n222 wk 5

anorexia nervosa

persistent energy intake restriction, low body weight, fear of gaining weight/being fat, common in adolescence-young adulthood, can be associated with stressful life

types of anorexia nervosa

restricting type, binge-eating/purging type

restricting type

type of anorexia nervosa, restricts intake and does not binge/purge

binge-eating/purging type

type of anorexia nervosa, engage in bingeing/purging and restriction, higher rate of impulsivity, more likely to abuse drugs/alcohol

bulimia nervosa

recurrently eating large quantities of food over short period of time followed by inappropriate compensatory behaviors, occurs once a wk for 3 mon, late adolescence-early adulthood, restrict caloric intake between binges

purging type behaviors

emesis, laxatives, diuretics, enemas

non-purging type

excessive exercise, fasting, diet pills

binge-eating disorder

eating large quantities of food over short period of time (2hrs) w/o use of compensatory mechanism, experience distress, lack of control, affects men and women (46-55), increases risk of chronic disorders, severity depends on number of binge episodes per wk

chronic disorders that can result from binge-eating disorder

type 2 DM, HTN, cancer

general assessment for pts with ED

perception of problem, eating habits, hx of dieting, methods used for weight control, value atttached to specific shape/weight, interpersonal and social functioning, psychological influence, occupational choices, participation in athletics

eating habits of ED

pushing food around plate, cutting into small pieces

interpersonal and social functioning of ED

parental pressure, school/peer pressure

psychological influence of ED

social media

cognitive distortions of ED

overgeneralizations, all-or-nothing thinking, catastrophizing, personalization, emotional reasoning

mental status of ED

cognitive distortions, high interest in preparing food but not eating it, intense physical regimen, possible obsessive-compulsive features

expected findings of anorexia nervosa

weight < 85% of normal, lanugo (face, back, extremities), yellow skin, pale cool extremities, poor skin turgor, acrocyanosis, constipation, amenorrhea, menstrual irregularities

expected findings of bulimia nervosa

normal weight/slightly elevated, Russell’s sign (if purging), enlarged parotid glands, dental erosion (if purging), cardiomyopathy, hypokalemia (vomiting), diarrhea (laxative use), self-induced vomiting, excessive use of diuretics/laxatives, esophageal tears, gastric rupture

V/S expected findings of both anorexia and bulimia

low BP, HR, temp, orthostatic hypotension

cardiovascular expected findings of both anorexia and bulimia

dysrhythmias, HF, peripheral edema

fluid/electrolyte expected findings of both anorexia and bulimia

acidosis/alkalosis, dehydration, electrolyte imbalances

musculoskeletal expected findings of both anorexia and bulimia

muscle weakness, decreased energy

GI expected findings of both anorexia and bulimia

abdominal pain

psychosocial expected findings of both anorexia and bulimia

low self-esteem, impulsivity, difficulty with interpersonal relationships, depressed, social withdrawal, irritability, insomnia

ciriteria for acute care tx of ED

rapid weight loss (> 30% over 6mon), unsuccessful weight gain, VS (HR < 40, SBP < 70, temp < 96.8), ECG change, electrolyte disturbances, psychiatric (severe depression, suicidal behavior, family crisis, psychosis)

nursing care for ED

monitor VS I&O weight (2-3lb/wk), reward positive behaviors, monitor during/after meals for purging, incorporate family in discharge planning, therapy, appropriate exercise, encourage decision making and participation in care plan, realistic goals, CBTs (cognitive reframing, relaxation techniques, journaling, densensitization)

working with dietitician for ED

pt’s preferences and ability to consume food, structured and inflexible eating schedule, small frequent meals to avoid feeling overwhelmed, liquid supplements, high fiber/low sodium/limit fat food, multivitamin and mineral supplement, avoid caffeine

refeeding syndrome

reintroduce food too quickly, starvation = rely on fat and protein, low insulin, loss of intracellular electrolytes (phosphate), sudden shift to carbohydrate metabolism = influx of insulin, intracellular uptake of phosphate, Mg, K, thiamine (lethal transfer) = HF, respiratory failure, seizures

how to avoid refeeding syndrome

reintroduce minerals and supplements slowly

pica

eating nonfood items

rumination

regurgitation with rechewing, reswallowing, spitting, no medical/mental reason

somatic symptom disorder

physical symptoms distress/disrupt daily life with excessive thoughts, feelings behaviors (symptoms are real), long-term use of healthcare services, vague/exaggerated, often reject psychological dx, comorbid with anxiety and depression

patient health questionnaire 15 (PHQ-15)

