Term
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Definition
) involve serious disturbances in eating behavior
•Extreme and unhealthy reduction of food intake
•Severe overeating
Feelings of distress or extreme concern about body shape or weight |
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Term
| eating disorder statistics |
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Definition
• Eating disorders currently affect approximately 25 million Americans
• Approximately 25% are male
Anorexia has the highest mortality rate among all psychological disorders |
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Term
| contributing factors to eating disorders include |
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Definition
Biological factors- genetic model- risk of developing an eating disorder is 50-80% determined by genetics
•Individuals with EDs have a characteristic phenotype:
•Constellation of personality traits that have been shown to be moderately heritable
•Female relatives of people with EDs are up to 12 times more likely to develop them as well.
•Social factors- unrealistic pressures to obtain the "perfect" body; the constant influx of images of perfection; and narrow definitions of beauty
•Psychological factors- substantial co-morbidity with other mental health disorders - ie. depression, anxiety
•Obsessive-Compulsive Disorder
•Low self-esteem
•Feelings of lack of control
•Interpersonal factors- history of abuse; being teased for size or weight; traumatic life event(s); and difficulty expressing feelings and emotions
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Term
| est lifetime prevalence of developing an |
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Definition
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Term
| est prevalence rate for developing bulima |
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Definition
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Term
| prevalance and comorbiditiy of ED |
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Definition
•Anorexia nervosa appears in early to middle adolescence.
•Bulimia nervosa appears in late adolescence.
•Women (aged 35 to 65 years): Changes in appearance and role potentially increase the risk for EDs.
•EDs are almost always co-morbid with other psychiatric illnesses.
•More than 50% of people with anorexia and 95% of those with bulimia have one other psychiatric disorder.
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Term
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Definition
•Significant co-morbidity with:
•Mood and anxiety disorders
•Substance abuse
•Body dysmorphic disorders
•Impulse control disorders
•Personality disorders, especially borderline and obsessive-compulsive personality disorders
•Always assess for psychiatric risk, including suicidal and self-harm thoughts, plans, and/or intent.
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Term
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Definition
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Term
| full feeling influenced by |
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Definition
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Term
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Definition
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Term
| weight loss influenced by |
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Definition
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Term
| weight loss influenced by |
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Definition
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Term
| weight influence influenced by |
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Definition
amylin
ghrelin
gastric inhibitory polypeptide
pancreatic polypeptide |
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Term
| range of eating disorders |
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Definition
qMaladaptive eating regulation responses
q Inability to regulate eating habits
q Frequent tendency to over or under use food
q Interference with the biological, psychological
and sociocultural aspects of the person’s life
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Term
| factors that interact in eating disorders |
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Definition
| appetitie, binge eating, body weight, duration rate of eating, food intake, hunger, neurochemicals, intermeal intervals, macronutrient selcetion, meal freq, meal initiation, meal size, saitey, rate of energy expenditure |
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Term
| eating disorder is classified as an... |
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Definition
addiction
•Complex neuro-biobehavioral disorder characterized by:
•impaired control
•compulsive use
•Dependency
•craving for the activity, substance or food
Relapses are possible even after long periods of abstinence
•“chronic brain disease”
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Term
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Definition
•Conscious awareness of desire to take a drug or participate in an activity
•Complex neuro-biobehavioral phenomenon based on previous experiences with addictive substances or activities
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Term
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Definition
•Chronic, relapsing neurochemical disease characterized by individuals having a body mass index (BMI) … 30kg/m(squared) or higher
•Currently, there is no generally accepted definition of obesity for children and adolescents
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Term
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Definition
•Recurrence of problem substance use or activity in someone who was abstinent from that substance use or activity
•Considered normal part of cycle of change in the recovery from addiction
•Involves experiencing a “slip” and reverting to exhibiting addictive behavior
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Term
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Definition
Repeated intentional weight losses followed by regains
Also called yo-yo dieting
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Term
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Definition
vPreoccupied with food and rituals of eating, along with voluntary refusal to eat
vExhibit morbid fear of obesity and refusal to maintain a minimally normal body weight (<85% expected normal weight)
Occurs most often females from teens to adulthood |
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Term
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Definition
vRestricting- drastically restricts food intake and does not binge or purge
vBinge-eating/purging
