Psych Test 3 Bitches…..txt

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Psych Test 3 Bitches…..txt
2010-08-03 04:50:50

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  1. In schizophrenia, these symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include:
    --Thought disorders
    --Disorganized behaviors

    Positive Symptoms
  2. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of all schizophrenic symptoms
  3. These usually involve seeing or hearing things that don't exist. They can be in any of the senses. Hearing voices is the most common example among people with schizophrenia.
  4. Difficulty speaking and organizing thoughts: may result in stopping speech midsentence or putting together meaningless words, sometimes known as "word salad."
    Thought disorder
  5. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation.
    Disorganized behavior
  6. Refers to a diminishment or absence of characteristics of normal function. They may appear months or years before positive symptoms. They include:

    *Loss of interest in everyday activities

    *Appearing to lack emotion

    *Reduced ability to plan or carry out activities

    *Neglect of personal hygiene

    *Social withdrawal

    *Loss of motivation

    Negative symptoms
  7. Involves problems with thought processes. These symptoms may be the most disabling in schizophrenia, because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms, but they may worsen when the disorder starts.
    They include:

    *Problems with making sense of information

    *Difficulty paying attention

    *Memory problems

    Cognitive symptoms
  8. Schizophrenia also can affect mood, causing depression or mood swings. In addition, people with schizophrenia often seem inappropriate and odd, causing others to avoid them, which leads to social isolation.
    Affective symptoms
  9. What is the #1 crime problem in South Carolina?
    domestic violence
  10. One in every four women will?
    experience domestic violence in her lifetime
  11. One in 33 men have?

