Exam 4 Flashcards
(104 cards)
1
Q
What population is anorexia nervosa most commonly seen in?
A
Sisters of those who have the disorder d/t modeling and mimicking
2
Q
What population is bulimia most commonly seen in?
A
Those with childhood obesity or early puberty, sometimes genetics
3
Q
What are the comorbidities of anorexia?
A
1) Bipolar
2) Depression
3) Anxiety
4) OCD
5) Substance use
4
Q
True or False:
Those with anorexia are less responsive to immediate gratification because they are doing severe restrictions over time
A
True
5
Q
What is a normal BMI?
A
18.5-24.9
6
Q
What is the BMI of someone with anorexia?
A
17 or less
7
Q
True or False:
Patients with anorexia experience edema because their body is trying to retain fluid
A
True
8
Q
What type of personality is usually seen in those with anorexia?
A
Type A
9
Q
What percentage of malnutrition would indicate a need for inpatient treatment for anorexia?
A
20% or below
10
Q
What percentage of malnutrition would indicate a need for long-term intensive hospitalization (ICU)?
A
30% or below
11
Q
What electrolyte imbalances are usually seen in those with anorexia?
A
1) Hypokalemia
2) Hypophophatemia
3) Hypomagnesium
4) Hypocalcemia
12
Q
What does phosphorus impact?
A
DTRs
13
Q
What are signs of dehydration in a patient that is anorexic?
A
1) Thirst
2) Orthostatic hypotension
3) Tachycardia
4) Hypernatremia
14
Q
What HR would require hospitalization for anorexia?
A
< 50 bpm
15
Q
What are comorbidities for bulimia nervosa?
A
1) Mood and anxiety disorders
2) Substance disorders
16
Q
True or False:
Those with bulimia receive instant gratification
A
True
17
Q
What do these physical assessment findings indicate:
1) Dental erosion/caries
2) Parotid sialadenosis (“chipmunk cheeks”)
3) Dehydration
4) Electrolyte imbalances
5) Tears in esophageal or gastric mucosa (RARE)
6) Russell’s sign
A
Bulimia
18
Q
What is Russell’s sign?
A
Bite marks along knuckles on the hand they use to create purge
19
Q
True or False:
Those with bulimia have impulsive/compulsive behaviors
A
True
20
Q
What is a possible end result of bulimia?
A
Gastric rupture
21
Q
Name the problem:
Eating until the intestines are stretched to the point of rupture – internal hemorrhaging, oftentimes fatal
A
Gastric rupture
22
Q
What comorbidities does engaging in binge eating increase the chances of?
A
-MI
-DM
-Obesity
23
Q
How long does a variant of compulsive overeating have to occur to be dx with binge eating?
A
at least 1x a week for 3 months
24
Q
True or False:
Those with binge eating disorder only eat a long amount of food when they are hungry
A
False – they eat when they are not hungry too or when they are stressed
25
True or False:
Binge eating is often a result of depression
True
26
True or False:
Binge eating is an attempt at mood regulation
True
27
What is the goal of tx for binge eating?
-Behavior modification
-Control depression
28
What are the most effective txs of binge eating?
1) CBT
2) BT
3) Dialectical behavioral therapy
4) Interpersonal therapy
29
How much weight do those need to gain per week for those with an eating disorder if they are hospitalized?
2-3 lbs/week
30
What happens if a patient with an eating disorder is admitted but emaciated or unwilling?
Requires NG tube with liquid diet
31
In a pt with an ED, what are you monitoring labs for?
Refeeding syndrome
32
What is refeeding syndrome?
Providing a lot of food to client& it causes reverse effects on the client (hypo- electrolytes)
33
What kind of food plan does someone with an ED need?
Help them create a plan for incorporating food from each food group with the goal of losing weight and meeting weight loss goals/exercise plan
34
True or False:
Nurses should make a behavioral contracts with clients who have an ED
True-- control is the issue, so this gives the client control
35
What does individual therapy do for those with an ED?
-Helps explore unresolved conflicts
-Maladaptive eating patterns
36
What medication class do you not give to a patient who is experiencing orthostatic hypotension?
TCAs d/t anticholinergic effects
37
What med classes are given to those with anorexia?
-SSRIs
-SNRIs
-TCAs
38
What specific meds are given to those with anorexia?
1) Fluoxetine (Prozac)
2) Anafranil
3) Pariactin
4) Thorazine
5) Zyprexa
39
What meds are given to those with bulimia?
1) Prozac
2) Tofranil
3) Desipramine
4) Amitriptyline
5) Aventyl
6) Phenelzine
40
What cravings does prozac decrease?
Carbs
41
Name the condition:
1) Development of a reversible syndrome of sx following excessive use of a substance
2) Direct effect on the central nervous system
3) Disruption in physical and psychological functioning
4) Judgment is disturbed and social and occupational functioning is impaired
Substance intoxication
42
What are the classes of psychoactive substances?