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Term
| AN assessment findings (1) |
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Definition
•Orthostatic changes
•Bradycardia
•Cardiac murmur
•Sudden cardiac arrest
•Prolonged QT interval
•Acrocyanosis
•Symptomatic hypotension
•Leukopenia
•Lymphocytosis
•Carotenemia
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Term
| AN assessment findings 2` |
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Definition
•Hypokalemic alkalosis
•Electrolyte imbalances
•Osteoporosis
•Fatty degeneration of liver
•Elevated cholesterol levels
•Amenorrhea
•Abnormal thyroid functioning
•Hematuria
•Proteinuria
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Term
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Definition
•Imbalanced nutrition: less than body requirements
•Decreased cardiac output
•Risk for injury (electrolyte imbalance)
•Risk for imbalanced fluid volume
•Disturbed body image
•Anxiety and chronic low self-esteem
•Deficient knowledge
•Ineffective coping
•Powerlessness and hopelessness
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Term
|
Definition
ØRecurrently eat large quantities of food over short period of time (binge), may be followed by purging
ØWeight normal or slightly higher
ØAverage age at onset 15-18 yo
ØMost common females
Two types:
ØPurging- self-induced vomiting, laxatives, diuretics, and or enemas
ØNonpurging- excessive exercise
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Term
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Definition
•Cardiomyopathy (ipecac toxicity)
•Cardiac dysrhythmias
•Sinus bradycardia
•Sudden cardiac arrest
•Orthostatic changes
in pulse and blood pressure
•Electrolyte imbalances
•Metabolic acidosis
•Hypochloremia
•Hypokalemia
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Term
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Definition
•Dehydration and renal loss of potassium as a result of self-induced vomiting
•Attrition and erosion of teeth
•Loss of dental arch
•Diminished chewing ability
•Parotid gland enlargement
•Esophageal tears as a result of self-induced vomiting
•Gastric dilation
•Russell sign
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Term
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Definition
•Decreased cardiac output
•Disturbed body image
•Powerlessness
•Chronic low self-esteem
•Anxiety
•Ineffective coping (e.g., substance abuse, impulsive responses to problems)
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Term
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Definition
vClients recurrently eat large quantities of food over short period of time without compensatory behaviors
vBoth sexes, ages 46-55
vWeight gain associated with increased risk for diabetes, hypertension and cancer
vComorbidities- depression, personality disorders, substance use disorders and anxiety
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Term
| cues of self induced vomiting |
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Definition
ÂRussell’s sign – calloused and/or reddened area of
knuckles on dominant hand
ÂSwollen cheeks, throat and parotid glands
Â
ÂWatery, bloodshot eyes
ÂChipped teeth with exposed dentin and/or minimal enamel
coating.
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Term
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Definition
How many times in your lifetime have you engaged in these activities
to lose or maintain your weight?”
u used diuretic pills
u
v used laxatives
v
w induced vomiting
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Term
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Definition
How many times during your lifetime have you engaged in these activities to lose or maintain your weight?”
_ Exercised more
_
_ Fasted
_
_ Skipped meals
_
_ Restricted the intake of food
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Term
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Definition
•How many times they have engaged in binge eating (rapid and uncontrollable consumption of a large quantity of food) during past month
• Assess specifics of pattern of binge eating
•Assess number of times individual has stolen food and/or other items to obtain money to purchase food
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Term
| assessment of ED patients |
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Definition
ùWaist circumference measurement
ù Waist-to-Hip ratio
ù Skinfold measurements (abdominal, suprailiac, thigh, triceps)
ù Computerized Tomography (fat content of body)
ùMagnetic Resonance Imaging
ùDual energy X-ray absorptiometry
ùBioelectric Impedance analysis
ùDensitometry
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Term
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Definition
amenhorea
disordered eating and osteoporosis |
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Term
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Definition
| depression, exhaustion, irritability, continue to train but level of performance dec |
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Term
| eating disorder nursing care |
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Definition
vEncourage client decision making and participation in plan of care
vMonitor vital signs, intake and output, weight
vIncorporate family as able
vMental health counseling
vNutrition counseling
vAnorexia- one-to-one supervision of meals
vRefeeding syndrome- potentially fatal complication when fluids, electrolytes and carbs introduced to severely malnourished client-cardiac dysrhythmias, severe bradycardia, hypotension. Monitor electrolytes, cardiac monitoring, fluid replacement
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Term
| reality of treating someone with obesity |
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Definition
Biases
2Prejudices
2 Stigma
2High Potential for Relapse
2 Long Term Nature of Diagnosis
2 Lack of Funding for Long-Term Care
2 Lack of Evidence-Based Treatment
2Lack of Success of Most Approaches
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Term
| more realities of treating someone with obesity |
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Definition
~NO TREATMENT for persons who are overweight
has been given an A or B rating
~ 95% of individuals who lose weight regain the weight within 5 years (unfortunately, this statistic also applies to individuals who have had bariatric – weight loss surgery)
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Term
| goal of weight management |
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Definition
vTo empower clients to live healthier, more fulfilled lives by honoring and caring for the bodies they presently have
v Focus should be on health promotion and disease prevention rather than physical appearance.
