w3 Flashcards by Garrett Anderson

BN
epidemiology & comorbidity:
- more common in women
- 25-45 y/o
- May occur with comorbid mood disorder, anxiety disorder, or substance use disorder like alcohol

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s/s ______ withdrawal
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin

s/s Opioid withdrawal (COWS)

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AN treatment:

Hospitalizations, intensive therapy, outpatient partial hospitalization (when stabilized)
- Weight restoration program
- Observation during meals and bathroom
- regularly scheduled weighs
- milieu therapy – focus on eating behavior, anxiety, dysphoria, self esteem, lack of control

Criteria for hospitalization: AN
- Extreme electrolyte imbalance
- Weight below 75% of normal
- < 10% body fat
- Daytime HR < 50
- Systolic BP < 90
- Temp < 96
- Arrhythmias

Goals -
#1 – depends on acuity, nutritional rehab, education
#2 – resolving body image disturbance, coping, assisting family

Biological treatment –
- pharmacotherapy – none, fluoxetine for OCD behaviors
- integrative therapy – yoga, massage, acupuncture, bright light therapy

psychological therapies
- CBT and other therapies for anorexia

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s/s ______ withdrawal
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual

s/s alcohol withdrawal (CIWA)

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Risk factors for ___:
- Female
- Family hx
- Hx of obesity
- Dieting
- Over exercising
- Low self esteem
- Body dissatisfaction
- Lack of assertiveness
- Other ED
- Hx of abuse
- Comorbid conditions
- Distorted body image
- Media
- Fashion industry
- Athlete

Risk factors for ____:
- Binge eating behaviors
- AN hx
- Depression
- Interpersonal relationship problems
- Impulsive, compulsive
- Anxiety
- SUD

AN
BN

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s/s or AN or BN?
- Low body weight ( at least 15% below what is expected)
- BMI determines severity
o <15 = extreme
o 15 - 16 = severe
o 16 – 17 = moderate
o >17 = mild
- Amenorrhea
- Lanugo
- Mottled, cool skin on extremities
- Peripheral edema
- Lack of energy, fatigue, muscular weakness
- Constipation
- Low BP, pulse and temp
- Abnormal lab values – more so expected with purging type
- Impaired renal function
- Decreased bone density
- Anemic pancytopenia

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Spectrum of ED
1. Normal eating
2. Development of risk factors
- Low self esteem
- Dieting
- Parental attitudes
- Body dissatisfaction
- Media ideal bodies
3. Partial syndrome ED
- Binge eating and serous dieting
4. Full syndrome ED
- Increase in frequency and severity of binge eating, purging, and starvation
5. Treatment

Facts
- All ages, genders, and backgrounds
- Serious but treatable
- 2nd highest mortality rate of any mental illness
- May cause someone to attempt suicide

Comorbidities and dual diagnoses with ED:
- Depression, anxiety
- Alcohol or substance abuse problem
- Personality disorders

Treating ED
- Often don’t seek help
- Not motivated to change
- Leave treatment
- Some recover spontaneously, some have long term problems

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___________
unconscious feelings that HC workers have toward patient
- occurs unconsciously displaces feelings r/t significant figures from nurses past onto the patient
- overinvolvement or impairs therapeutic relationship
- nurse must examine own attitude, recognize past experiences may impact their perception and influence how they provide care

countertransference

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________ NCD – interferes with daily functioning and independence
- Alzheimers
- Dementia
- TBI
- HIV infection
- Parkinsons, huntingtons, prion disease

______ NCD – does not interfere with ADLs, does not progress

Major NCD – interferes with daily functioning and independence
- Alzheimers
- Dementia
- TBI
- HIV infection
- Parkinsons, huntingtons, prion disease

Mild NCD – does not interfere with ADLs, does not progress

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s/s Opioid withdrawal (COWS) vs s/s alcohol withdrawal (CIWA)

___________
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual

____________
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin

s/s alcohol withdrawal (CIWA)
- n/v
- tremors
- anxiety
- agitation
- sweats
- orientation
- h/a
- disturbances/hallucinations – tactile, auditory, visual

s/s Opioid withdrawal (COWS)
- Increase in resting pulse rate
- sweating
- Restlessness
- Pupil size
- Bone/joint aches
- Runny nose or tearing
- GI upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin

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are any of these appropriate language to use r/t addiction
- addict
- alcoholic
- drunk
- substance or drug abuser
- drug habit
- dirty