    experienced an attempted or completed rape

  12. There were 35,894 victims of domestic violence in South Carolina in 2005. 43% of reported domestic violence cases ended in a(n) ?
  13. The most common relationship between homicide perpetrators and victims was boyfriend/girlfriend and the second most common relationship was between
  14. How long do you have to have the symptoms to classify as schizophrenia?
    Symptoms x30 days for greater than 6Months
  15. How long for schizophrenoform DO?
    Symptoms less than 6 months
  16. What is SAFD?
    Schizoaffetive Disorder….Symptoms with & without mood episode
  17. this is a psychiatric diagnosis denoting a psychotic mental disorder that is characterized by holding one or more non-bizarre delusions[1] in the absence of any other significant psychopathology. Non-bizarre delusions are fixed beliefs that are certainly and definitely false, but that could possibly be plausible, for example, someone who thinks he or she is under police surveillance
    Delusional Disorder (Non-bizarre delusion x 1month)
  18. How long is a brief psychotic disorder?
    Greater than a day, less than a month
  19. What is a shared psychotic disorder?
    A disorder that takes on other delusions
  20. Some other psychotic disorders can be caused by what?
    • *Medicine/drugs
    • *NOS?
  21. What is the diagnosis criterion for schizophrenia?
    • 1. Positive or negative symptoms for 30 days for greater than 6 months
    • 2. Marked social/vocational dysfunction
    • 3. NOT due to:
    • *medical
    • *drugs
    • *SAFD
    • *Manic Depressive Disorder (MDD) with psychotic features
  22. What are the 4 types of POSITIVE symptoms?
    • 1. Delusions
    • 2. Hallucinations
    • 3. Disorganized Speech
    • 4. Catatonia
  23. Grandiosity, persecution, somatic, reference, thought: insertion, withdrawal, broadcasting, etc?
  24. auditory, visual, tactile, olfactory, gustatory?
  25. clang, neologisms, thought block, loose associations, perseveration?
    Disorganized Speech
  26. stupor, posture, excitation?
  27. What are the NEGATIVE symptoms of schizophrenia?
    • -Affective blunting
    • -Anhedonia
    • -Anergia
    • -Alogia
    • -Apathy
    • -Avolition
    • -Asociality
    • -Attention problems
  28. What are the subtypes of schizophrenia?
    • *Paranoid
    • *Disorganized
    • *Catatonic
    • *Undifferentiated
    • *Residual
  29. Negative symptoms that persist inspite of resolution of positive symptoms
  30. What are the gender differences of Schizophrenia?
    • *Male > Female (up to 20%) (Onset: male (18-25 yr) female (25-35 yr))
    • *Second peak in onset women after 45 yrs
    • *Pre-morbid function females > males
    • *Males – More positive symptoms
    • *Females – More negative symptoms
    • *Women have more emotional/affective symptoms (misdiagnosed MDD or SAFD)
  31. What are the etiological theories concerning Schizophrenia?
    • *Genetic – familial= 10% greater chance
    • *Hormonal – onset S/P puberty, thyroid, DM
    • *Apoptosis/Excessive pruning
    • *Virus – selectivity; dormancy; triggered by stress/hormones; alters cellular process without destroying cells
    • *Neurotransmitter – drugs can either mimic or eleviate symptoms
  32. What is the pathology behind Schizophrenia?
    • •Up To 25% loss of gray matter
    • •Enlarged ventricles
    • •Enlarged amygdala
    • •Neurological abnormalities
    • •Impaired cognitive function
    • •Decreased prefrontal brainfunction
    • •Impaired awareness of illness
  33. What are the 4 stages of progression when dealing with Schizophrenia?
    • 1. Premorbid
    • 2. Prodromal
    • 3. Psychotic
    • 4. Recovery
  34. Asymptomatic with genetic/environmental vulnerability.
    Premorbid (0-35 yrs.)
  35. Insidious decline in work/ school/ social/ adaptive functioning
    Prodromal (2-5 yrs.)
  36. Abrupt onset of (+) & significant worsening of (-) symptoms. Often hospitalized due to inability to care for self.
    Psychotic (wks.-yrs.)
  37. Exacerbations & remissions with 80% relapse rate. Degree of illness/level of functioning plateau after 10yrs.
    Recovery (yrs.)
  38. What are some ways to treat Schizophrenia without medications?
    • •Supportive psychotherapy
    • •Family therapy
    • •Socialization/social skills training
    • •Cognitive Behavioral Therapy
    • •Hospitalization
  39. What are the two types of pharmacotherapeutics that treat Schizophrenia?
    • 1. Typicals
    • 2. Atypicals
  40. These Alleviate positive symptoms, have More side effects, but are Less expensive
  41. These will alleviate positive symptoms, offer some help with negative symptoms, have fewer side effects, and MIGHT have neuroprotective effects????
  42. What are the medication forms that treat Schizophrenia?
    • •Pill/capsule
    • •Elixir
    • •Orally disintegrating tabs (ODT)
    • •IV/IM
    • •Deaconate
  43. What are the drug side effects for drugs that treat Schizophrenia?
    • •Histaminic effects – Sedation
    • •Adrenergic effects – Orthostasis
    • •Anticholenergic effects – Dry mouth
    • •Hyperprolactinemia – Sexual
    • •Metabolic effects: Weight gain, Hyperglycemia/ diabetes, Hyperlipidemia
  44. What are the other med risks?
    • •Seizures
    • •Stroke
    • •Sudden death (dementia)
    • •QT Prolongation
    • •Extrapyramidal symptoms (EPS)
    • •Tardive dyskinesia(TD)
    • •Neuroleptic malignant disorder (NMS)
    • •Agranulocytosis (Clozaril)
  45. What does the nurse need to monitor the patient for that is receiving treatment for Schizophrenia?
    • •Vital signs – include orthostatic BP (falls)
    • •Weight & BMI
    • •EKG
    • •AIMS – Abnormal Involuntary Movement Scale (TD)
    • •Labs – CBC, renal function,lipids, glucose, HgbA1C, LFTs, TFTs, prolactin
    • •Suicidality
  46. This syndrome is probably, in part, a genetic condition. People with this syndrome have motor tics and vocal tics. Motor tics are movements of the muscles, blinking, head shaking, jerking of the arms, and shrugging. When a person with this syndrome suddenly begins shrugging, he or she may not be doing it on purpose. This may be a motor tic.