v Preventing weight gain is critical to preventing overweight and obesity
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Term
| treatment of indiv who are overweight or obese |
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Definition
qPromote weight maintenance as primary initial focus rather thanweight reduction (especially as soon as the person has gained 10 pounds)
q Promote health rather than focusing on improving physical appearance
qUtilize stages of change framework to promote minimal, realistic changes
vAppreciate the reality of the person having a “chronic neurochemical disease”
v Acknowledge the tendency to avoid health care professionals.
v Professional might initially focus on promoting the change of exercising for 10 minutes 3 days a week rather than a goal of losing a certain number of pounds.
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Term
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Definition
-Self-Acceptance
- Physical Activity
- Normalized Eating
- Satisfy Hunger
- Stop When Full
- Promote perspective that long-term use of diets that omit whole food groups is NOT effective
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Term
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Definition
•Waste elimination
•Kidneys filter through 200 quarts of blood to produce 2 quarts of waste each day
•Regulate electrolytes, acid-base balance, red blood cell production
•Control BP, fluid balance
•Secrete prostaglandins-line stomach, released during inflammatory process
•Calcium/Phosphate balance and Vit D
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Term
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Definition
•Make urine, filtering
•Urine can be adequately made with >20% of nephrons functioning
•Do the work
•Someone in renal failure may still produce urine
•Ersf-creatinesky high, K sky high
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Term
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Definition
| site of reabsorb of K-why Lasix causes hypokalemia |
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Term
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Definition
•inside nephron)
•The capillary bed where filtration occurs in the kidney.
•Kidneys receive ~25% of total cardiac output-these kidneys rely heavily on blood.
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Term
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Definition
-where filtration starts
Remants work down loop of henle-proximal to distal
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Term
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Definition
-renin regulation (severe hypertension-180 systolic)
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Term
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Definition
•(inside glomerulus)
•Filtered fluid forms at Bowman’s, then travels to the:
•Proximal Tubule à Loop of Henle
•Part that adjusts filtrate based on body’s needs, site of re-absorption
•Distal Tubule
•Part that regulates renin
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Term
| chornic kidney disease (CKD) |
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Definition
•Progressive destruction of kidney nephrons
•Diagnosed in stages based on GFR after a 3 month sustained decrease.
•Stage I – GFR ‘normal’ with kidney damage
•Stage II – GRF = 60-89 ml/min/1.73m2
•Stage V – GFR < 15 ml/min/1.73m2 (Now End-stage)
•Gfr naturally dips with age ( ~65)
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Term
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Definition
•HTN
•Diabetes mellitus
•Cardiovascular disease
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Term
| other risk factors for kidney disease |
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Definition
•Age >60 years
•GFR declines naturally with age
•Acute kidney injury-obstruction, infec (pyelonephritis), unresolved UTI
•Urinary tract obstruction (e.g., benign prostatic hyperplasia)
•Autoimmune disease/vasculitis/connective tissue disorder
•Nephrotoxic drugs (lithium, salicylate, high doses NSAIDs)
•Congenital anomalies; obstructive uropathy; renal aplasia/hypoplasia/dysplasia
•Hyperlipidemia
•Obesity/smoking
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Term
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Definition
•Pre-renal (Vascular)-before the kidney
•Post-renal
•Obstruction (benign prostatic hyperplasia)
•Interstitial-tubular
•Infections usually
•Glomerular
•Nephritis
•Autoimmune (SLE)
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Term
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Definition
•Glomerular inflammation
•Post-infection (group A beta-hemolytic)
•Can be acute pylenephritis
•Viral syndromes
•Epstein-Barr-common
•HIV
•Hepatitis
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Term
| presentation of acute nephritic syndrom |
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Definition
•Hematuria (common)
•Edema
•HTN
•Fever
•Headache
•Flank pain
•Azotemia
•Term used to describe elevated BUN and proteinuria.