No, stigmatizing language

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reasons for continued use: the addicted brain
- repeated use leads to tolerance and withdrawal r/t changes in neurotransmitters, decreased D2 receptors, and decreased dopamine release
- this results in – compulsive behaviors, decreased inhibitory control, increased impulsivity, impaired regulation of intentional action
- alcohol and nicotine metabolize into ______

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_________ – occurs when a person no longer responds to the substance in the way that the person initially responded
- Using increasing amounts of substance overtime to achieve the same level of response and a diminished effect occurs with continued use
- Some substances cause rapid physiological tolerance (cocaine) and some cause tolerance after weeks or months of use (rx pain meds)
- Increased tolerance may result in a person being able to tolerate a higher Blood alcohol level (BAC) while exhibiting fewer symptoms

Tolerance

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AN vs BN?

_________
An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain

_________
Life threatening eating disorder
- Intense fear of weight gain
- Severely distorted body image
- Restriction of calories relative to requirements with significantly low BMI
- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise
- Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)

Bulimia nervosa (BN)
An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain

Anorexia nervosa (AN)
Life threatening eating disorder
- Intense fear of weight gain
- Severely distorted body image
- Restriction of calories relative to requirements with significantly low BMI
- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise
- Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)

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risk factors: addiction
- genetic
- neurotransmitters
- environmental – chronic stressors, anxiety, abuse, trauma, addiction in family or peers, access to substances, ineffective coping strategies
- starting certain substances at _____ age

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biology and addiction
- genetic predisposition
- __creased dopamine
- immature brain development
- acetate function
- males
- depression, ADHD, PTSD, increase potential to self-medicate with substances

dopamine and drug use
- dopamine (feel good neurotransmitters) __crease with substance use = feeling high
- relapse is common

increase

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off label meds for behavioral symptoms of AD
- antipsychotics
- antidepressants
- antianxiety
- anticonvulsants

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Neurotransmitters in AD - too much or too little?
- ____ Acetylcholine produced
- _____ glutamate

Neurotransmitters in AD
- Less Acetylcholine produced (med- cholinesterase inhibitors keep enzyme from breaking down acetylcholine)
- Excessive glutamate (med – NMDA antagonists reduce excess calcium by blocking some NMDA receptors)

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Bulimia nervosa vs anorexia nervosa
_______ is
- more prevelant
- older at onset
- normal weight
- not life threatening
- outpatient treatment
- better outcomes
- lower mortality rates
- effective medications

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_________ – a comprehensive integrated public health approach to the delivery of early intervention and treatment services for person with SUD and those at risk

Goal: reduce and prevent related health consequences, disease, accidents, injuries, costs and healthcare utilization

SBIRT
Screening, brief intervention, and referral to treatment

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emergency treatment:________ kits
- drug (injection or nasal mist) can quickly reverse effects of heroin OD

naloxone

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___________
Food avoidance
- May be r/t strong dislikes from sensory of food, appearance, color, smell, texture, temp, and tase
- Can result in significant weight loss, nutritional deficiency, dependence on supplements/enteral feeding, functioning
- Infancy and early childhood
- Males and females equally
- Risk factors – personal or family anxiety

Treatment
- Behavioral modification
- Family support and education
- Treat anxiety and depression

Feeding disorders

Avoidant/restrictive food intake disorder (ARFID)

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Complications d/t weight loss and starvation: AN
- Musculoskeletal – muscle and fat loss, osteoporosis early onset
- Metabolic – hypothyroidism, hypoglycemia, electrolyte issues
- Cardiac – bradycardia, hypotension, cardiac muscle loss, small heart, arrhythmias, chest pain, sudden death
- GI – delayed emptying, bloating, constipation, abd pain, gas, diarrhea, GERD, hemorrhoids
- Reproductive – amenorrhea, irregular periods, loss of libido, infertility
- Dermatologic – dry skin, brittle nails, lanugo, edema, acrocyanosis (blue hands/feet), thinning hair, yellow skin, poor wound healing
- Hematologic – leukopenia, anemia, thrombocytopenia, hypercholesterolemia, hypercarotenemia
- Neuropsychiatric – abnormal taste sensation, apathetic depression, mental symptoms, sleep issues, fatigue