1) Depressants
2) Stimulants
3) Opioids
4) Hallucinogens
5) Cannabis
6) Inhalants
43
What are examples of depressants in psychoactive substances?
1) Alcohol
2) Sedatives
3) Hypnotics
4) Anxiolytics
44
What are examples of stimulants in psychoactive substances?
1) Caffeine
2) Cocaine
3) Nicotine
4) Meth
5) Ecstasy
6) Bath salts
45
What are examples of opioids in psychoactive substances?
1) Morphine
2) Heroin
3) Methadone
46
What are examples of inhalants in psychoactive substances?
1) Pain thinners
2) Gasoline
3) Spray cans
4) Glues
47
Name the vocab:
When drugs are taken together (of same class – alcohol & benzos – depressants), effect of either or both is intensified or prolonged: ex: mixing ETOH with benzodiazepines
Synergistic effect
48
Name the vocab:
When drugs are taken together (opposite ends – stimulant v depressant (cocaine v narcan)), effect of one is inhibited or weakened Ex: cocaine and Narcan together
Antagonistic effects
49
What is the gold standard of determining if someone might have a substance abuse disorder?
Two Questions of Importance
50
What are the 2 questions of importance when determining if someone might have a substance abuse disorder?
1) In the last year, have you ever consumed alcohol or used drugs more than you meant to?
2) Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?
51
Name the assessment tool:
Determines if there is a problem with ETOH (alcohol)
CAGE
52
When does alcohol withdrawal peak?
24-48 hrs after cessation
53
What are sx of alcohol withdrawal delirium?
1) Hallucinosis
2) Convulsive Seizures
3) DTs -- tremors
54
What can you tx alcohol withdrawal delirium with?
-Ativan
-Benzo
-Librium
55
What meds are given for alcohol use disorder?
1) Librium
2) Naltrexone
3) Antabuse
4) Acamprosate
56
Name the med tx of alcohol use disorder:
Top priority drug to given when someone is in detox or in withdrawal from ETOH
Librium
57
True or False:
Librium is a benzo & can develop a tolerance/dependence to the drug
True
58
Name the med tx of alcohol use disorder:
Reduces or eliminates alcohol craving
Naltrexone
59
Name the med tx of alcohol use disorder:
-Only for those that no longer want to drink anymore, only given during recovery
-Cannot be around those that drink or party with alcohol
Antabuse
60
What happens if you mix alcohol with antabuse?
1) Sevre vomiting
2) HA
3) Flushed face
4) Tachycardia
5) Dyspnea
61
Name the med tx of alcohol use disorder:
Taken 3 times a day to reduce unpleasant effects of not taking the drugs (anxiety, restlessness, dysphoria)
Acamprosate
62
Name the med for abstinence of opioids:
-Synthetic opiate blocks craving for and effects of heroin
-Dependence is transferred from illegal drugs to med
-Can potentially be weaned off
Methadone
63
Name the med for abstinence of opioids:
An alternative to methadone, but similar effects
LAAM
64
Name the med for abstinence of opioids:
Antagonist that blocks euphoric effects of opioids
Naltrexone
65
Name the med for abstinence of opioids:
Effective somatic tx when combine with naltrexone
-Helps with withdrawal
-Doesn't help reduce cravings
Clonidine
66
Name the med for abstinence of opioids:
Blocks S&S of opioid withdrawal
-May help with compliance of staying sober
Buprenorphine
67
What is the aim of tx for those in abstinence of opioids?
Self-responsibility
**Stating they have a problem & they can't control it
68
Name the disorder:
The expression of psychological stress through physical sx & cannot be explained by underlying medical cause
**NOT truly medical
Somatic Symptom Disorder
69
True or False:
Those with somatic symptom disorder spend a great deal of time worrying about their physical sx & reject the idea of it being a psychological disorder or r/t increased stress
True
70
True or False:
Those with somatic sx disorder seek out one HCP for dx
False-- they get multiple opinions and have high medical bills
71
What are RFs of Somatic Sx Disorder?
1) 1st degree relative
2) Decreased serotonin & endorphine
3) Depression, personality disorder, anxiety
4) Childhood trauma, abuse, neglect
5) Learned helplessness (ex: childhood cancer)
72
What is Step 1 of Reattribution tx of somatic sx disorder?
Feeling understood
73
What is Step 2 of Reattribution tx of somatic sx disorder?
Broadening the agenda
74
What is Step 3 of Reattribution tx of somatic sx disorder?
Making the link
75
What is Step 4 of Reattribution tx of somatic sx disorder?
Negotiating further tx
76
Name the disroder:
-Misinterprets physical manifestations as evidence of a serious disease process
-Clients will research suspected disease and examine themselves repeatedly
-May seek numerous opinions, or none at all
-Continued anxiety despite negative results
Illness Anxiety Disorder
77
What are findings for Illness Anxiety Disorder?
