Term
| pts with bulimia nervosa will "compensate" after binge eating by.. |
|
Definition
| exercising, laxative, diuretics, purging, or fasting |
|
|
Term
| what demographic (female) is at least risk for an eating disorder? |
|
Definition
|
|
Term
| statistics concerning bulimia/anorexia may be inaccurate bc |
|
Definition
| most cases are unreported (50%) or do not meet full DSMV criteria |
|
|
Term
| who's at the highest risk for devleloping an eating disordeR? |
|
Definition
| middle aged (baby boomer) women, R/T media, abundance of food |
|
|
Term
| major cause of death of those with eating disorders.. |
|
Definition
| SUICIDE. not malnutrition. |
|
|
Term
| defining comorbidities associated with AN/BN is difficult because.. |
|
Definition
| most people who are depressed/suffering from mental illness, have increased diet/loss of appetitie |
|
|
Term
| Comorbid conditions w/ eating disorders |
|
Definition
| OCD (25%), substance abuse (25-40%- bulimia, 10-20% anorexia), sexual abuse (20-50%) |
|
|
Term
| there is a high rate of what sort of personality disorder associated with eating disorders? |
|
Definition
| avoidant personality - (cluster C personality) fits the picture of being overly concerned with other's view of one's self |
|
|
Term
| males who have been sexually abused have a higher prevalence of.. |
|
Definition
| bulimia (binge and purge specifically) - twice as many as girls |
|
|
Term
| do genetics have anything to do with AN, BN? |
|
Definition
| YES. strongly correlated - heritability is greater than 50% (twins) - no definitive gene can be identified tho |
|
|
Term
| neurobiological wise, AN/BN pts tend to have.. |
|
Definition
| poor serotonin function associated with OCD, perfectionism (associated in childhood)- contribute to developing an eating disorder in the future |
|
|
Term
| tryptophan is important bc.. |
|
Definition
| comes from food, without it, increases dysfunction of neuortransmitters within the brain, |
|
|
Term
| antidepressants won't work until.. |
|
Definition
| an underweight patient has reached a 90% optimal weight |
|
|
Term
| sxs of anorexia nervosa.. |
|
Definition
| amennorhea, yellow skin(hypercaretonemia), lanugo, electroencephalographic changes, impaired renal function |
|
|
Term
| habits associated with anorexia nervosa |
|
Definition
| cutting food into small bits, pushing food around, terror of gaining weight, measuring self worth by weight, preoccupation with thoughts of food |
|
|
Term
| criteria for admission for ppl with eating disorder |
|
Definition
| POOR HEALTH- 30% weight loss, inability to gain weight during inpatient, severe hypothermia, bradycardia, hypotension, arrhythmias |
|
|
Term
| when caring for a patient with an eating disorder.. |
|
Definition
| make sure you separate them from their illness, their illness isn't a choice! |
|
|
Term
| what is refeeding syndrome? |
|
Definition
| treatment complication involving a metabolic alteration in serum electrolytes, vitamin deficiency, and sodium retention |
|
|
Term
| "plan of care" for pt with E.D |
|
Definition
| treat the physical deficiencies first! then psychological. remember maslow? |
|
|
Term
| important point in treating pt with E.D |
|
Definition
| all team members should confront the pts cognitive distortions (unrealistic ideas) CONSTANTLY. |
|
|
Term
| there are no pharmacological interventions for.. |
|
Definition
| eating disorders.. you should treat the mental distrortion. you can however treat the comorbidities such as depression |
|
|
Term
| since there are no cures or permanent treatments for E.D the disorder.. |
|
Definition
| waxes and wanes, comes and goes throughout patient's lifetime |
|
|
Term
|
Definition
sinus brady, elevated serum bicarb-metabolic acidosis
EROSION OF TEETH, parotid gland enlargement, esophageal tears |
|
|
Term
|
Definition
| callus on knuckles from self-induced vomiting.. hmm |
|
|
Term
| patient with bulimia may feel.. |
|
Definition
| shame concerning their behavior so.. be super careful.. be accepting and nonjudgemental |
|
|
Term
| what is the first priority with any patient with an ED |
|
Definition
|
|
Term
| medical evaluation for pt w E.D includes |
|
Definition
| electrolyte levels, glucose level, thyroid function tests, CBC, EKG |
|
|
Term
| what is the most effective tx for bulimia nervosa |
|
Definition
| cognitive behavioral therapy (and ssri's) |
|
|
Term