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Epidemiology & comorbidity: BED
- Most common ED
- More common in females
- Equal in racial groups
- Normal, overweight, or obese individuals
- May be genetic
- May have another psychiatric disorder – phobia, social issues, PTSD, alcohol abuse or dependence
- Impulsive and reward sensitive
- Low self esteem
- Body dissatisfaction
- Difficulty coping with feeling
- Hx of trauma or adverse child events
- Hx of food insecurity

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Epidemiology of AN: - More common in female - Adolescence or young adult - Athletes - LGBTQ - Less common than bulimia nervosa - Comorbid with bipolar disorder, anxiety, OCD, depression, PTSD, trauma, alcohol or substance use disorder Etiology of AN: Biological - Genetic - Glucose and lipid metabolism - Neurobiological – serotonin Physical and cognitive - Ego-syntonic disorder – knows actions are harmful but believes benefits outweigh harm - Emotional identification, regulation, and processing issues - Low distress tolerance and deficits in behavioral control in response to stress Environmental - Internalization of a thin body idea - Associated with cultures that value thinness

______– co-ocurring mental illness and substance use or addictive disorder

Dual diagnosis

Alzheimer's meds Class = acetylcholinesterase inhibitors (AChEI) Drugs = donepezil, rivastigmine, galantamine or Class = NMDA antagonists Drug = memantine - 2nd line or combo - restore function of damaged nerve cells and reduce abnormal excitatory signals of glutamate - s/e = dizzy, confusion, h/a, constipation

Class = NMDA antagonists Drug = memantine

substance _________ - Specific substances (alcohol, caffeine, opioids, etc.) have their own disorder - chronic medical condition with roots in enviro, NT, genetics, and life experiences - strong craving of a substance - persistent desire to cut down without success - impacts life, unable to fulfill role obligations - increased social isolation - hazardous activity - continuation despite potential harmful consequences - excessive time spent trying to get the substance or recover from use - tolerance or withdrawal

addiction

Warning signs and s/s of _____: - Present as overwhelmed, overly committed social butterflies, difficulty setting limits/boundaries - Rules about food - Shame, guilt, disgust regarding binge/purge - Compulsive, impulsive - Binge eating – large amounts of food disappear in a short amount of time, finding a bunch of wrappers - Purging – frequent trips to bathroom after meals, signs/smell of vomit, wrappers/packages of laxatives, diuretics. - Excessive, rigid exercise regimen – feel the need to burn off calories taken in - Schedules to make time for binge/purge session - Withdrawal socially - Behavior showing weight is primary concern - Parotid gland swelling – unusual swelling of cheeks or jaw area - Russells sign – calluses, scars on back of hands/knuckles from self-induced vomiting - Dental caries, tooth erosion, discoloration/staining Warning signs of ____: - Dramatic weight loss - Preoccupation with weight, food, calories, etc. - Refusal to eat certain foods and restrictions - Frequent comments about feeling fat despite weight loss - Anxiety about gaining weight - Denial of hunger - Development of food rituals - Consistent excuses to avoid mealtimes - Excessive rigid exercise regimen, the need to burn off calories taken in - Withdrawal socially - Behaviors indicating weight is primary concern

BN AN

_______ ED characterized by recurrent episodes of binge eating, with accompanying distress and impaired control over such behavior

Binge eating disorder (BED)

treatment: reduce cravings and controls withdrawal symptoms for opioid addiction - methadone – ceiling effect?, monitor closely - buprenorphine + naloxone - buprenorphine – ceiling effect?, limits OD potential

- methadone – no ceiling effect, monitor closely - buprenorphine + naloxone - buprenorphine – ceiling effect, limits OD potential

s/s of what alcohol withdrawal complication? - agitation - increased anxiety - confusion - tremors - seizures - delusions - hallucinations - paranoia - autonomic hyperactivity – tachycardia, diaphoresis, fever, anxiety, insomnia and HTN

delirium tremens (DTS)

alcohol craving and acetate - alcohol breaks down into ______ - acetate triggers craving for more acetate - normal drinker = acetate moves through system _______ - in addiction = acetate accumulates in their body with only one drink bc it is barely processed out (r/t slow filtering of pancreas and liver) so by staying in the body it triggers craving for more acetate - control is lost and the craving cycle begins

alcohol craving and acetate - alcohol breaks down into acetate - acetate triggers craving for more acetate - normal drinker = acetate moves through system quickly - in addiction = acetate accumulates in their body with only one drink bc it is barely processed out (r/t slow filtering of pancreas and liver) so by staying in the body it triggers craving for more acetate - control is lost and the craving cycle begins