    Tourette's Syndrome
  47. These tics are sounds that a person with Tourette syndrome might make with his or her voice: Throat clearing, grunting, and humming are all common tics. A person with Tourette syndrome will sometimes have more than one type of tic happening at once.

    Vocal Tics
  48. Tics are usually worse when a person is under what?
  49. Tourette syndrome is not a psychological condition, it is a ? one
  50. With Tourette's psychological factors are very important in this condition. Psychological distress can make the tics worse, and kids with Tourette syndrome might feel very upset because of the tics and the problems that go with them. Counselors and Tourette syndrome organizations can help kids learn how to explain tics to others. It ? at least 1 in 1,000 to 2,000 people and maybe more. It is believed that about 100,000 Americans have Tourette syndrome.
  51. What drugs is ADHD treated with?
    ADHD is usually treated with the aid of stimulant drugs like Ritalin & Concerta and with non-stimulant Straterra as well as amphetamines, such as Dexedrine and Adderall.
  52. Stimulants are believed to work by increasing ? levels in the brain. Stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
  53. Stimulants for ADD / ADHD come in both short and long-acting dosages. Short-acting stimulants
    peak after several hours, and must be taken (x) times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken (y)?

    • (x)= 2-3 times
    • (y)= 1 time per day
  54. There is evidence of a strong association between suicide risk and bisexuality or
    in ?
  55. Suicide attempts were reported by 28. 1% of bisexual/ homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual ?

  56. Limiting access to lethal means of self-harm is an ? strategy to prevent self-destructive behavior, including suicide.

  57. Some suicidal acts are ?, resulting from a combination of psychological pain or despair coupled with easy availability of the means to inflict self-injury: firearms, carbon monoxide, medications, sharp objects, tall structures.
  58. By limiting the individual's ? to the means of self-harm, a suicidal act may be prevented.

  59. The ? is to separate in time and space the individual experiencing an acute suicidal crisis from easy access to lethal means of self-injury and personal harm
  60. The hope is by making it harder for those intent on self-harm to act on that impulse, one can buy time for the ? to pass and for healing and recovery to occur.
  61. ? are the most common method of completed suicides nationwide (54%), followed by suffocation (20%), poisoning (17.5%), falls (2.3%), cut/pierce (1.8%), and drowning (1.2%)
  62. Suicide by firearms seems to be associated with their availability in the home and with victim ?
  63. Many homes contain guns and nearly half (43%) of all homicides and suicides occur in a ?. Most victims are shot: 67% of the homicides and 54% of the suicides in. In some studies, ? pose the greatest risk.

    • home
    • handguns
  64. The lack of demonstrated ? is possibly the most dysfunctional aspect of Asperger's syndrome.
  65. Individuals with Asperger's Syndrome experience difficulties in basic elements of (A), which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest), a lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as (B(4))?

    • A= social interaction
    • B= 1. eye contact, 2. facial expression, 3. posture 4. gesture
  66. Qualitative impairment in social interaction, as manifested by at least two of the following: (4 items)

    • (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction

    • (B) failure to develop peer relationships appropriate to developmental level

    • (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)

    • (D) lack of social or emotional reciprocity

  67. (II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following: (4 items)

    • (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

    • (B) apparently inflexible adherence to specific, nonfunctional routines or rituals

    • (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)

    • (D) persistent preoccupation with parts of objects

  68. It is estimated that 8 million Americans have an ? – seven million women and one million men

    Eating Disorder
  69. Eating disorders have the highest ? rate of any mental illness
  70. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 – 10% of anorexics die within 10 years after contracting the disease; 18-20% of anorexics will be dead after 20 years and only ? ever fully recover
    30 – 40%
  71. 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and ?
    heart problems
  72. Common co-morbid conditions with eating disorders include ? (50% to 75%), sexual abuse, obsessive-compulsive disorder, substance abuse, and bipolar disorder

