Chap. 20 Essentials of Psy. Health nsg

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cwb102
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198765
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Chap. 20 Essentials of Psy. Health nsg
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2013-02-07 20:09:19
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Eating disorders
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  1. Dx:  anorexia nervosa; refusal to maintain wt. @ or above min. norm. wt. for age/ht.; wt. loss leading to wt. of <85% of IBW; failure to make expected wt. gain during period of growth; intense fear of gaining wt. or getting fat; body image disturbance; denial of seriousness of low body wt.; amenorrhea or absence of @ least 3 consecutive menstrual cycles; in restricting- individual hasn't engaged in binging/purging behavior; in binge-eating/purging type- individual has regularly engaged in binge eating/ or purging behaviors
    Sx: morbid fear of obesity; gross distortion of body image (resulting from individual perception of being fat); preoccupation w/ food; and refusal to eat; hunger pangs experienced (w/ less than 200 kcal/day); individual underweight/emaciated; weight loss accomplished by reduction in food intake or often extensive exercise, self induced vomiting, abuse of laxatives/diurectics; hypothermia; bradycardia; hypotension; edema; lanugo; amenorrhea usually follows weight loss, may preclude in some cases; may be obsessed w/ food; age of onset 12-30; feelings of depression/anxiety are common

    Tx: cognitive therapy; individual therapy; family therapy; contract based on wt. gain (only used for wt. restoration)

    psychopharmacology-- for anxiety/depression associated w/- fluoxetine (prozac), clomipramine (anafranil, in particular for those w/ OCD as well), cyproheptadine (periactin) as appetite stimulant, chlorpromazine (thorazine) as an antipsychotic, olanzapine (zyprexa)
  2. Dx: bulimia nervosa; episodes of binge eating characterized by eating in a discrete period of time (2 hours) an amount of food that is more than norm. for most people; sense of lack of control over eating; recurrent inappropriate compensatory behavior in order to prevent wt. gain such as self induced vomiting, laxatives/diurectics, enemas, fasting or excessive exercise; binge eating and inappropriate compensatory behaviors that both occur on avg. twice a week for 3 mo.; self eval. is unduly influenced by body shape/wt.; disturbance doesn't occur exclusively during episodes of AN; purging type-engages in purging activities; nonpurging type- no purging activities, uses exercise or fasting
    • Sx: see above; individuals are usually within norm. wt., maybe a little over/under; may have mood disorders, anxiety disorders, substance abuse or dependence (amphetamines/alcohol)
    • Tx: behavior modification, cognitive therapy; individual therapy; family therapy

    antidepressants (ssri -fluoxetine/prozac), imipramine (tofranil), desipramine (norpramin), amitriptyline (elavil), nortriptyline (aventyl), and phenelzine (nardil)
  3. Dx: binge eating disorder; recurrent binge eating characterized by eating in discrete period of time (2 hours) an amount that is more than norm. and sense of lack of control; episodes associated w/ 3 or more of - eating very rapidly, eating until uncomfortable, eating large amounts when not hungry, eating alone to avoid embarrassment, feeling disgusted/depressed after overeating; marked distress regarding binge eating is present; episodes occur on avg. 2/week for 6 mo.; episodes not associated w/ use of inappropriate compensatory mechanisms such as purging and doesn't occur exclusively during AN
    • Sx: see above;¬†
    • Tx:¬†cognitive therapy; individual therapy; family therapy

    anti-convulsant topiramate (topamax) in long-term tx; fluoxetine (ssri) which may help to decrease cravings for carbs; anoreciants- not widely used b/c have serious heart/lung complications; sibutramine (meridia) used only for individuals w/ sig. amount of wt. to lose, inhibits serotonin and norepi. , some claims w/ this med. about cardiac complications

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