Timing of withdrawal symptoms following alcohol intake __-__ hours - Minor withdrawal s/s - Insomnia - Tremors - Mild anxiety - GI upset - h/a - diaphoresis - palpitations - anorexia __-__ hours - hallucinations – visual, auditory, tactile __-__ hours - seizures – generalized, tonic-clonic __-__ hours - delirium tremens - hallucinations – visual usually - disorientation - tachycardia - hypertension - low grade fever - agitation - diaphoresis

Timing of withdrawal symptoms following alcohol intake 6-12 hours - Minor withdrawal s/s - Insomnia - Tremors - Mild anxiety - GI upset - h/a - diaphoresis - palpitations - anorexia 12-24 hours - hallucinations – visual, auditory, tactile 24-48 hours - seizures – generalized, tonic-clonic 48-72 hours - delirium tremens - hallucinations – visual usually - disorientation - tachycardia - hypertension - low grade fever - agitation - diaphoresis

________ – caused by excessive consumption of alcohol followed by episodes of amnesia - During episode a person actively engages in behaviors, can perform tasks, and appears normal - No the same as passing out

Blackouts

Factors contributing to ED: - Genetics - Onset of puberty - Vulnerable person - Female - History of obesity - Uncontrollable dieting - Major life changes or stressors - Family functioning style - Sociocultural emphasis on slimness - Perfectionism - Impulsivity What causes ED: Psychological factors - Low self esteem - Feeling inadequate - Lack of control in life - Depression, anxiety, stress, loneliness, trauma Interpersonal factors - Troubled relationships - Difficulty expressing emotion - History of being teased about weight, physical/sexual abuse Social factors - Cultural pressure to be thin and value perfect body - Narrow definition of beauty - Cultural norms that value physical appearance Biological factors - Irregular hormone functions - Genetics Neurobiology - Altered brain serotonin which contributes to dysregulation of appetite, mood, and impulse control Environmental - Childhood trauma - Sexual abuse

immature brain development - early experiences affect brain development - early stress/trauma change brain response - brain continues to develop until 24+ - brain matures from back (emotion, memory, impulse, psychomotor) to front (executive functioning, planning, problem solving, judgements, impulse control, organization) - pathways and patters are being established - when making decisions – adults rely on frontal cortex and teens rely on amygdala

treatment: DTS - _________!!! - medicate adequately - monitor closely - listen and respond to patients subjective symptoms - treat complications - give thiamine and other meds - life support as indicated - labs – electrolytes - hydration - vitals - anticonvulsants (phenytoin or phenobarbital) to treat seizures - oral diazepam to treat symptoms of acute agitation, tremors, impending or acute DTS, hallucinations - IV lorazepam to treat severe symptoms when delirium appears - Antipsychotics (haloperidol) prn - Clonidine to treat HTN - Oral or IV fluids to treat dehydration exacerbated by diaphoresis and fever

treatment: DTS - prevention - medicate adequately - monitor closely - listen and respond to patients subjective symptoms - treat complications - give thiamine and other meds - life support as indicated - labs – electrolytes - hydration - vitals - anticonvulsants (phenytoin or phenobarbital) to treat seizures - oral diazepam to treat symptoms of acute agitation, tremors, impending or acute DTS, hallucinations - IV lorazepam to treat severe symptoms when delirium appears - Antipsychotics (haloperidol) prn - Clonidine to treat HTN - Oral or IV fluids to treat dehydration exacerbated by diaphoresis and fever

_________ An ED where the individual has recurrent episodes of uncontrollable binge eating and compensatory behavior (self-induced vomiting, laxatives, diuretics, excessive exercise) to avoid weight gain

Bulimia nervosa (BN)

BN Etiology: Biological - Neuropathological – eating dysregulation may cause changes in brain - Genetics - Genes - Lower brain serotonin Psychological & cognitive - Anxiety, low self esteem - Impulsive, compulsive - Chaotic, non-nurturing family - Difficult interpersonal relationship - Triggers – stress, poor body image, food, restrictive dieting, boredom Environmental - Thin body idea, weight bullying - Sexual or physical abuse, trauma, stress Clinical course: - Few outward s/s, doesn’t appear physically ill - Normal weight - Binge/purge in secret - Delayed treatment - Treatment started when eating is uncontrollable - After treatment, complete recovery of ED, mood disorders may remain