    • 1. major depressive disorder
    • 2. dysthymia
  73. Medical Complications of Anorexia?
    • 1. Amenorrhea Bradycardia
    • 2. Orthostatic Blood Pressure Drop
    • 3. Osteoporosis
    • 4. Stress fractures
  74. Cold intolerance, constipation, cyanosis, edema, hypoglycemia, low albumin
    Amenorrhea Bradycardia
  75. What are the Structural and functional brain changes associated with anorexia?
    Thyroid dysfunction
  76. What can appetite suppressant abuse cause?
    • Anxiety, hypertension, tremors, tachycardia, Purging type reflux, parotid abnormalities, gastrointestinal bleeding, hypokalemia, Dental caries, enamel erosion, dehydration, cardiac arrhythmias, and Renal failure

  77. TREATING ANOREXIA involves what three components?
    • 1. Restoring the person to a healthy weight

    • 2. Treating the psychological issues related to the eating disorder
    • 3. Reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
  78. Common co-morbid conditions with eating disorders include ? (50% to 75%), sexual abuse, obsessive-compulsive disorder, substance abuse, and bipolar disorder

    • 1. Manic Depressive Disorder

    • 2. Dysthymia
  79. This explores the critical and unhealthy thoughts underlying anorexia. The focus is on increasing self-awareness, challenging distorted beliefs, and improving self-espteem and sense of control. Also involves education about anorexia.

    Cognitive Therapy
  80. This promotes healthy eating behaviors through the use of rewards, reinforcements, self-monitoring and goal setting. Teaches the patient to recognize anorexia triggers and deal with them using relaxation techniques and coping strategies.

    Behavior Therapy
  81. Examines the family dynamics that may contribute to anorexia or interfere with recovery. Often includes some therapy sessions without the anorexic patient (particularly important element when the person with anorexia denies having an eating disorder)
    Family Therapy

  82. Allows people with anorexia to talk with each other in a supervised setting. Helps to reduce the isolation many anorexics may feel. Members can support each other through recovery and share their experiences and advice.
    Group Therapy

  83. Genetic factors (nature) and childhood experiences (nurture) are predisposing causes for developing ?
    psychiatric illness
  84. Experience combined with ? begins to explain complexity of development of child psychiatric illness
    genetic predisposition
  85. Child psychiatric illnesses can be ˜related to roles of ? and brain development
  86. Brain mechanisms down-regulate stress reaction after ? has passed, returning brain to prior level of functioning
    *Rapid and reversible during acute stress

  87. ˜If prolonged, severe, or repetitive stress, increased neurotransmitter activity often ?
  88. Resilient Children
    • Resilience: ability to withstand stress
    • ØAffected by individual characteristics, early life experiences
    • *˜Protective factors in their environment
    • *˜Are competent, realistic, flexible, assured of their own inner resources and support
    • ØHave strong sense of personal control
    • ØTake age-appropriate responsibility
    • ØRecover quickly when faced with stressors
  89. Challenges for Nurses
    *Derive realistic, well-defined goals

    ˜*Respond to complex social needs

    ˜*Understand and advocate for child

    ˜*Develop comprehensive treatment plan that identifies and integrates child’s needs and family resources

    *˜Realize that behavior is cultural, must be viewed from sociocultural perspective

  90. Communication
    ˜First goal: to establish therapeutic alliance with child and parents if child’s verbal communication is vague or unclear, ask for more explanations

    • ˜*Child may not respond to problem-centered lines of communication
    • **First discuss more general aspects of child’s life (family members, school, friends)
  91. Strategies for communicating with children
    • *Understand age-related development
    • *Convey respect and authenticity
    • *Use familiar vocabulary at child's level of understanding
    • *Assess child's needs in immediate situation
    • *Assess child's capacity to cope with change
  92. Strategies for communicating with children
    ˜*Increase coping skills by creative, unstructured play

    *˜Use indirect age-appropriate communication techniques (storytelling, picture drawing, creative writing)