| pts with bulimia develop a better relationship with the nurse more quickly because they... |
|
Definition
| realize they have a real problem more quickly |
|
|
Term
| eating disorders (10), addictive disorders (15), personality disorders (15), disorders in adolescence (10) |
|
Definition
|
|
Term
|
Definition
| recurrent episodes of binge eating- eating a whole lot, and feeling a lack of control over eating during the episode |
|
|
Term
| overeating can also be a symptom of.. |
|
Definition
| atypical depression (frequent comorbidity) |
|
|
Term
| another major priority in treating pt with E.D is.. |
|
Definition
| establishing a therapeutic alliance with the pt |
|
|
Term
| which female pt should the nruse recognize as having the highest risk to develop bulimia nervosa? |
|
Definition
|
|
Term
| the nurse is caring for a 16 yo female pt with anorexia nervosa. what should the initial nursing intervention be upon admission? |
|
Definition
| Self-assess to decrease tendencies towards authoritarianism.. ? |
|
|
Term
| nurse caring for pt with bulimia, which intervention is appropriate? |
|
Definition
| monitor pt on bathroom trips after eating |
|
|
Term
| nurse is admitting pt who weighs 100 lbs/5'6", bP 130/80, Pulse-72, k-2.5, normal ekg. eroded teeth, shakey hands, and swollen parotid gland..nursing diagnosis? |
|
Definition
| Risk for injury (not impaired nutrition bc potassium is fine, there is more evidence of her behaviors, as opposed to her physical illness) |
|
|
Term
| what are appropriate outcomes for a pt with an eating disorder? |
|
Definition
| decrease in depression, pt will identify four methods to control anxiety, the pt will identify two people to contact if suicidal thoughts occur |
|
|
Term
| diagnosis of dependence involves the two concepts of.. |
|
Definition
|
|
Term
| which drug is the most abused in the us |
|
Definition
| alcooohooool- and poses the most withdrawal danger. |
|
|
Term
| diff between abuse and dependence. |
|
Definition
| dependence has incidence of tolerance and withdrawal, unsuccessful desire to cut down, substance used despite knowledge of how harmful it is |
|
|
Term
| synergistic vs. antagonistic effects.. |
|
Definition
| antagonistic effects- depressant+stimulant= heroin is taken to soften the come-down from the cocaine. they negate one another |
|
|
Term
| synergistic effects can only occur with.. |
|
Definition
| cns depressants - results in greater cns depression |
|
|
Term
|
Definition
| clutser of behaviors seen in families of alcoholics.. they take responsibility and charge over the addict.. attempting to control their abuse, spending a lot of time obsessing over it, MAKING EXCUSES FOR THEIR ADDICT'S BEHAVIOR. |
|
|
Term
| what percentage of population will become dependent on alcohol at some point in their lives.. |
|
Definition
|
|
Term
| alcohol abuse is more common in.. |
|
Definition
| men, young ppl, whites, and those who are unmarried. native americans and ppl with low incomes.. |
|
|
Term
| comorbidity rate with substance abuse.. |
|
Definition
| 60%- multiple substance abuse, modd and anxiety disorders.. paranoid, histrionic, and antisocial personality disorders. only 25% of ppl with alcohol dependence get tx. |
|
|
Term
| what is a co-occurring disorder |
|
Definition
| ex. cocaine addiction and major depression combined.. alcoholism with anxiety disorder. etc |
|
|
Term
| intravenous drug users have a higher incidence of.. |
|
Definition
| infections and sclerosing of the veins |
|
|
Term
| intranasal drug users usually present with.. |
|
Definition
| sinusitis infections and may have a perforated nasal septum |
|
|
Term
| commonly associated diseases with alcoholism are.. |
|
Definition
|
|
Term
| Alcoholism can effect all organ systems, particularly CNS.. what may this include? |
|
Definition
| wernicke's encephalopathy, korsakoff's psychosis |
|
|
Term
| Alcoholism can effect other organ systems and may be presented through.. |
|
Definition
| esophagitis, gastritis, pancreatitis, alcoholic hepatitis, and cirrhosis of the liver. |
|
|
Term
| (acquired) diseases/incidents associated with alcoholism include.. |
|
Definition
| TB, accidents, suicide and homicide |
|
|
Term
| what is addiction characterized by? |
|
Definition
| loss of control of substance consumption, substance use despite associated problems, tendency to relapse |
|
|
Term
| what are the three neurotransmitters associated with the positive feedback system of addiction? |
|