________ disorders - Consistently below/above person’s caloric needs to maintain a healthy weight - Can have anxiety and guilt - Occurs without hunger or without satiety - Results in physiologic imbalances or medical complications

eating d/o

treatment: alcohol withdrawal goals - control agitation - decrease seizure risk - decrease morbidity and mortality meds - chlordiazepoxide - diazepam - lorazepam - ________ - daily replacement critical, give prior to IV dextrose, helps prevent wernickes syndrome - schedule and PRN dosing for breakthrough autonomic symptoms - clonidine – HTN

treatment: alcohol withdrawal goals - control agitation - decrease seizure risk - decrease morbidity and mortality meds - chlordiazepoxide - diazepam - lorazepam - thiamine - daily replacement critical, give prior to IV dextrose, helps prevent wernickes syndrome - schedule and PRN dosing for breakthrough autonomic symptoms - clonidine – HTN

_________ Ingestion of substance with no nutritional value (ex: Dirt, Paint) - May begin in early childhood, adolescence or adulthood - Males and females equal - Treatment – monitor eating, reward appropriate eating

Feeding disorders Pica

___________ – a set of physiological symptoms that occur when a person stops using a substance - Specific to each substance - Mild to life threatening - The more intense the symptoms = the more likely the person is to start using again

Substance withdrawal

Alzheimer's meds Class = acetylcholinesterase inhibitors (AChEI) Drugs = donepezil, rivastigmine, galantamine or Class = NMDA antagonists Drug = memantine - 1st line - Indication = mild to moderate AD - Delays cognitive decline - s/e = n/v - peaks in 3 mos, then continues to decline - rivastigmine route – PO and patch

Class = acetylcholinesterase inhibitors (AChEI) Drugs = donepezil, rivastigmine, galantamine

treatment: substance use disorder medication assisted treatment - combo medication, counseling, and behavioral therapies pharmacotherapy - naltrexone - disulfiram - clonidine - acamprosate reduce cravings and controls withdrawal symptoms for specifically _____ addiction - methadone – no ceiling effect, monitor closely - buprenorphine + naloxone - buprenorphine – ceiling effect, limits OD potential

treatment: substance use disorder medication assisted treatment - combo medication, counseling, and behavioral therapies pharmacotherapy - naltrexone - disulfiram - clonidine - acamprosate reduce cravings and controls withdrawal symptoms for opioid addiction - methadone – no ceiling effect, monitor closely - buprenorphine + naloxone - buprenorphine – ceiling effect, limits OD potential

Wernickes encephalopathy: treatment - _________ replacement - Improve nutrition

Wernickes encephalopathy: treatment - Thiamine replacement - Improve nutrition

alzheimer's Stages Mild – priority care is delay ________ - Forgetful - Misplaces things - Decreased recall - Social withdrawal - Frustrated with self - Changes may not be apparent to others Moderate - priority care is ______ - Decreased self care, way finding - Disoriented to time and place - Wandering, pacing - Hallucinations or delusions - Decreased visual perception - Required supervision - Emotional lability - Symptoms noticeable Severe - priority care is _______ needs - Cant care for self - Loss of language - Minimal long term memory - Constant complete care

Stages Mild – priority care is delay cognitive decline - Forgetful - Misplaces things - Decreased recall - Social withdrawal - Frustrated with self - Changes may not be apparent to others Moderate - priority care is safety - Decreased self care, way finding - Disoriented to time and place - Wandering, pacing - Hallucinations or delusions - Decreased visual perception - Required supervision - Emotional lability - Symptoms noticeable Severe - priority care is physical needs - Cant care for self - Loss of language - Minimal long term memory - Constant complete care

(wernicke’s) Aphasia Hyperorality Confabulation (broca’s area) Apraxia Preservation Agnosia _______– loss of language Expressive aphasia _________ – cant find words to express ideas Receptive aphasia _______– cant interpret what is said ________– loss of purposeful movement _______ – loss of ability to recognize objects __________ – unconscious creation of stories/answers in place of actual memories (not done intentionally, maintains self esteem) _________ – persistent repetition of a word, phrase, or gesture ________– tendency to put things in mouth to taste or chew

Aphasia – loss of language Expressive aphasia (broca’s area) – cant find words to express ideas Receptive aphasia (wernicke’s) – cant interpret what is said Apraxia – loss of purposeful movement Agnosia – loss of ability to recognize objects Confabulation – unconscious creation of stories/answers in place of actual memories (not done intentionally, maintains self esteem) Preservation – persistent repetition of a word, phrase, or gesture Hyperorality – tendency to put things in mouth to taste or chew

