Anorexia/Bulimia/3D's

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foxyt14
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220184
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Anorexia/Bulimia/3D's
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2013-05-18 17:46:00
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Final N171
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  1. Huge hurtle for treating anorexia?
    they don't realize they have a problem....

    EGO SYNTONIC
  2. Concomitant Disorders with Anorexia
    • Major Depression
    • OCD
    • Panic/Phobia Disorders
    • Substance Abuse
  3. How can you determine if a person is anorexic?
    • Weighs 85% of normal weight for height
    • BMI of 17.5% or less
    • Loss of 15% of weight in last 6 months
  4. Cognitive signs of anorexia
    • Distortions of body image
    • Perfectionist
    • OCD with food
    • Food is control
    • Cognitive slowing
  5. Physical signs of anorexia
    • CONSTIPATION
    • Hypotension/Bradycardia
    • Hypothermia
    • Peripheral Edema
    • Abnormal CBC
    • Lanugo
    • Amenorrhea
  6. What is Bulimia?
    • Recurrent episodes of binge eating followed by compensatory behaviors:
    • purging
    • laxatives
    • diuretics
  7. Describe the bulimic
    • may be overweight....but weight fluctuates
    • skip meals
    • binge eat
    • purge

    Once was extroverted....becomes introverted
  8. Person with Bulimia is EGO
    Dystonic
  9. Physical signs of bulimia
    • loss of teeth enamel/cavities
    • enlarged salivary glands
    • Russell signs
    • menstrual irregularities
    • electrolyte imbalances
    • cardiac arrhythmias
  10. Serotonin and Bulimia and Anorexia
    Bulimia-decreased serotonin, decreased satiety....eat and purge

    Anorexia-increased serotonin, increased satiety...don't eat.
  11. What causes eating disorders?
    genes.....NOT FAMILY!!
  12. alexithymia
    denial of hunger
  13. Planning for person with Eating Disorder
    • improved nutritional status
    • improved coping behavior
    • improved perception of body image
    • improved self esteem
  14. Nursing intervention for eating disorders
    • multidisciplinary
    • nutritional counseling
    • behavior modification
    • counseling
    • FAMILY Counseling and INTERVENTION KEY!
  15. Drugs given to Bulemics....and why?
    Prozac or Zoloft

    they increase serotonin and increase satiety so they don't binge eat.
  16. Drugs given to anorexics and why?
    • Prozac or Zoloft
    •  
    • given to help with depression and OCD
  17. What is given to the anorexic to manage delusional thinking?
    Abilify
  18. What kind of therapy do anorexics/bulimics receive?
    psychotherapy
  19. How do you help a person stop binge eating?
    • help learn difference between emotions and hunger
    • ID foods that trigger binge eating
    • ID situations that trigger binge eating
    • Teach alternative behaviors and develop a safety plan
  20. When they are starting to eat again....what kind of foods should be restricted?
    fats/carbs...hard to digest
  21. General interventions for eating disorder
    • body image diary
    • reframe negative thoughts....and journal when they come up
    • list positive affirmations
    • confront all or nothing thinking patterns, perfectionism and overgeneralizations
  22. Where should people with Eating Disorders eat?
    in the dining room with other people....make it a social situation
  23. Which herb exacerbates mania and precipitates acute anxiety and insomnia?
    Ginseng
  24. Which herb exacerbates mania?
    Evening Primrose
  25. Which herbs help with nervousness, insomnia and irritability?
    Yohimbe and Ephedra
  26. Which herb improves a persons memory?

    But what's the bad part?
    Gingko.....decreases clotting time
  27. Which herb is good for mild depression?

    Details
    St. John Wart

    MAOI....don't take with other anti depressants or anticonvulsants
  28. What does vitamin E do?
    delays the development of Dementia....recommended for patients with Tardive Dyskinesia
  29. Dementia
    Aging brain....characterized by a loss of intellectual abilities involving personality changes and impairment of memory, judgment and abstract thinking
  30. Describe signs of dementia
    • slow and progressive onset
    • difficulty with recent events
    • confabulation
    • impaired attention
    • irreversible
    • sundowning
  31. Delirium
    a medically urgent condition that develops rapidly and is reversible.  Prompt medical attention is needed to prevent permanent damage or death.

    Disturbed cognition and inability to focus
  32. Describe signs of delirium
    • sudden and reversible onset
    • clouded state of consciousness with fluctuating arousal
    • restlessness
    • impaired memory/poor attention
    • HALLUCINATIONS
    • fear suspicious anxiety depression
  33. What causes delirium?
    • Any disruption to CNS
    • electrolyte imbalances
    • problems with kidneys, liver, heart, lungs
  34. Depression
    person who has a pervasive, pessimistic doomed attitude about life.....which can be linked to a date of onset
  35. Signs of depression
    • sleep and appetite disturbances
    • low self esteen
    • poor attention to ADL's
    • slow movement/response
    • loss of concentration/memory
    • responds with "I DONT KNOW"
    • normal attention
    • oriented x4
  36. Stage 1 of AD
    no apparent symptoms
  37. When a person is forgetful, losing things...but compensate by keeping structure in their life
    Stage 2 of AD
  38. What stage of AD is there a decline in cognition, lose train of thought mid sentence, driving difficulties, sleep pattern changes and problems with $$
    Stage 3
  39. Which stage of AD is it a good time to get an Advanced Directive and Power of Attorney in place?
    Stage 3
  40. What stage of AD does the person start to forget major events, have confabulation, becoming depressed and socially withdraw.....see delirium here
    Stage 4
  41. At what stage of AD does the p erson lose the ability to perform ADL's and are disoriented to time and place?
    Stage 5
  42. What stage of AD is the person forgetting family members names, losing language skills, needing assistance with AD, starting to wander

