transport)

- plaques and tangles contribute to death of neurons

- head trauma: increased risk for AD

- genetic factors

alzheimer S/S

- frontal lobe: impaired reasoning, inability to perform tasks, poor judgment

- parietal lobe: impaired orientation and visuospatial skills

- occipital lobe: impaired language interpretation, inability to recognize objects

- temporal lobe: inability to recall words or use correctly

- hippocampus: impaired memory

- amygdala: impaired emotions, depression, anxiety, personality changes, paranoia

progression of Alzheimer's

stage I: no apparent sx

stage II: forgetfulness

stage III: altered work performance, gets lost, altered concentration, poor word & name recall

stage IV: forgets events, less able to complete ADLs, social withdrawal

stage V: inability for ADLs, forgets names of close relatives, disorientation, social withdrawal

nursing process for neurocognitive disorders (7)

- MSE

- confabulation (creating stories)

- aphasia (loss of language ability)

- apraxia (loss of purposeful movement in absence of motor or sensory impairment)

- agnosia (inability to recognize words)

- behavior may be uninhibited, inappropriate

- sundowning

what are the nursing interventions of neurocognitive disorders (6)

- supportive care

- individualized care plan

- anticipate needs

- SAFETY!!

- teach strategies for communicating and structuring self-care

- DO NOT ARGUE, gently redirect

what are our pharm options

cholinesterase inhibitors (increase ACh)

- donepezil, rivastigimine, galantamine

SE: dizziness, GI upset, fatigue, HA

NMDA antagonist (regulates the activity of glutamate)

- memantine

SE: dizziness, HA, constipation

for behavioral sx: antipsychotics for dementia-related psychosis

mental health and aging (4)

- emotional and mental illnesses INCREASE over the life-cycle

- severe memory loss is not normal

- older adults = less likely to be dx

- economic concerns

depression and older adults

- more are likely to die by suicide

- psychomotor & cognitive slowing of depression = can resemble neurocognitive disorder (pseudodementia)

what is reminiscence therapy

thinking about the past and reflecting on it; promotes mental health

what is life review

a more directed cognitive process that constructs a history in an autobiographical way

what are the interventions for depression in older adults (6)

- structure milieu environment

- safety risk assessment

- promotion of self-care activities

- encourage group activities

- antidepressant medications

- ECT for severe depression

what are the special considerations of working with older adults

- orient; making questions short

- allow time to respond

- interview in a quiet setting

- medications: start slowly, lower doses

- consider the effects of polypharm

- Medication adherence can be challenging

core concepts of children and adolescents (4)

- disorder onset can disrupt the normal pattern of childhood development

- early dx and tx is essential

- children belong to a family system

- prognosis good w/ treatment

what are 8 factors impacting children mental health

- genetic background

- family hx

- adverse experiences

- family conflict

- poverty

- chronic illnesses

- temperament (good!!)

- resilience (good!!)

what are the 6 characteristics of resilient children

- adaptable to changes in the environment

- able to form relationships with other adults (if parent unavailable)

- able to distance themselves from emotional chaos

- social intelligence

- problem-solving skills

- able to perceive the future

what are the assessments a nurse would do for children

MSE: adapted to be appropriate for child's developmental stage

- HUGE look on characteristics of play

Developmental Assessment: learning and adapting to the environment and bonding w/ others

- HUGE look to see if the child is on tract

what are the 4 general interventions with children

- play therapy

- expressive arts therapy

- behavioral interventions

- family interventions

play therapy

children to express feelings through natural use of play

- good for younger children to access and work through bad memories

expressive arts therapy

provides nonverbal means of expressing difficult or confusing emotions

behavioral interventions

aim to reward desired behaviors to reduce maladaptive ones

family interventions

nurses help families to develop goals and work to achieve the goals for the family

what are our neurodevelopmental disorders (6)

- communication disorders

- motor disorders

- specific learning disorders

- intellectual disability

- autism spectrum disorder

- attention-deficit/hyperactivitiy disorder

what are communication disorders (concept and 4 specific disorders)

manifested in deficits in language, speech, communication ; result in impairments in academic acheivement, socialization, or self-care

- language disorder

- speech sound disorder

- child-onset fluency disorder

- social communication disorder

language disorder

difficulty attaining and using language due to deficits in production or comprehension of language

speech sound disorder

problems in making sounds

- ex: saying wabbit for rabbit

child-onset fluency disorder

aka stuttering

social communication disorder

problems using verbal and non-verbal means for interacting socially

- autism must be ruled out first

what are our motor disorders (3)

- developmental coordination disorder

- stereotypic movement disorder

- tic disorders

developmental coordination disorder

impairments in motor skill development

stereotypic movement disorder

repetitive movements; like hand-waving, rocking, head banging, etc

Tic disorders

sudden, nonrhythmic, and rapid motor movements or vocalizations

- motor tics: involve head, torso, or limbs

- vocal tics: spontaneous production of words and sounds

- tourette's disorder: multiple motor tics and at least one vocal tic for more than 1 year

tourette's disorder: nursing process (3)

- onset 4-6 years

- USUALLY peaks in early childhood and subside w/ age

- child may have low self-esteem, feel ashamed, self-conscious, rejected by peers

what are the interventions for tourettes (2)

- FOCUS on safety: helmets for children who are at risk for head injury

- behavioral techniques reduce tic expression

pharm tx for tourettes

antipsychotics (haloperidol, aripiprazole, risperidone

alpha 2A agonist: guanfacine, clonidine

specific learning disorder (3)