self-report measuring somatic symptom severity, higher score = higher severity

nursing care for somatic symptom disorder

accept somatic manifestation as real to pt, identify culture impact on pt view of health and illness, report new physical manifestation to provider, limit amount of time allowed to discuss somatic manifestations

illness anxiety disorder (hypochondriasis)

misinterprets physical manifestations as evidence of serious disease, obsessive thought/fear of illness, overly aware of bodily sensations, research suspected disease excessively, seek numerous medical opinions, anxiety despite reassurance of provider

conversion disorder (functional neurologic disorder)

neurologic manifestations in absence of neurologic dx, transmits emotional/psychological stressors into physical manifestations, can cause extreme anxiety/distress with lack of emotional concern (La belle indifference)

conversion disorder manifestations

blindness, paralysis, seizures, gait disorders, hearing loss

factitious disorder (Munchausen syndrome)

conscious decision by pt to falsely report physical/psychological manifestations, absence of personal gain other than fulfillment of emotional need for attention, can inflict self-injury

factitious disorder imposed on another (Munchausen syndrome by proxy)

deliberately causes injury/illness to vulnerable person, emotional need for attention/relief of responsibility, average-above average IQ, dramatic description of illness, use proper med terms, reports new manifestations following negative results

malingering

not mental illness, intentional faking/exaggeration of pysical/psychological sx to obtain external reward

external rewards pts want through malingering

disability benefits, evading miltary service, drug-seeking, temporary housing/bedding

phases of cycle of violence in abusive relationships

honeymoon phase, tension-building phase, acute battering phase

honeymoon phase

perpetrator is loving and contrite, victim wants to believe and hope for change

tension-building phase

perpetrator has minor ep of anger and can use substances, both try to reduce if tension builds, victim is tense and accepts blame

acute battering phase

tension too much and serious abuse occurs, victim cover up injuries/get help, most violent/shortest stage

risk factors for violence

female, trying to leave relationship, pregnancy, older adults who are dependent/poor health, children < 4yrs (unwanted, disabled, vulnerable traits)

characteristics of victim

negative self image (low self-esteem, helpless, hopelessness, powerless, guilt, shame), protect perpetrator (accepts responsibility for abuse), denial of severity of issue

characteristics of perpetrator

use intimidation and threats to control victim, extreme disciplinarian (believes in physical punishment), poor impulse control, control finances and maintain dependency, violent outbursts, poor coping, low self-esteem

shaken baby syndrome

shaking/impact results in intracranial hemorrhage, respiratory distress, bulging fontanels, increase in head circumference, retinal hemorrhage

assessment for preschoolers/adolescents for abuse

unusual areas for bruising (abdomen, back, buttocks), doesn’t match story, bruises in various stages of healing, burns (glove/stocking = boiling water, small round = cigs), fractures in unusual areas (spiral = twisting), bite marks, head injuries

rape

nonconsensual sexual activity, penetration of vagina/anus with body part/object, oral penetration by sex organ of another, crime of violence, aggression, anger, power

types of rape

stranger, martial, date, acquaintance

substances used to rape

gamma-hydroxybutyrate (G/liquid ecstasy), flunitrazepam (roofies), ketamine (special K), used for sedative/amnesia effect

rape-trauma syndrome

sustained/maladaptive response to forced violent sexual penetration against one’s will/consent

stages of RTS

initial emotional reaction, emotional follow-up, potential for somatic reactions

initial emotion reaction to rape

expressed reaction (overt, emotional outbursts): crying, laughing, hysteria, anger, incoherence, controlled reaction (ambiguous): calm/blunted affect, numbness, confusion, indecisive

emotional follow-up

embarrassment, revenge-seeking, guilt, anger, fear, anxiety, denial

compound rape reaction

additional disorders bc of sexual assault = depression, substance use disorder

silent rape reaction

does not report/tell anyone, abrupt changes in relationships, nightmares, anxiety, changes in sexual behavior, phobic reactions

nursing care for rape pts

nurse self assess for emotional feelings regarding event, should be empathetic, objective, nonjudgmental, initial/ongoing assessment of pt for anxiety, coping, support systems, private environment, let them know they’re safe, informed consent for data collection, let them know it’s not their fault, SI, admin prophylactic tx for STD, evaluate for pregnancy, encourage verbalization of story

sexual assault nurse examiner (SANE)

physical head to toe and genitals, provide immediate injury care, collect evidence, document injuries (photos, body maps, written narrative verbatim), discharge protocol

sexual assault collection kit

blood, oral swabs, hair samples, nail swabs/scrapings, genital/anal/penile swabs

discharge protocols for rape pts

outpatient modalities, 24hr phone service, psychotherapy/group therapy, after-care