MH EXAM #4 Flashcards

Question

Anorexia Nervosa Manifestations

Answer 1

Clients preoccupied with food and the rituals of eating, along with a voluntary refusal to eat. Fear of being obese and will refuse to maintain a normal body weight (usually <85%) of expected normal body weight in the absence of a physical cause. Occurs mostly in females adolescent to young adulthood

Answer 2

Clients eat large quantities of food over a short period of time(binging), which may be followed by inappropriate compensatory behaviors, such as self-induced vomiting(purging) to rid the body of excess calories. Usually maintain a weight within a normal range or slightly higher. Occurs mostly in females. Onset is females 15 to 18 or between 18 and 26 years of age

Answer 3

1) Restricting type- restricting food intake and does not binge or purge; maintain weight or a little less 2) Binge-eating/purging type- engages in binge eating or purging

Answer 4

1) Two types Purging type- client used self-induced vomiting, laxatives, diuretics, and or enemas 2) Non-purging type- compensate binge eating through other means such as exercising and the use of laxatives, diuretics, and/or enemas.

Answer 5

Clients recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa. Affects men and women of all ages, but is most common in adults age 46 to 55. The weight gain associated with binge eating disorders increases the risk for other disorders, including type 2 diabetes, hypertension, and cancer. Other comorbidities are depression, personality disorders, anxiety, and substance use. Increased mortality rate and high suicide rates. Treatment focuses on normalizing eating patterns and addressing health issues.

Answer 6

client’s perception, eating habits, dieting, methods of weight control, value attached to weight control, interpersonal and social functioning, difficulty with impulsivity and compulsivity, family dynamics.

Answer 7

Mental status, vital signs, weight, skin, hair, and nails, head, neck, mouth, and throat; cardiovascular system, musculoskeletal system, and gastrointestinal system. It is critical nursing assessment includes knowing expectations regarding the above. Review page 165 in ATI book.

Answer 8

Mental status: Overgeneralizations- other girls don’t like me because I am fat; all or nothing such as if I eat desert, I will gain 50 pounds. Catastrophizing- my life is over if I gain weight. Personalization- when I walk in the hospital, everyone is looking at me. Terrified of gaining weight, has high interest in preparing food but wont eat, client perception is they will get fat from eating, low self esteem, impulsivity and difficulty with interpersonal relationships, may exhibit need for intense physical regimen. May have guilt from binge eating behaviors. Vital signs- low blood pressure with possible orthostatic hypotension, decreased pulse and body temperature or hypertension for those with binge eating. Weight- those with anorexia nervosa have a body weight less than 85% of expected normal weight, Thise with bulimia maintain a weigth that is within the normal range or slightly higher. Clients with binge eating disorders are typically overweight or obese. Skin, hair, and nails- those with anorexia nervosa may have fine, downy hair(lanugo) on the face and back; yelloed skin; mottles, cool extremities, and poor skin turgor. Head, neck, mouth, and throat- enlargement of the parotid glans (bulmia nervosa) dental erosion and caries(ourging). Cardiovascualr- irregular heart rae (dysrhythmias) heart failure, cardiomyopathy, peripheral edema Muscle weakness GI- constipation, self-induced vomiting and excessive use of laxatives or enemas/diuretics.

Answer 9

Hypokalemia(vomiting); dehydration (sodium retention and potassium excretion). Anemia and leukopenia with lymphocytosis. Possible impaired liver function (increased enzyme levels). Possible elevated cholesterol, abnormal thyroid function tests, elevated carotene levels( skin appears yellow), decreased bone density (possible osteoporosis) abnormal glucose level, ECG changes. Must focus on electrolyte imbalances associated with bulimia nervosa which depend on purging method (laxatives, diuretics, vomiting): Hypokalemia, hyponatremia, hypochloremia. Screening tools: Eating Disorders Inventory, Body Attitude Test, Diagnostic Survey for Eating Disorders, and Eating Attitudes Test.

Answer 10

Fluoxetine (SSRI)

Answer 11

Medications- remind client medications may take up to 1 to 3 weeks to work for initial response and 2 months for maximal response. Instruct to avoid hazardous activities and if sexual dysfunction occurs and is tolerable. Teamwork/collaboration- a registered dietitician is needed for nutritional guidance and support. Consistency among staff is important. Discharge-develop a maintenance plan related to weight management; encourage follow-up treatment in an outpatient setting, support group, individual and family therapy. Complications- refeeding syndrome is the potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to a severly malnourished client. Nurse must consult with the provider and dietitian to develop a controlled rate of nutritional support during initial treatment. Monitor serum electrolytes, and administer fluid replacement as ordered. Cardiac dysrhythmias, severe bradycardia, and hypotension- nurse place the client on cardiac monitoring, monitor vital signs frequently, report changes in the clients condition to the provider.

