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Anorexia:
literally means loss of appetite...
Anorexia Nervosa- when ppl have an appetite but ignore it (can be mental)
Highest Mortality Rate
- Med Comps:
- cardiac, GI, reproductive, neuropsychiatric, skeletal
- (the body will start using muscle for its energy if there's no fat...heart is muscle!!
- often hospitalized, restore nutritional state, CBT, family therapy
- daily blind weight, daily I&O, monitor electrolytes, observe 2 hours after meals
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Bulimia Nervosa:
entire sense of self depends on their weight
-recurrent episodes binge eating-lack of control during binges
1. Purging Type
2. Nonpurging Type
Purging=hypokalemia
- Med Comps: F&E disturbances, GI injury, reflex constipation, rebound edema, cardio, enamel erosion,
- Russell's sign(fingers), Chipmunk face, Pancreatitis
- *Depression is common (Prozac ^dose), substance abuse & anxiety common
- NSG diagnoses: anxiety, disturbed body image, ineffective coping, ineffective denial, compromised family coping, fluid volume deficit, nutrition, chronic low self esteem
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Personality disorders: (only d/o on AxisII for adult)
Organic disorder- head injury (accidents) ppl have personality changes
personality d/o have a ^death rate, ^seperation, ^divorce
personality d/o usually improve with age
- Cluster B: behaviors described as dramatic, emotional, or erratic
- *Antisocial personality d/o
- -Borderline personality d/o
- *Narcissistic personality d/o
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Borderline Personality d/o: (cutters, branders)
-Most common personality disorder, 2x more common in women
no self identity (get close to someone and "be them" ; single white female)
intense fear of being alone
- BPD pattern of intense and chaotic relationships
- directly or indirectly self destructive
- clinging and distancing, splitting, manipulation, self-destructive behav, very impulsive
- what we see with BPD is chronic depression ppl that becomes worse and may become suicidual
- and get hospitalized.
- BPD have difficulties with boundaries
- If behavior is minimal you may want to try and ignore behaviortend to wear out friends and fam very quickly
- Monitor, verbal contract, evaluate, staff be consistant
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No drugs specifically treat BPD or any other personality d/o
drugs ease symptoms of disorder! Talk therapy 1st line treatment..
- **Improve emotional instability/ impulsivity = Abilify, Zyprexa
- **Mood stabilizers aided emotional control = Depakote, Lamictal
- **Help with depression = Omega 3
- symptoms usually lessen with age
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Dialectical behavior therapy- designed for BPD focuses on distorted thinking and behavior based on assumption that poorly regulated emotions are the underlying problem (focus on thought and where does that thought take the patient)
- BPD pt's are very afraid of being alone this is the common reason why the hurt themselves.
- nurse may have "homework assignment" punch pillows, yoga, music, writing a letter etc..
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What does the Cocktail consist of? and what is it given for?
- **Haldol, Ativan, Bendryl
- given for agitation or assultive behavior --- PO or IM
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Anger/ Aggression;
-normal emotion when expressed assertively.
-can be a cue that something is wrong
-anger can be bad when its not processed
- If you notice anger behavior try to intervin early....talk...meds.
- Ask "what's going on".
- redirect, give them something to do that they normally like...be prepared to "code"
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