•
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Term
| nephricitc syndrome despcription |
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Definition
| full of scabs and lesions-permanent scars, kills out nephrons, can’t make urine |
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Term
|
Definition
•Increased Glomerular permeability
•Damage to the capillary membrane
•Common – occurs as a result of any renal condition
•Massive increase in protein (albumin)
•Unable to filter properly
•Edema (soft, pitting)
•Peri-orbital-like a moon face
•Dependent
•Ascites
•
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Term
| nephrotic syndrome description |
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Definition
beer=nephrotic syndrome
Pungent smell, protein foams like beer
Low albumin-peeing out protein and its not supposed to, should be reabsorbing
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Term
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Definition
•Edema
•Na+ retention
•Metabolic acidosis-dropped Ph
•Anemia of chronic disease
•Kidneys unable to make erythropoietin
•Increased Phosphate (Ca transfers phos-more free circ from dec Ca)
•Decreased Calcium
•Look at GFR, then BUN, then creatinine
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Term
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Definition
•Weakness/fatigue (lack of Mag)
•Confusion-Mag
•Tremors-Na/Mag
Seizure-Na |
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Term
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Definition
•Puritis-itching w/o rash
•Purpura-purple spots
•Grayish color/dusky
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Term
| cardiovascular changes ESRD |
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Definition
•HTN
•Pitting edema
•Pericardial effusions
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Term
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Definition
•Crackles-fluid has to go somewhere
•Thick sputum
•SOB
•Tachypnea
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Term
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Definition
•Ammonia odor to breath
•Metallic taste
•Anorexia (no appetite), nausea
•GI Bleeding-loss of prostaglandins
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Term
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Definition
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Term
| musculoskeletal changes ESRD |
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Definition
•Cramping
•Bone pain/fractures
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Term
| acute renal failture (ARF) |
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Definition
•Sudden, rapid loss of renal functioning due to damage or severe disease to the kidneys, resulting in metabolic acidosis, multi-system failure, and death.
•Incidence
•5% of hospital and 30% of ICU admissions have a diagnosis of acute renal failure (ARF).
•25% of patients develop ARF while in the hospital.
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Term
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Definition
•(~55%) Pathology secondary to decreased renal perfusion leading to a decrease in glomerular filtration rate (GFR). BLOOD GOING TO KIDNEYS
•Volume loss
•Heart Failure
•Sepsis
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Term
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Definition
•(~45%) Pathology secondary to pathology within the kidney; acute tubular necrosis (no exchange of electrolytes) (ATN) is the most common cause
•Glomerulonephritis
•NSAIDs, ACE-I (causes kidneys to work harder), IV dye, Antibiotics (-mycins)
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Term
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Definition
•(~5%) Pathology secondary to extrinsic or intrinsic obstruction of the urinary collection system.
•Stones, tumors, BPH
•
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Term
| pre renal, intra renal, and post renal ARF signs |
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Definition
•Pre-renal signs: Tachycardia, orthostatic hypotension, dry mucous membranes, decreased skin turgor; look for stigmata of associated comorbidities such as liver and heart failure, as well as sepsis.
•Intra-renal signs: Pruritic rash, livedo reticularis, subcutaneous nodules, ischemic digits despite good pulses
Post-renal signs: Suprapubic distension, flank pain, and enlarged prostate |
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Term
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Definition
| initiation, oliguria, diuersis, recovery |
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Term
|
Definition
•The renal ‘injury’ occurs
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Term
|
Definition
•Urine output < 400 ml/24 hrs.