Answer 12

* Apologize when a mistake is made * Cease from gossiping about patients * Do not ask about gender confirmation surgery * Do not ask about genitalia unless it relates to care * Do not ask a transgender patient what their “real” name is * Do not insist the patient use the name on the medical record * Most of all, check your personal biases

Answer 13

A. History: recounts of trauma, and/or severe stress; extent of dissociation or amnestic symptoms varies widely with different dissociative disorders B. Include physical symptoms: May report symptoms of depression or anxiety, headaches common with DID C. Mental status examination Appearance: facial expressions and mannerisms may vary widely within one session or appearance may vary widely from day to day (DID) Mood: anxious, depressed; some clients have little mood change ! Memory: amnesia for events (variable extent) 4. Perception: feelings of detachment from self or environment, feeling of physical change in body ! 5. Insight: impaired, unaware of memory impairment

Answer 14

— Dissociation is a defense mechanism in which experiences are blocked off from consciousness, so that affect, behavior, identity, memories, and/or thoughts are not integrated — Repression is a defense mechanism in which thoughts and feelings are kept from consciousness

Answer 15

a dissociative disorder in which the client cannot remember important personal information that cannot be accounted for by ordinary forgetfulness

Answer 16

a dissociative disorder characterized by suddenly wandering away or taking a trip away from one’s usual place, accompanied by amnesia for some or all of the past

Answer 17

*Formerly known as split-personality disorder* a dissociative disorder characterized by two or more distinct personalities or identities (alters) in an individual person

Answer 18

Experiences recurrent alterations in self-perception; feeling a sense of unrealness — e.g. “detached from my body” or “being in a dream”

Answer 19

1. a. Localized amnesia: short time period (hours) after a disturbing event b. Selective amnesia: amnesia for some, but not all, events c. Generalized amnesia: amnesia for whole lifetime of experiences (very rare) d. Continuous amnesia: forgets successive events as they occur

Answer 20

Suddenly unable to recall memories 2. Not ordinary forgetfulness 3. Able to recall other information, learn, and function coherently 4. Most common during wars and natural disasters 5. Primary gain: symbolic resolution of unconscious conflict that decreases anxiety and keeps the conflict from awareness 6. Secondary gain: receipt of extra support and caring when experiencing an illness 7. Usually terminates abruptly 8. Special interventions: Survivor support groups; Gradual reconstruction of events through talking and listening/reading of others’ accounts of the trauma

Answer 21

1. Travels from usual environment 2. Unable to recall important aspects of identity and assumes new identity a. Old and new identities do not alternate b. Incomplete new identity c. Does not know information is forgotten 3. Usually lasts from hours to days, rarely months; considerable confusion when returns to pre-fugue state 4. Often is a response to psychological stressors (war, family, marital) ! 5. Once the client has returned to pre-fugue state, he or she has no memory for events during the fugue 6. Special interventions: hypnosis, drug-facilitated interviews, support groups

Answer 22

1. Client has two or more alters (separate, distinct identities or “personalities”) a. An alter is a personality state or identity that recurrently takes over the behavior of a person with DID b. Each alter has relatively enduring pattern of perceiving, relating to, and thinking about itself and the environment c. Formerly known as multiple personality disorder (MPD)

Answer 23

Personalities with different influences and power over one another a. May represent different ages, genders b. Alters each have different physiological responses and disorders (one alter may be myopic, while another is not) c. Communicate with one another through “executive” alter d. Some alters share “co-consciousness,” aware of each other’s experience and behavior, while others are only aware of own existence e. “Switching” occurs by dissociating from one alter to another f. Number of personalities range from 2 to over 100, with 50% of clients having more than 10 personalities g. Host personality: primary identity that holds the person’s name h. The host personality is typically unaware of the alters (the anxiety-provoking aspects of personality), but the alters are typically aware of the host personality

Answer 24

3. “Loses time” when alternate personality is present for a period of time a. Usually client is unable to give full account of childhood (few memories) because of dissociation b. May appear forgetful and is often accused of lying ! 4. Mental status variations a. Marked variation in appearance from time to time b. Blinking, eye rolls, headaches, covering or hiding the face, and twitches may occur when “switching” from one alter to another c. Marked variation in speech for brief periods of time d. Impaired insight, usually unaware of alters e. May appear anxious or depressed 5. Associated with severe physical or sexual abuse during childhood a. Many posttrauma symptoms (nightmares, flashbacks, hypervigilance) b. Self-mutilation, suicidal, or aggressive behavior

Answer 25

a. No-harm contract and environmental safety if client is suicidal or is self- mutilating b. Meeting and recognizing alters and their unique experiences and needs c. “Mapping” personality system, noting characteristics of alters and co-consciousness d. Creation of emotionally safe environment for all alters e. Individual therapy with therapist skilled in working through trauma leading to integration (moving together of aspects of all identities) f. Development of new coping skills for integrated client and for clients who choose not to integrate so that dissociation is either not necessary or is under control g. Family therapy with partners and children to help client avoid dissociation, deal with hostile personalities, understand therapy process, and to confirm experience with client’s behavior h. Hypnosis or drug-facilitated interviews; use is controversial because of the possibility of remembering “too much, too soon” and being overwhelmed with anxiety i. Issue: the therapist’s “creating” memories and alters by his or her verbal and non-verbal behavior in suggestible client

Answer 26

1.Experiences recurrent alterations in self-perception a. Depersonalization: feeling of detachment or separation from one’s self, as if in a dreamlike state b. Client describes self as “detached from my body” or “being in a dream” c. Feels strange or unreal d. Able to function during the experience 2. Client may report distress about experiences and become depressed and anxious a. Often fears being “crazy” b. May be accompanied by derealization, which is the feeling that the external world is unreal or strange 3. Precipitated by stress and anxiety 4. Most common in teenagers and young adults 5. Special interventions: Problem solving to reduce stress in general, Stress-management techniques; “Grounding” or focus on external environment

MH EXAM #4 Flashcards

(52 cards)