    ˜*Use alternative communication devices for children with special needs (sign language, computer aids)
  93. Ego Competency Skills Important to learn
    • 1. Focus nursing assessment on specific skills all children need to become competent adults
    • 2. Regardless of medical diagnosis, assess child for mastery of these skills:
    • *Establishing closeness and trusting relationships
    • *Handling separation/independent decision making
    • *Negotiating joint decisions and interpersonal conflict
    • *Dealing with frustration/unfavorable events
    • *Celebrating good feelings and experiencing pleasure
    • *Working for delayed gratification
    • *Relaxing and playing
    • *Cognitive processing through words, symbols, images
    • *Establishing adaptive sense of direction or purpose
  94. More common childhood psychiatric illnesses
    • ADHD
    • Depression
    • Anxiety
    • Conduct Disorder
    • Autism
  95. Effective Coping behaviors for children
    • *Withdrawing from stressful situations
    • *Postponing immediate response
    • *Finding more manageable situation
    • *Restructuring (manipulating or shaping) environment
    • *Accepting good and bad as part of life
    • *Working toward maintaining optimal conditions of adjustment, security, comfort
  96. Treatment for childhood illnesses
    • *˜Medication: improve brain functioning
    • *Social skills training: improve socialization
    • *˜Behavior management: learn impulse control
    • *˜Cognitive therapy: practice problem solving and communication
    • *Parent education: integrate new behaviors and skills into child’s life
  97. Adaptive Eating Responses
    • •Balanced eating patterns
    • •Appropriate caloric intake
    • •Body weight appropriate for height
    • •Able to regulate eating habits
    • •Resists overuse or underuse of food
    • •Maintains biological, psychological, sociocultural integrity
  98. Maladaptive eating responces
    • -Anorexia Nervosa
    • -Bulimia Nervosa
    • -Binge Eating Disorder
    • -Night Eating Disorder
  99. Implications of eating disorders
    • *Eating disorders more common among females b/c males are more reluctant to seek treatment
    • *Sociocultural norms result in distorted body image
    • * Eating disorders can cause biological changes: altered metabolic rates, profound malnutrition, possibly death
    • *Eating obsessions can cause psychological problems, e.g., depression, isolation, emotional lability
  100. Anorexia
    • •Anorexia nervosa in approximately 0.5%-1% of females
    • •About 5%-10% of people with anorexia are male
    • •Usual onset between 13-20 years but can occur in any age
    • •Although hungry, person with anorexia refuses to eat because of distorted self-perception of fatness
    • •Starvation ensues
    • •Can become chronic illness
    • •Estimated mortality from anorexia nervosa: 5% of those with the disorder
  101. Bulimia
    • •Bulimia nervosa more common –Estimated in 1%-4% of population, mostly females –4%-15% of female high school and college students
    • •Onset usually at 15-18 years old
    • •Uncontrolled binge eating alternating with vomiting or dieting
    • •Same patient may have bulimia and anorexia
    • •Bulimia usually occurs in people of normal weight but people may be obese or thin
  102. Binge Eating
    • •Binge eating disorder: consuming large amounts of calories in contained amount of time
    • •Differs from bulimia because person does not attempt to prevent weight gain
    • •Purging behaviors not used
    • •Prevalence: approximately 2%-4% of population
  103. Night Eating
    • *pattern of awakening during night associated with food intake
    • –Not yet listed as separate eating disorder in DSM-IV-TR
    • –Estimated 1.5% in general population
    • –Make up 27% of severely obese population seeking surgical treatment
  104. Assessment for Eating Disorders
    • •Complete biological, psychological, sociocultural evaluations
    • •Full physical examination: vital signs; weight; skin; cardiovascular system; evidence of laxatives, diet pills, diuretic abuse, and/or vomiting; dental examination
    • •Psychiatric history: dieting and substance use, family assessment, medication
    • •Actual and desired weight, weight history, menstruation•Food avoidances, restrictions, dieting, fasting patterns/unusual nutrition beliefs
    • •Frequency, extent, timing of binge eating, and/or purging/compulsive exercise patterns
    • •Use of laxatives, diuretics, diet pills, other methods of purging/chewing and spitting food
    • •Weight or shape preoccupation/body image disturbances
    • •Food preferences, peculiarities
    • •Impact of illness on school, work, social life
  105. Screening for Eating Disorders
    • •Focus specific attention on assessment of eating regulation responses
    • •Several questionnaires and rating scales screen for eating disorders
    • •Adding these two questions may be as effective as more extensive questionnaires to identify people with eating disorders:
    • –Are you satisfied with your eating patterns?
    • –Do you ever eat in secret?