________ disorders - Progressive deterioration of cognitive functioning and global impairment of intellect - No change in consciousness - Acquired condition, not developmental - Difficulty with memory, problem solving, complex attention - Affects orientation, attention, memory, vocabulary, calculation ability, abstract thinking

Neurocognitive

__________ - most severe form of alcohol withdrawal - can result in death - can occur in 48-72 hours after cessation of heavy drinking - hepatitis or pancreatitis can increase risk - rare in individuals with good physical health - risk of being misdiagnosed as a psychiatric disorder

delirium tremens (DTS)

Clinical course of AN: - Chronic condition, with relapses - May continue to be preoccupied with food - May develop bulimia nervosa - May die by suicide - Poor outcome r/t lower initial weight, purging, earlier onset - Difficult to treat, but recovery is possible

Consequences of ____: - HTN - High cholesterol - Heart disease - DM - GI disease - Gallbladder issue - Musculoskeletal problems Treatment of ___: - Outpatient treatment - Education - Pharmacotherapy – SSRIs, lisdexamfetamine dimesylate - Psychological – CBT, DBT, group or support therapy

BED

_________ – excessive use of substance that results in reversible substance specific syndrome - judgement impaired, inappropriate and maladaptive behaviors, impaired functioning - CNS changes, disruption in pshysiological and psychological functioning - Can happen with one time use of substance - Ex: alcohol – physiological symptoms (slurred speech, poor coordination, impaired memory, stupor, coma) and behavioral symptoms (inappropriate behavior)

substance intoxication

Treatment: BN - If life threatening complications or suicide risk – hospitalization - Otherwise, outpatient - Stabilize eating, interrupt binge/purge - Restructure thoughts about eating - Healthy boundary setting - Nutrition counsel - Behavioral techniques Pharmacotherapy - SSRIs - Fluoxetine (in combo with CBT) Psychological - CBT – 1st line - DBT - Group therapy - Family therapy not used d/t age

Wernicke encephalopathy vs Korsakoff syndrome ______ - Acute and reversible - May clear up within a few weeks of may progress (more severe, and chronic) ______ - Chronic and debilitating - Not reversible

Wernicke encephalopathy Korsakoff syndrome

Life threatening eating disorder - Intense fear of weight gain - Severely distorted body image - Restriction of calories relative to requirements with significantly low BMI

Anorexia nervosa (AN)

__________ Undigested food being returned to the mouth, rechewed, reswallowed or spit out - Dx after 1 month of s/s - Can begin at any age, usually 3-12 mos - More common with intellectual disabilities - Predisposing factor – childhood neglect Interventions: - Reposition during feeding - Improve interactions between caregiver and child - Making mealtime a pleasant experience - Distracting child when behavior starts - Family therapy

Feeding disorders Rumination disorder

________ – recurrence of alcohol/drug dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detoxification

Relapse

long-term medication management: methadone maintenance for pregnant women - decreases variability of drugs on fetus - newborns have more predictable outcomes - limits exposure to health risk for mom and fetus – unknown toxic additives, dirty needles - dosages may need to be adjusted upward as pregnancy progresses - dosing options – smaller 2x per day dose or 1 large dose per day - dosage titrated depending on opioid withdrawal scoring - maintained until delivery then withdrawn - fetus withdrawal symptoms may be 2-3x as intense as moms

neurocog d/o: Medications ____________ - Donepezil - Rivastigmine – PO and transdermal - Galantamine __________ - Memantine

Medications Acetyl/cholinesterase inhibitors (AChEI) - Donepezil - Rivastigmine – PO and transdermal - Galantamine NMDA antagonists - Memantine

Wernicke encephalopathy vs Korsakoff syndrome _________ - Confusion - Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors - Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping _________ - Confusion - Ataxia – loss of muscle coordination, affects posture and balance, can lead to tremors - Vision changes – nystagmus (abnormal eye movements), double vision, eyelid drooping - Severe, irreversible persistent memory impairments – problems forming and recalling memories - Confabulation – unknowingly lying - Hallucinations - Repetitious speech and actions - Problems with decision making