Definition
| opioid, catecholamine (especially dopamine), and gamma-aminobutryic acid (GABA) |
|
|
Term
| alcohol and other cns depressants act on what receptors of the brain? why does this explain the addictive and cross tolerance effects that occur when you mix ETOH with benzos and barbiturates? |
|
Definition
| They act on GABA, and increase bioavailability of glutamate, norepinpehrine AND dopamine. |
|
|
Term
| cocaine and amphetamines increase the levels of.. |
|
Definition
| norepinephrine, serotonin, and dopamine |
|
|
Term
| what is incentive salience? |
|
Definition
| dopamine is responsible for this--the craving of a substance many users experience when not currently not using the substance. particularly if the person is presented with a stimulus that reminds them of their high. explains high rate of first year relapse |
|
|
Term
| some psychodynamic factors for addictive personalities.. |
|
Definition
| inability to tolerate: frustration and pain. lack of success in life, lack of meaningful relationships, and low self esteem and low self regard.. plus, RISK TAKING PROPENSITY |
|
|
Term
| 50% of asians lack what substance, making the prevalence of alcohol abuse relatively low.. |
|
Definition
|
|
Term
| why is drug abuse more prevalent among men? |
|
Definition
| women who abuse drugs are viewed much more negatively than men. and they can hide it better if they do abuse. :P |
|
|
Term
| 2 questions to ask to identify an abuser.. |
|
Definition
| in the last year, have you ever drunk or used drugs more than you meant to?? have you felt you wanted or needed to cut down on your drinking or drug uses in the last year? |
|
|
Term
| what are some client responses that raise red flags and indicate need for further assessment? |
|
Definition
| you'd smoke dope too if.. i figured you'd ask that...(or slow responses, indicating they're needing to be careful about what they say) |
|
|
Term
| determining which came first, drug abuse or psych problems, can be difficult bc.. |
|
Definition
| some ppl self medicate to deal with psych issues, and some have psych issues bc they abuse. |
|
|
Term
| when answering questions about obstacles to recovery, or reaching out to the patient.. remember that.. |
|
Definition
| patient's may feel hopeless because of previous attempts to get sober.. and they may feel they need the substance to survive |
|
|
Term
| what is a predictable defense style? |
|
Definition
| various defense mechanisms and behaviors that addicts use to protect against feelings of insecurity and anxiety about sense of self. |
|
|
Term
|
Definition
| inability to rouse them, cold clammy skin, <10 respirations, cyanosis in fingernails or gums, and emesis (conscious or unconscious) |
|
|
Term
| withdrawal symptoms for alcohol last as long as ? and look like? |
|
Definition
| 24-48 hrs (peak), and then rapidly disappear- person may appear hyperalert, jerky movements, irritable, "shaking inside", delirium. illusions |
|
|
Term
| grand mal seizures may appear how long after alcohol cessation? |
|
Definition
| 7-48 hours- happen especially if person has history of seizures |
|
|
Term
| diff between illusions and hallucinations |
|
Definition
| objects are present, but appear morphed/misinterpretations.. illusions can be clarified by the nurse.. they may be terrifying to the pt. |
|
|
Term
| alcohol withdrawal delirium.. |
|
Definition
| medical emergency- death due to sepsis, MI, fat emboli, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia and suicide. |
|
|
Term
| sxs of alcohol delirium.. |
|
Definition
| autonomic hyperactivity- tachycardia, diaphoresis...severe sensorium disturbance- disorientation...perceptual disturbances- visual/tactile hallucinations..delusions- paranoid |
|
|
Term
| blood alcohol measurements.. |
|
Definition
| 5-6 drinks: .10 mg%(clumsiness)...10-12drinks: .20%.(staggering/ataxia). .20-24 drinks: .40% mg (coma)... 25-30 drinks: .5% death. |
|
|
Term
| phases of cocaine withdrawal.. |
|
Definition
| phase 1: crash phase(up to four days), phase 2: dysphoria, anhedonia, and no motivation. phase 3: intermittent cravings (could be permanent) |
|
|
Term
| first phase of heroin intoxication..second.. third.. |
|
Definition
| euphoria, facial flushing, and deepning of the voice. second phase includes a sense of well being that lasts hours, 3rd phase- "the nod," - lethargy/unconsciousness. 4th- phase before withdrawal occurs |
|
|
Term