  106. Behaviors: Binge Eating

    Rapid consumption of much food in discrete period

    Emphasis on patient’s perception of loss of control, perceived excessive caloric intake more important than total number of calories consumed, but must assess both

    • Usually binge secretively, often feel shame

  107. Behaviors: Binge Eating

    • Person
    • with bulimia typically average weight or slightly overweight with unsuccessful
    • dieting history

    • Several
    • times weekly to more than 10 times/day, or occasional binges related to
    • stressful situations

  108. Behaviors: Fasting or Restricting

    • People
    • with anorexia eat 500-700 calories (as few as 200) daily

    • Eliminate
    • all meat, poultry, fish, dairy; do not substitute nonanimal protein, nutrients

    • May
    • be obsessive-compulsive: eat same foods repeatedly, foods in predetermined
    • order, bizarre food preferences, avoid fattening food, fast for days

  109. Behaviors: Purging

    • Excessive
    • exercise

    • Forced
    • vomiting

    • Over-the-counter
    • or prescription diuretics, diet pills, laxatives, steroids

    • Laxative
    • abuse common, inefficient way to
    • lose; abuse can increase to 60 doses/week

    • Many
    • patients engage in more than one purging behavior

  110. Medical Complications of

    Eating Disorders

    Central nervous system



    • GastrointestinaI



    • Cardiovascular

  111. Medical Problems

    Related to Anorexia

    • Patients
    • 30% below ideal body weight often have life-threatening clinical, laboratory
    • findings

    • People
    • who vomit and use laxatives or diuretics, regardless of weight, usually have
    • health problems

    • Metabolic
    • and endocrine abnormalities result from malnutrition/starvation

  112. Medical Problems

    Related to Anorexia

    • Often
    • see amenorrhea, osteoporosis, hypometabolic symptoms (cold intolerance, bradycardia)

    • Starvation
    • may cause hypotension, constipation, acid-base, fluid-electrolyte disturbances,
    • e.g., pedal edema

  113. Medical Problems

    Related to Bulimia

    • Potassium depletion and hypokalemia from vomiting,
    • laxative or diuretic abuse

    • Symptoms of potassium depletion: muscle weakness,
    • cardiac arrhythmias, conduction abnormalities, hypotension

    • Gastric, esophageal, bowel abnormalities common in
    • patients with bulimia

    • May erode dental enamel, cause enlarged parotid glands

  114. Medical Problems

    Related to Binge Eating

    • Excess
    • weight: serious health problems

    • Increased
    • weight: exacerbate health problems

    • Medical
    • problems common

    • Excess
    • weight: hypertension, cardiac problems, sleep apnea, difficulties with
    • mobility, diabetes mellitus

  115. Co-morbid Mental Illnesses

    • Depression
    • or dysthymia in 50%-75% of people
    • with anorexia and bulimia

    • Obsessive-compulsive
    • disorder in up to 25% of patients with anorexia nervosa

    • Patients
    • with bulimia have increased rates of anxiety disorders, posttraumatic stress
    • disorder, substance abuse, mood disorders

  116. Predisposing Factors

    Psychological: rigidity, perfectionism

    • Environmental: illnesses, sexual abuse, drug abuse,
    • media influences

    Familial: increased risk in female relatives

    • Biological: probable relationship to serotonin and
    • dopamine levels

    • Sociocultural: shifting cultural norms for young women to face
    • multiple, ambiguous, often contradictory role expectations