Wernicke encephalopathy Korsakoff syndrome

Treatment: opioid withdrawal - Give scheduled _________ on time Nonpharmacological interventions done before prn meds - Nausea – crackers, ginger ale, tea, flat warm cola - Muscle aches – hot shower, warm compress - Anxiety reduction – distraction, relaxation, talk therapy Pharmacologic interventions for: - n/v (Must see emesis before giving) – ondansetron, promethazine PO or rectal suppository (avoid giving IM r/t rush effect) - anxiety, lacrimation (watery eyes), rhinorrhea – hydroxyzine, avoid benzodiazepines - insomnia – trazadone - pain – acetaminophen (long term alcohol use pt may have esophageal varices or gastric ulcers), NSAIDS - diarrhea – kaopectate (first line), avoid loperamide b/c sedation effect

Treatment: opioid withdrawal - Give scheduled methadone on time Nonpharmacological interventions done before prn meds - Nausea – crackers, ginger ale, tea, flat warm cola - Muscle aches – hot shower, warm compress - Anxiety reduction – distraction, relaxation, talk therapy Pharmacologic interventions - n/v (Must see emesis before giving) – ondansetron, promethazine PO or rectal suppository (avoid giving IM r/t rush effect) - anxiety, lacrimation (watery eyes), rhinorrhea – hydroxyzine, avoid benzodiazepines - insomnia – trazadone - pain – acetaminophen (long term alcohol use pt may have esophageal varices or gastric ulcers), NSAIDS - diarrhea – kaopectate (first line), avoid loperamide b/c sedation effect

Anorexia nervosa (AN) Types: - ________ type – weight loss accomplished through dieting, fasting, or excessive exercise - ________ type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)

- Restricting type – weight loss accomplished through dieting, fasting, or excessive exercise - Binge eating and purging type – weight loss accomplished through binge-eating or purging behaviors (self-induced vomiting or misuse of laxatives, diuretics, or enemas)

____ complications – - refeeding syndrome – sudden shifts in electrolytes can be fatal Complications from ____: - Erosion of dental enamel, xerostomia – dry mouth, tooth decay - Neuro issues – seizures, fatigue, weak, mild mental symptoms - Cardiac – cardiomyopathy, arrhythmias - Russells sign

AN BN (purging)

_________ – ACUTE cognitive impairment with rapid onset, caused by medical condition or direct physiological cause ________ – CHRONIC cognitive impairment, differentiated by cause not symptoms, Degenerative progressive - emotional, and behavioral changes, physical and functional decline, ultimately death

Delirium – ACUTE cognitive impairment with rapid onset, caused by medical condition or direct physiological cause Dementia – CHRONIC cognitive impairment, differentiated by cause not symptoms, Degenerative progressive - emotional, and behavioral changes, physical and functional decline, ultimately death

s/s of _________ - Disturbance in executive functioning - Aphasia – loss of language - Apraxia - Agnosia - MMSE – cant name things - Sundowning - Memory impairment – confabulation - Preservation - Hyperorality - Hoarding

Alzheimers Most common dementia

__________ Neurological disorder caused by lack of thiamine (vitamin B1) - requires immediate treatment Develops most often in people with Alcohol use d/o or malnutrition - Chronic alcoholism decreases intestinal absorption of thiamine - Must r/o other causes of thiamine deficiency – malnutrition, ED, chronic infections, surgery

Wernicke-korsakoff syndrome

AN or BN? Parotid gland swelling Russells sign

BN - Parotid gland swelling – unusual swelling of cheeks or jaw area - Russells sign – calluses, scars on back of hands/knuckles from self-induced vomiting

Risk factors for ________ - Age, family hx - CV disease - Social engagement - Diet - TBI - HTN and dyslipidemia - Neuronal degeneration - Genetics Etiology of _____ - Tau proteins and beta amyloid plaques (sticky clumps between nerve cells) create neurofibrillary tangles (abnormal collections of protein threads inside nerve cells) - Oxidative stress and free radicals - Inflammation - Brain atrophy

alzheimer's

2 stages: Wernicke-korsakoff syndrome - _________ – acute - _________ – chronic

- Wernicke encephalopathy – acute - Korsakoff syndrome – chronic - ½ of people with Wernicke encephalopathy eventually develop korsakoff syndrome

s/s of ______: - Frequent episodes of eating large amoutns of food in shorts time periods - Feeling out of control overeating during episode - Feeling depressed, guilty, disgusted - Eating when not hungry - Eating alone b/c of embarrassment of quantity eating - Eating until uncomfortably full - Upper and lower GI problems that bring them to HCP

BED