-Excessive anxiety about illness for >6 months
-Preoccupation with performing health behaviors
-Health seeking behaviors
78
Name the disorder:
-Neuro sx in absence of neuro dx
-Can have severe deficits in voluntary motor functions (blindness, paralysis, seizures, gait disorders, hearing loss)
-Someone who has experienced an undo amount of stress
Conversion disorder
79
What are RFs of conversion disorder?
Same as somatic
-Mental or neuro condition
-Recent stressful event
-Female
-Adolescent or young adult
-Low socioecon status
-Lower educational status
80
What are findings of conversion disorder?
1) Paralysis
2) Seizure like movements
3) Blindness
4) Aphonia
5) Anosmia
6) Numbness/tingling/burning (loves gabapentin)
7) Deafness
81
What is aphonia?
Inability to speak
82
What is anosmia?
Inability to smell
83
Name the disorder:
Conscious decision by client to report physical or psychological sx when there are none
-May induce self-injury
-Can be imposed on by another to gain attention
-Often have an average or below avg IQ
-Reports new manifestations after receiving negative results
Factitious Disorder (Munchausen)
84
True or False:
Personality fluctuates throughout life
False-- usually remains stable and predictable over time
85
True or False:
To be dx w/ personality disorders, pt must meet the minimum number of criteria & sx must cause functional impairment and/or subjective distress
True
86
What are cluster A disorders characterized as?
Odd & Eccentric
87
What are the cluster A disorders?
-Paranoid
-Schizoid
-Schizotypal
88
What are cluster B disorders characterized as?
Impulsive & Erratic
89
What are the cluster B disorders?
-Histrionic
-Narcissistic
-Antisocial
-Borderline
90
What are cluster C disorders characterized as?
Anxious and avoidant
91
What are the cluster C disorders?
-Dependent
-Avoidant
-Obsessive-compulsive
92
What are the RFs of personality disorders?
1) Comorbid substance used disorders
2) Hx of violent and non-violent crimes (including sex offenses)
3) Childhood abuse/trauma
4) Developmental factors associated w/ parenting
5) Genetics
93
What are findings for all personality disorders?
1) Inflexibility or maladaptive response to stress
2) Compulsiveness and lack of social restraint
3) Inability to emotionally connect in social & professional relationships
4) Tendency to provoke interpersonal conflict
94
What are the communication strategies with a pt with a personality disorder?
1) Be firm
2) Be consistent
3) Set limits
4) Maintain professional boundaries
5) Assess self (RN) for counter transference (do NOT engage)
95
Name the Cluster A disorder:
characterized by distrust and suspiciousness towards others- may believe others want to cause harm “everyone wants to harm them”
Paranoid
96
Name the Cluster A disorder:
Characterized by emotional detachment, disinterest in close relationships/will not engage in relationships whatsoever, indifference (don’t like) to praise or criticism, often uncooperative
Schizoid
97
Name the Cluster A disorder:
Characterized by odd beliefs/behaviors leading to interpersonal difficulties, may have an eccentric appearance, and may have magical thinking that are not clear delusions or hallucinations; NONE OF THESE ARE SCHIZOPHRENIA DIAGNOSES- NO DELUSIONS OR ANY S/S OF PSYCHOSIS IS PRESENT- PERSONALITY ONLY – very indifferent, but can also be detached
Schizotypal
98
Name the Cluster B disorder:
disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility, evidence of conduct disorder by age of 15 (will harm others/animals with no regard or remorse), entitlement, manipulative (be nice & sweet to get what they want), impulsive, sexually seductive, and is verbally charming and engaging.
Ex: serial killers/psychopaths
Antisocial
99
Name the Cluster B disorder:
instability of affect, identify, and relationships. Has splitting behaviors (commonly seen), manipulation, impulsiveness, and fear of abandonment (to the point where they will hurt themselves or others/threaten suicide or engage in act of suicide if someone tries to leave them), affect is unstable, difficulty maintaining relationships often engages in self harm, potential for suicide
Borderline personality
100
Name the cluster B disorder:
emotional attention seeking behavior, in which the person needs to be center of attention. Often seductive and flirtatious
Histrinoic
101
Name the cluster B disorder:
arrogance, grandiose views of self importance, need for constant admiration, and lack of empathy for other- sensitive to criticism
Narcissistic
102
Name the cluster C disorder:
social inhibition and avoidance of all situations that require interpersonal contact despite wanting close relationships. Extreme fear of rejections- they have feelings of inadequacy and are anxious in social situations
Avoidant
103
Name the cluster C disorder:
extreme dependency in close relationships with an urgent search to find a replacement when one relationship ends
Dependent
104
Name the cluster C disorder:
indecisiveness and perfectionism with a focus on orderliness & control to the extent that the individual might not be able to accomplish a task
Obsessive-Compulsive