| why is doing a self assessment important? |
|
Definition
| examining your own feelings ensure that you're always in check about not being understanding or sympathetic to an addict's plight |
|
|
Term
| "planning" is often difficult for a nurse to do because.. |
|
Definition
| addict's usually deteriorate their social status and social relations as a result of abuse |
|
|
Term
| substance abusers with a job/strong involved social support systems often end up in.. |
|
Definition
|
|
Term
|
Definition
| trexan, revia- tx of drug addiction- blocks opiate receptors thereby interfering with the mechanism of addiction/reinforcement - eliminates cravings. comes in injectable forms that are long acting |
|
|
Term
|
Definition
| used for ppl who wish to remain abstinent- its helpfulness for ppl who have not undergone detox. reduces inatke of alcohol by suppressing excitatory neurotransmission |
|
|
Term
|
Definition
| alcohol drug- reduces alcohol craving by inhibiting the release of mesocorticolimbic dopamine |
|
|
Term
|
Definition
| used for ppl who are well established in their sobriety, helps them avoid drinking bc ETOH in combination with this drug makes them reaaaally sick |
|
|
Term
| methadone is a drug of choice for tx of.. |
|
Definition
| opioid addiction- synthetic opiate that blocks craving for and effects of heroin- only drug approved for tx of pregnant opioid addict |
|
|
Term
| levo-alpha-acetylmethadol is a.. |
|
Definition
| alternative to methadone- LAAM- effective for up to 3 days, pts need only come to clinic 3 times a week to get it- makes it easier for pts with jobs and other responsibilities |
|
|
Term
|
Definition
| yes.. prolly why patients who are on it, stick to their treatment more so than those on methadone. :/ |
|
|
Term
| clonidine/catapres is used for.. |
|
Definition
| high BP med, but effective somatic tx for some chemically dependent individuals when combined w/ naltrexone. |
|
|
Term
| buprenorphine is used for.. |
|
Definition
| partial opioid agonist.. blocks sxs of opioid withdrawal, shown to suppress heroin use in both inpatient and outpatient settings |
|
|
Term
| which is preferred, nicotine gum or patch? why? |
|
Definition
| blood levels are steadier, little long term dependence occurs, and instructions are less complicated |
|
|
Term
| nurse caring for pt w/ addictive disorder but now sober. Pt experiences repeated occurences of vivid, frightening images and thoughts. what's this? |
|
Definition
|
|
Term
| which condition would the nurse be most concerned about when caring for a pt who abuses alcohol? |
|
Definition
|
|
Term
| the nurse is caring for four patients- which pt should be seen first, bases up on substance abuse risk potential? |
|
Definition
| male patient of native american descent! |
|
|
Term
| which pt response "have you ever drunk more alcohol or taken more drugs than you meant to?" should immediately cause the nurse to assess further? |
|
Definition
| i figured you'd ask me about that. |
|
|
Term
| which pt behaviors should the nurse suspect as related to alcohol withdrawal? |
|
Definition
| hyperalert state, jerky movements, easily startled. |
|
|
Term
| dsmv diagnosis of personality disorder.. |
|
Definition
| an enduring pattern of experience and behavior that deviates significantly from the expectations within the individuals culture |
|
|
Term
| personality disorders are characterized on which axis? |
|
Definition
| axis II- along with mental retardation |
|
|
Term
| why are axis 1 and 2 separated? |
|
Definition
| no fundamental difference in pathology, just want to make sure ppl dont forget personality disorders in light of Axis 1 disorders. |
|
|
Term
| paranoid personality disorder is defined as... |
|
Definition
| pervasive distrust and suspiciousness of others- others' motives are determined as malicious (out to get me!), and identify benign remarks as having hidden demeaning or threatening meanings |
|
|
Term
| schizoid personality disorder is defined as.. |
|
Definition
| a pervasive pattern of detachment from social relationships and a restricted range of expression in interpersonal settings, beginning by early adulthood- solitary, no sexual interest, emotional coldness |
|
|
Term
| schizotypal personality disorder is defined as.. |
|
Definition
| social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentric behavior (antisocial but weird too) |
|
|
Term
| reduced metabolism in the prefrontal cortex is associated with.. |