- dx when a child demonstrates persistent difficulty in reading (dyslexia), math (dyscalculia), and/or writing (dysgraphia)

- identified during school years

- receive treatment through school-based settings (like communication disorders)

intellectual disability (4)

characterized by deficits in three areas: intellectual functioning, social functioning, daily functioning

- ranges from mild to severe

- children cared for through early community intervention programs

- can require short-term hospitalization (aggression, self-harm, self-care deficits)

- CHRONIC

autism spectrum disorder (2) and S/S

complex neurobiological and developmental disability; affecting social interaction and communication skills

- neurodevelopmental delays (with or w/o intellectual disability)

- onset in early childhood

- RANGES

S/S: repetitive speech, over-adherence to routines or rituals, hyper or hypoactivity to sensory input

nursing process for autism spectrum disorder

1. protection from self-harm (protective devices)

2. improvement in social functioning

3. improvement in communication

what are potential medications for autism

antipsychotics: risperidone, aripiprazole to improve

- irritability

- severe temper tantrums

- aggression

- compulsive behavior

attention-deficit/hyperactivity disorder (ADHD) (3)

persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

- sx present before 12

- sx present in TWO or more settings

- sx interferes with functioning

some children are inattentive but not hyperactive (ADHD aka ADD)

ADHD S/S

- low frustration tolerance

- temper outburst

- labile moods

- poor school performance

- peer rejection

- low self-esteem

ADHD nursing interventions (6)

- structure environment

- Reinforce positive behaviors

- use simple, clear instructions

- discuss expectations: checklist with rewards

- set up a schedule

- medication teaching

ADHD medications (stimulants)

1. methylphenidate, dexmethylphenidate

2. amphetamines, lisdexamphetamine

SE: insomnia, WL, tremor, tachycardia, HTN, arrhythmias

- avoid caffiene

- monitor growth (weight, BP, pulse) --> drug holiday

- take AFTER meal

- take AM

ADHD medications (non-stimulants)

atomoxetine (SNRI)

SE: GI disturbance, dizziness, fatigue, insomnia, liver injury

clonidine, guanfacine (alpha 2A agonist)

SE: dry mouth, dizziness, constipation, sedation --> slow taper so no rebound SE

what are our impulse control disorders (3)

- oppositional defiant disorder

- conduct disorder

- intermittent explosive disorder

Oppositional Defiant Disorder (3)

- pattern of angry/irritable mood

- argumentative/defiant behavior

- vindictiveness

affects child's life and makes school functioning, friendships, and family life difficult

conduct disorder

shows antisocial personality disorder S/S but under the age of 18

Intermittent Explosive Disorder (2)

A pattern of behavioral outbursts characterized by

- inability to control one's aggressive impulses (verbal or physical)

- targeted towards other people, animals, poverty, or even oneself

nursing interventions for impulse control disorder (7)

- promote a climate of safety

- set limits and expectations

- provide structure and boundaries

- follow through w/ consequences of rule breaking

- provide opportunities for achievement

- Seclusion and restraint may be necessary to ensure safety

- pharm aimed at targeting sx such as outburst, anger, and aggression

family interventions (3)

family structure may be determined based on affection, emotional ties, sense of belonging, and durability of membership

- increase the level of differentiation of self while remaining in touch with the family system

- facilitate change in family structure

- change destructive communication patterns among family members

family functioning assessment (6)

communication: express honest feelings; all members participates

self-concept reinforcement: members feel loved, valued

family expectations: realistic, flexible, individualized

handling differences: open, nonattacking manner

interactional patterns: constructive, promote needs of all members

family climate: founded on trust, reflected in openess

family interventions: boundaries

clear boundaries: adaptive and healthy

diffuse boundaries: promote enmeshment, or exaggerated connectedness

rigid boundaries: promote disengagement, or extreme separateness

resilience

positive adaptation; the ability to maintain or regain mental health despite adversity

normal stress response

hyperarousal in the sympathetic system is balanced by the parasympathetic system

trauma stress response

parasympathetic response triggers a hypo-aroused state; with dysregulation --> can lead to dissociation

dissociation

disconnection of thoughts, emotions, sensations, and behaviors connected with a memory

- severe dissociation occurs for those who have suffered significant trauma

what are our three trauma and stressor-related disorders

- posttraumatic stress disorder (PTSD)

- acute stress disorder

- adjustment disorder

what is PTSD

exposure to trauma causes intense fear, helplessness, detachment, and other symptoms

- CHRONIC; sx last longer than 1 month

what is acute stress disorder

exposure to trauma causes symptoms like PTSD

- SHORT-TERM; sx are time-limited, lasting less than 1 month

- if sx last longer than 1 month --> PTSD

what is adjustment disorder?

maladaptive reaction to stressor

- response occurs within 3 months after onset of the stressor, persists for no longer than 6 months

what is PTSD characterized as

persistent re-experiencing of a highly traumatic event

- sx can begin a month after exposure; delay of months to years is not uncommon

- not everyone who experiences trauma will develop PTSD

what are the S/S of PTSD

- re-experiencing trauma: intrusive recollections, flashbacks

- avoidance of stimuli associated with trauma, accompanied by feelings of detachment

- sx of increased arousal: irritability, hypervigilance, exaggerated startle response, difficulty sleeping

- Alterations in mood: depression, lack of interest in previously pleasurable activities

what is acute stress disorder characterized as

unpleasant and dysfunctional reaction after exposure to a traumatic event

- short-term!