    hyperorality
    sundowning
    aphasia, agraphia, agnosia
  43. Stage 6
  44. What stage of AD is the person bedfast, have bladder and bowel incontinence
    Stage 7
  45. What will a person with AD die from?
    immobility complications
  46. What causes alzheimers?
    • aging brain
    • poor diet
    • stress...increased cortisol
    • smoking
    • low education
    • increased amyloid
  47. Nursing interventions for a person with AD
    • reality reorientation
    • pics of family
    • keep explanations simple
    • talk about relative events and people
    • monitor med side effects
    • simple structured environment
    • Provide assistance.....but encourage independence
  48. Interventions for the family members of a person with AD
    • discuss nature of the illness....what caused it and what to expect
    • teach ideas of how to manage....safety, reality orientation, assistance with ADL's and nutrition
    • make sure they know support services available to them...financial, legal, support, respite and home health
  49. Medication for dementia that increases ACh...which is needed for memory
    • Cognex
    • Aricept
    • Rivastigmine
    • Exelon
  50. What drug with used with Cognex, Aricept, Rivastigmine and Exelon in the early stages of AD?
    Namenda
  51. What drugs are given to assist with behavioral problems associated with AD
    • Antipsychotics
    • Anti depressants
    • Anti Anxiety
  52. inability to carry out a skilled purposeful movement
    apraxia
  53. examining objects by placing them in the mouth
    hyperorality
  54. repetitive behavior that has no purpose or meaning...continued repetition of meaningless words or phrases
    Perseveration
  55. Compulsive toughing of objects....especially dangerous when they don't recognize them as being too dangerous to touch
    Hyperetamorphosis
  56. loss of ability to understand and use language...both receptive and expressive
    aphasia
  57. inability to write
    agraphia
  58. inability to recognize familiar objects, situations and people
    agnosia
  59. unable to recognize things when you see them
    alexia
  60. unable to recognize things when you touch them
    astereognosia
  61. BMI for an obese person
    30+
  62. Diagnositc criteria for a binge eating disorder
    • eating in a discrete period of time (2 hrs) an amount of food that is definitely larger than most would eat in a similar period of time
    • a sense of lack of control over eating during the episode....cant stop
  63. Which behavioral strategies are useful in treating the patient with anorexia or bulimia?
    They MUST perceive they are in control of their treatment

    Cognitive therapy WITH behavior modifications
  64. Sundowning
    phenomenon in dementia in which symptoms worsen in the late afternoon and evening
  65. Abuse to elderly by female vs. male
    • female = neglect
    • male=violence/rape
  66. What makes an elderly person most susceptible to abuse?
    Their amount of dependency
  67. Which disorder do you see dirurnal fluctuations?
    Delirium
  68. Which disorder will you see unstable vital signs?
    Dementia or Delirium?
    delirium....cuz caused by an underlying medical condition
  69. perseveration
    unpurposeful, repetitive behavior
  70. When do you see physiologic issues with AD?
    Not till stage 7!!
  71. What is pseudomentia?
    depression
  72. How do you decrease your likelihood of mental disorders?
    • exercise
    • vitamin E
    • fish oil
  73. How do you assess pain on a person that is cognitively impaired?
    visual pain scale with smiley faces....

    OR

    put a pen in their fingernail!!
  74. What mental disorder can polypharmacy cause?
    delirium
  75. Diagnostic tests for dementia
    • CT
    • MRI
    • Lumbar puncture for amyloids in CSF
    • EEG
    • PET
  76. Diagnostic tests for Delerium
    • blood
    • urine....testing obth of infection
  77. Diagnostic tests for depression
    NONE
  78. How do you manage aggressive behavior in a patient with dementia?
    • assess if needs are being met? frustrated
    • remain calm and soothe them
    • minimize stimuli...soft music
    • avoid physical contact/confrontation
    • distract
    • or give antipsychotics
  79. Remember antipsychotics have a black box warning for.....
    increased death risk
  80. How can you decrease the incidence of sundowning?
    • play soft music
    • decrease stimuli
    • reduce afternoon naps
    • encourage activities...ball toss/exercise
    • low carb snacks at bedtime
    • avoid alcohol/nicotine
  81. How do you improve meal time behavior with a person who has AD?
    • reduce distractions...TV
    • sit in a chair at a table
    • arrange tray to encourage self feeding
    • wearing glasses/dentures
    • serve one food at a time/finger foods too
    • verbal cueing
  82. With a person with AD, make sure what sort of evaluation is done regularly?
    swallow
  83. How do you help a person with AD get dressed?
    • encourage independence
    • give enough time
    • snaps, Velcro garments
  84. How must the environment be modified in order to provide safety for the client with dementia?
    • arrange furniture to facilitate movement
    • bed in lowest position
    • assist with ambulation
    • find a safe place to wander
    • night light
    • stimuli low
    • remove throw rugs

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