|
Definition
|
|
Term
| frontal lobe dysfunction may be related to.. |
|
Definition
| problems with aggression in antisocial personality disorder |
|
|
Term
| sociopaths and psychopaths who have a blatant disregard for others and the law often have.. |
|
Definition
| antisocial personality disorder |
|
|
Term
| high mortality rate of 10% can be seen in patients with.. |
|
Definition
| Borderline personality disorder |
|
|
Term
|
Definition
| instability in relationships, emotions, and mood.. "splitting" |
|
|
Term
| narcissistic personality disorder is marked by.. |
|
Definition
| arrogance with a grandiose view of self importance. personal entitlement, when paired with their lack of social empathy, it may result in exploitation of other ppl... UNDERNEATH THIS.. patient's may feel intense shame and fear of abandonment . |
|
|
Term
| flirtatious, demands the best of everything and can be very critical |
|
Definition
|
|
Term
| unstable emotions, lots of interpersonal relationships and self image distortions |
|
Definition
|
|
Term
| to be dx with antisocial PD patient must be at least.. |
|
Definition
|
|
Term
| extreme sensitivity to rejection and robust avoidance of interpersonal situations |
|
Definition
|
|
Term
| a timid temperament in childhood is associated with this dosrder |
|
Definition
|
|
Term
| need to be taken care of, and fear of taking care of self |
|
Definition
|
|
Term
| establish relationships where they are submissive passive and self doubting |
|
Definition
|
|
Term
|
Definition
| shared delusional belief by two persons-- dependent |
|
|
Term
| these individuals do not have full blown obsessions or compulskons but may seek treatment for anxiety or modo disorders |
|
Definition
| obsessive compulsive personality |
|
|
Term
| difference between OCPD and OCD |
|
Definition
| hoarding behaviours, perfectionism, and preoccupation with details is seen in OCD.. just a bunch of anxiety about stupid shit is seen in OCPD |
|
|
Term
|
Definition
|
|
Term
| how many americans meet criteria for personality disorder |
|
Definition
|
|
Term
| the dsmv criteria emphasizes that a personality disorder cannot be diagnosed until.. |
|
Definition
| the axis 1 mental health condition is resolved, because they can be co-occurring |
|
|
Term
|
Definition
| personality disorders only emerge when stressors come about.. |
|
|
Term
| ppl who grew up in households where they were the objects of excessive rage and humiliation- feelings of inadequacy. they blame others for their shortcomings. |
|
Definition
|
|
Term
| genetic predisposition to shyness, often raised in a cold and neglectful atmosphere where they conclude that relationships are unsatisfying |
|
Definition
|
|
Term
| genetically linked, higher incidence of schizo related disorders in family members |
|
Definition
|
|
Term
| genetically linked - predisposition is set into motion by a childhood environment of inconsistent parenting, significant abuse, and extreme neglect |
|
Definition
|
|
Term
| develop as a result of early abandonment, resulting in ustable view of self, and others. 69% heratibility in twin studies |
|
Definition
|
|
Term
| 3-5 year olds who become very close with opposite sex parent and feel that same sex parent will retaliate - emoitonal expressivness and egocentricity |
|
Definition
|
|
Term
| result of childhood neglect and criticism, the child does not learn that other ppl can be sources of comfort and support. as adults they hide feelings of emptiness with an exterior of invulnerability and self sufficiency |
|
Definition
|
|
Term
| linked with parental and peer rejection and criticism. anxiety. related to SAD |
|
Definition
|
|
Term
| chronic physical illness or punishment of independent behavior in childhood... submissiveness may be inheritied |
|
Definition
|
|
Term
| excessive parental criticism, control and shame,. child responds to this by trying to control his environment through perfectionism and orderliness. compulsive, oppostional may be inherited |
|
Definition
|
|
Term
| when assessing patients with personality disorders it may be best to refer to.. |
|
Definition
| . "you said that you werent emoitnally distant, how would your wife describe you?" |
|
|
Term
|
Definition
| mindfulness which makes patient realize their own thoughts and actions and evaluate them |
|
|
Term
| pervasive developmental disorder diagnoses |
|
Definition
| aspergers autistic and rett's |
|
|