•Elevated levels of urea, creatinine, uric acid, cations (K, Mg, Na)
•GFR starts to decrease
•Azotemia
•Fluid retention
•Metabolic acidosis
•Hypertension, CHF, pulmonary edema
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Term
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Definition
•Nephrons regenerate
•Gradual increase in urine output
•GFR increases again
May dehydrate-IV fluid (NS 80/hour) |
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Term
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Definition
`
•Azotemia resolving still
•BUN, creatinine back to normal or low
•May take up to 12 months to stabilize completely
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Term
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Definition
•Specific gravity is low (normal = 1.010-1.025)
•One of the first changes to be seen
•Azotemia develops (either pre-renal or intra)
•BUN starts to increase based on how much protein is circulating
•GFR starts to decline next
•Breakdown of protein causes elevation of K+
•Progressive metabolic acidosis begins and renal buffering system fails (HCO3)
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Term
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Definition
•Treatment - Current treatment is focused on primary prevention, treating the underlying cause, and treating associated complications.
•– Correcting the associated complications!
•Mortality up to 90% of patients
•
•Stabilization - ABCs of resuscitation
•Treat hyperkalemia emergently, especially with ECG changes.
•If volume depleted, give IV fluids-hypotonic solution (1/2 normal Saline-will pull fluid out of interstitial).
•Place a Foley catheter-for strict I and O
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Term
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Definition
•Review drug list: nephrotoxic drugs
•Always record ins and outs and daily weights.
•Follow low sodium, low protein ‘renal’ diet
•Watch for complications, including hyperkalemia, pulmonary edema, and worsening acidosis—all potential reasons to start dialysis!
•
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Term
|
Definition
> 6.0-6.5 mEq/L
•Muscle weakness
•Diarrhea
•Nausea
•Cardiac arrhythmias
•Cardiac arrest
•EKG changes-peaked T waves
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Term
| treatment of hyperkalemia |
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Definition
•Restrict potassium intake
•Kayexalate - orally or rectally via enema
•Exchanges K+ for Na+ in large intestine-where it works and what it does
•Concentrated glucose (D50%) with regular insulin IV
•Moves ECF potassium ICF space
•Insulin increases permeability of cell membrane
•Calcium gluconate IV to counteract effects of K+ on heart
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Term
|
Definition
serum CA less than 9
•Assessment
•Chvostek’s sign (poke face) /Trousseau’s sign(BP cuff hand curls)
•cardiac effects: arrhythmias
•seizures
•muscle cramps and weakness
•Some EKG changes-QT prolongation to Torsades
•Treatment
•calcium chloride or gluconate (oral or IV)
•calcium with activated vitamin D
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Term
|
Definition
greater than 4.5 mg/dL
•Assessment
•Seizures
•Muscle cramps and weakness
•Hemolytic anemia
•Platelet dysfunction
•Treatment
•Aluminum hydroxide: amphogel, alternaGEL or alucaps, nephrox
•Renagel – binds with phosphate in intestine
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Term
|
Definition
•Sepsis, infection, seizures, peripheral edema, CHF, pulmonary edema, arrhythmias, pericarditis, bleeding, GI bleed, hypotension, anemia, hyperkalemia, uremia.
•Death
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Term
|
Definition
•Loop diuretics (Lasix/Bumex) commonly used, but are they affective?
•Dopamine?
•ACE-I, ARBs (Sartans)-probably not effective
•Digoxin-pos inotropic
•Beta-Blockers-block beta blockers to slow hr and dec PR, do nothing regarding renal circ in Peripheries,
Loop diruetics-not effective if GFR less than 20, not really gonna kick out K
Dopamine-causes contractility-causes perfusion, (SE is inc HR)
To control BP CCB’s most effective because they don’t work in kidneys-work in heart and peripheries
Gen 1: diltiazem (Cardizem) dec heart rate, in tachycardicpx such as A fib
Gen 2: Norvasc, amlodipine- only cause peripheral dilation, no effect on HR
****drug you give patients with renal disease-clonidine (catapress), alpha adrenergic blocker, works in brain, non kidney dependent
***Nitrates-dilates
**spiralactone
Dialysis best treatment
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Term
| impaired RBC production and ARF |
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Definition
Decreased erythropoietin secretion
Shorter RBC life
•Anemia
•Bruising
•Platelet dysfunction
•Bleeding disorders
•Monitor CBC
•Check for occult blood in urine and stool
•Epogen to stimulate RBC production
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Term
| impaired skin intergrity and ARF |
|
Definition
•Skin care
•Oral care
•Edematous skin - prone to breakdown
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Term
| high risk for infection and ARF |
|
Definition
•Weakened immune system
•Avoid nosocomial infections and others with infectious processes
•Pneumonia is common
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