  117. Sociocultural Influences

    • In
    • some cultures, thinness highly valued, culturally rewarded, associated with
    • achievement

    • Contemporary
    • U.S. ideal woman is lean, strong, graceful, feminine with emphasis on fitness,
    • health

  118. Sociocultural Influences

    • Children,
    • adolescents, young adults living where emphasis placed on weight and size often
    • develop eating disorders

    • Activities
    • or occupations that emphasize beauty or fitness also promote preoccupation with
    • weight, eating behaviors

  119. Appraisal of Stressors

    • Include
    • peer pressure, daily solitude, interpersonal rejection, loss

    • Environmental
    • pressures, stress if lacking self-concept, realistic body image

    • Rely
    • on external feedback

    • Rely
    • on external cues

    • Food
    • a replacement for deficient internal regulator

  120. Stuart Stress Adaptation Model: Eating Regulation

  121. Medical Diagnoses

    • Anorexia
    • nervosa

    • Includes intense fear of gaining weight, disturbed body
    • image

    >15% below minimum normal weight for age/height

    Can be restrictive type or binge eating/purge type

    • Binge
    • eating disorder

    • Bulimia
    • nervosa

  122. Short-Term Goals

    • Patient
    • will identify cognitive distortions about food, weight, body shape

    • Develop
    • nutritionally balanced menus

    • Accurately
    • describe body dimensions

    • Exercise
    • moderately only when nutritionally, medically stable

  123. Short-Term Goals

    • Demonstrate
    • positive family interactions and successful movement toward achievement of
    • separation and individuation issues

    • Describe
    • complications of eating disorder behaviors
  124. Planning

    • Nursing
    • care varies based on treatment setting of patient with maladaptive eating
    • regulation responses

    • Factors
    • affecting choice of treatment setting

    Patient’s physical and psychological condition

    Financial resources

    Availability of treatment specialists

    • Patient’s preference

  125. Care Settings for Eating Disorders

    • Outpatient
    • settings: day treatment, intensive, partial hospitalization programs

    • Weekly
    • outpatient office visits

    • Reimbursement
    • for inpatient programs often difficult to obtain

    • Inpatient
    • treatment: 24-hour nursing care to ensure safety, support behavioral change,
    • monitor physiological responses

  126. Outpatient Treatment

    • Allows
    • patient greatest opportunity for self-control, autonomy

    • Requires
    • high patient motivation

    • Need
    • family’s active support, involvement

    • Need
    • ongoing physiological monitoring

  127. Evidence-Based Treatment for Bulimia Nervosa

    • Manual-based
    • CBT is treatment of choice

    • Several
    • antidepressants produced short-term reductions in binge eating, purging

    • Long-term
    • effects untested

    • CBT
    • with antidepressants may affect bulimia slightly by treating co-morbid anxiety,
    • depression

  128. Nurse-Patient Contract

    • Goal:
    • to engage in therapeutic alliance and obtain commitment to treatment process

    • Before patient admitted to eating disorder treatment
    • program, obtain cooperation with nurse-patient contract

    • By signing contract, patients show they understand
    • treatment they will be receiving

    • Assists patient to make informed decisions about
    • treatment process, ability to honor contract

  129. Implementation:

    Nutritional Stabilization

    • High
    • priority for nursing intervention

    • Set
    • healthy target weights

    • In
    • life-threatening circumstances, malnourished patients may need refeeding interventions

    • Treatment
    • programs develop specific nursing interventions to promote weight
    • stabilization, healthy eating patterns

  130. Eating Disorder Program Protocols

    • Time,
    • frequency, procedure for weighing patient and if patient may view reading

    • Time
    • and number of meals each day

    • How
    • staff will interact with patients at mealtimes to maximize therapeutic value of
    • their presence

    • Allowing
    • diet foods, condiments, or food substitutions?

