childhood and eating disorders

nursing assessment of physical health for anorexia

• evaluate the body systems due to starvation

• determine BMI

• determine menses hx

anorexia nervosa

• low body weight

• intense fear of gaining weight

• disturbance in shape

nursing assessment for behavioral responses in anorexia

• symptoms of body distortion

• avoidance of conflict and expressing negitive emotions such as anger

nursing assessment of self concept and coping

• many patinets come across as competent but often feel they are not good enough

• They control their stress and anxiety with their eating patterns

Social assessment of anorexia

Focus should be on family interaction, influence, and peer relationship

medication used for anorexia or bulimia

• fluoxetine (high dose)

• monitor for suicide ideation (first 2 weeks)

bulimia nervosa

• distortion of body image

• obsession to loose weight

• over eating » depression

• self induced vomiting / laxatives ( purging )

characteristics of bulemia

• normal / over weight

• social butterfly

• difficulty setting limits and establishing boundaries

• enormous rules for food

• impulsivity (spending habits)

treatments for bulimia

• multimodal tx approach

• cognitive behavioral therapy

• antideppressants

• nutritional counseling

• Group therapy

• Support group

• Fluoxetine 60 mg

binge eating disorder

• eating a lot

• no purging

• obese

• 10-30 percent of all obese people

• underlying depression

• (fluoxetine)

autism spectrum disorder

• repetitive rocking

• hand flapping

• do not try to stop this (let it happen)

treatment of autism spectrum disorder

• residential care may be necessary as the child reaches adulthood

• need a structured physical environment (do not change nurses continuously)

Diagnostic criteria for ADHD

• Difficulty handling one task at a time

• Easily distracted

• Impulsive

• Failure to consider consequences

Pharmacology for ADHD

• Methylphenidate-psychostimulant

• Concerta

• Ritalin

• Meditate - longer acting

• Adderall

• Atmoxetine ( least likely to disrupt sleep)

Medications for Tourette's and tic disorders

• Aripiprazole - or other antipsychotics

• A adrenergic receptor antagonist (clonidine)

Mood disorders are

• Recurrent disturbances or alterations that caused psychological distress and behavioral impairment

• Children tend to act out

• Changes in sleep, appetite, activity, and interest

Which finding is a core feature of anorexia nervosa

• Intense fear of gaining weight despite low body weight

Centers on restricted and take an intense fear of weight gain and a distorted body image, even when the client is specifically underweight

client with anorexia nervosa has a resting heart rate of 42 bpm. How should the nurse interpret this?

• A sign of medical and stability that may require hospitalization

Starvation related bradycardia signals cardiac compromise a heart rate below about 50 bpm while awake is a common criteria for impatient admission

which nursing action is most appropriate at meal times for a client with anorexia nervosa

• Stay with the client during the meal and for a set period afterwards

Supervising the meal and the time after it helps prevent hiding food purging or exercising without putting the focus on calories

which topic is most important to include in discharge teaching for a client recovering from anorexia nervosa

• Setting realistic achievable goals

Perfectionism and unrealistic expectations. Feed the disorder calorie counting in frequent weighing reinforce the preoccupation. The client is working to let go of

a client says if I eat even one dessert I'm a total failure which cognitive distortion is this

• dichotomous (all or nothing) thinking

She's only extremes with no middle ground perfect control or complete failure

and nurse notices calluses and scarring on the back of a client's knuckles. What is this finding called?

• Russell sign

Comes from the hand, repeatedly rubbing against the teeth during self-induced vomit

lab results for a client who frequently self induced vomit would most likely show

• Hypokalemia

Losing gastric, contents, deplete, potassium, and hydrochloric acid, causing hypokalemia and metabolic alkalosis

which psychotherapies is first line for bulimia and is often combined with medication

Cognitive behavioral therapy

a client was bulimia. Nervous asked to keep self monitoring diary. What is the main purpose of this?

I identify situations feelings and queues that trigger binges