  131. Eating Disorder Program Protocols

    • Amount
    • of water patient may drink each day

    • Vital
    • signs/intake and output/required laboratory work

    • Conditions
    • for bathroom privileges

    • Indications
    • for close observation by staff

  132. Eating Disorder Treatment

    • Patients
    • able to master eating their meals can move toward having more independence over
    • scheduling meals

    • Select
    • own menus with assistance is next

    • Then
    • can shop for, cook food with supervision

    • By
    • discharge, should have high level of comfort with food and its preparation

  133. Eating Disorder Treatment

    • Getting
    • patient with anorexia to gain weight is difficult

    • Nurse-patient
    • contracts can be effective

    • May
    • set goal of gaining 1 pound/week

    • If
    • fails to gain 4 pounds in 1 month, contract would stipulate that patient would
    • agree to enter hospital, day treatment program, or more intensive type of care

  134. Cognitive Behavioral Therapy (CBT)

    • Single
    • most effective treatment for patients with eating disorders

    • Must
    • work with patients regarding cognitive distortions or faulty thinking about
    • body shape, weight, food

  135. Cognitive Distortions in Maladaptive Eating

    • Magnification:
    • overestimating significance of undesirable events

    • Superstitious
    • thinking: believing in cause-effect relationship of noncontingent events

    • Dichotomous
    • or all-or-none thinking


    Selective abstraction

    • Personalization and self-reference

  136. Awareness of Cognitive Distortions

    • Patient
    • to monitor and record eating, bingeing, and purging behavior and thoughts and
    • feelings regarding weight, shape, food

    Cues that trigger eating responses

    Thoughts, feelings, assumptions with cues

    Connection between these and eating regulation responses

    • Consequences from eating responses

  137. Eating Regulation Responses

    • Help
    • patient solve problems and make decisions after identifying alternatives

    • Encourage
    • patient to list high-risk situations that cue maladaptive eating, purging
    • behaviors

    • May
    • benefit from assertiveness training, role-modeling sessions with nurse

  138. Body Image

    • Body
    • image distortion in eating disorders involves perceptions, attitudes, behaviors

    • Distinguish
    • body image distortion vs. body dissatisfaction

    • Body
    • image distortion: discrepancy between patient’s actual size and perceived body
    • size

  139. Body Image

    • Body
    • dissatisfaction: degree of unhappiness person feels in relation to body size

    • All
    • people may express dissatisfaction with their bodies at some point, but such
    • dissatisfaction is constant in persons with anorexia or bulimia

  140. Body Image Interventions

    • First determine if patient has problems with perception,
    • attitude, or behavior

    Devise program targeting specific problem

    • Cognitive behavioral interventions effective, as are
    • dance therapies; enhance integration of mind and body, clarify body boundaries,
    • modulate negative feelings

    • Other therapeutic approaches: imagery and relaxation,
    • working with mirrors, art

  141. Other Interventions

    • Family
    • involvement

    • Engage families from beginning of treatment, include in
    • family meetings, treatment planning sessions

    • Group
    • therapies

    • Reality testing, support, communicating with peers
    • essential therapeutic factors provided

    • Outpatient support helps reinforce social alliances,
    • encourage to express feelings

  142. Interventions: Medication

    • Patients
    • with anorexia often resist medication; no drugs completely effective

    • Do
    • not as primary treatment for anorexia

    • Antidepressants
    • therapeutic effect on many patients with bulimia

    • May
    • decrease frequency of binge eating vomiting

    • Used
    • with other interventions

  143. Evaluation

    • Did
    • nurse provide effective role modeling, emotional support, biological
    • monitoring, reinforcement of patient’s attempts to explore and experiment with
    • new cognitive and behavior patterns?

    • Have
    • normal eating patterns been restored?

  144. Evaluation

    • Have
    • biological and psychological sequelae of malnutrition been corrected?

    • Have
    • associated sociocultural and behavioral
    • problems been resolved so that relapse does not occur?

    • Do
    • goals and evaluation together with patient