Huge hurtle for treating anorexia?
they don't realize they have a problem....
Concomitant Disorders with Anorexia
- Major Depression
- Panic/Phobia Disorders
- Substance Abuse
How can you determine if a person is anorexic?
- Weighs 85% of normal weight for height
- BMI of 17.5% or less
- Loss of 15% of weight in last 6 months
Cognitive signs of anorexia
- Distortions of body image
- OCD with food
- Food is control
- Cognitive slowing
Physical signs of anorexia
- Peripheral Edema
- Abnormal CBC
What is Bulimia?
- Recurrent episodes of binge eating followed by compensatory behaviors:
Describe the bulimic
- may be overweight....but weight fluctuates
- skip meals
- binge eat
Once was extroverted....becomes introverted
Person with Bulimia is EGO
Physical signs of bulimia
- loss of teeth enamel/cavities
- enlarged salivary glands
- Russell signs
- menstrual irregularities
- electrolyte imbalances
- cardiac arrhythmias
Serotonin and Bulimia and Anorexia
Bulimia-decreased serotonin, decreased satiety....eat and purge
Anorexia-increased serotonin, increased satiety...don't eat.
What causes eating disorders?
denial of hunger
Planning for person with Eating Disorder
- improved nutritional status
- improved coping behavior
- improved perception of body image
- improved self esteem
Nursing intervention for eating disorders
- nutritional counseling
- behavior modification
- FAMILY Counseling and INTERVENTION KEY!
Drugs given to Bulemics....and why?
Prozac or Zoloft
they increase serotonin and increase satiety so they don't binge eat.
Drugs given to anorexics and why?
- Prozac or Zoloft
- given to help with depression and OCD
What is given to the anorexic to manage delusional thinking?
What kind of therapy do anorexics/bulimics receive?
How do you help a person stop binge eating?
- help learn difference between emotions and hunger
- ID foods that trigger binge eating
- ID situations that trigger binge eating
- Teach alternative behaviors and develop a safety plan
When they are starting to eat again....what kind of foods should be restricted?
fats/carbs...hard to digest
General interventions for eating disorder
- body image diary
- reframe negative thoughts....and journal when they come up
- list positive affirmations
- confront all or nothing thinking patterns, perfectionism and overgeneralizations
Where should people with Eating Disorders eat?
in the dining room with other people....make it a social situation
Which herb exacerbates mania and precipitates acute anxiety and insomnia?
Which herb exacerbates mania?
Which herbs help with nervousness, insomnia and irritability?
Yohimbe and Ephedra
Which herb improves a persons memory?
But what's the bad part?
Gingko.....decreases clotting time
Which herb is good for mild depression?
St. John Wart
MAOI....don't take with other anti depressants or anticonvulsants
What does vitamin E do?
delays the development of Dementia....recommended for patients with Tardive Dyskinesia
Aging brain....characterized by a loss of intellectual abilities involving personality changes and impairment of memory, judgment and abstract thinking
Describe signs of dementia
- slow and progressive onset
- difficulty with recent events
- impaired attention
a medically urgent condition that develops rapidly and is reversible. Prompt medical attention is needed to prevent permanent damage or death.
Disturbed cognition and inability to focus
Describe signs of delirium
- sudden and reversible onset
- clouded state of consciousness with fluctuating arousal
- impaired memory/poor attention
- fear suspicious anxiety depression
What causes delirium?
- Any disruption to CNS
- electrolyte imbalances
- problems with kidneys, liver, heart, lungs
person who has a pervasive, pessimistic doomed attitude about life.....which can be linked to a date of onset
Signs of depression
- sleep and appetite disturbances
- low self esteen
- poor attention to ADL's
- slow movement/response
- loss of concentration/memory
- responds with "I DONT KNOW"
- normal attention
- oriented x4
Stage 1 of AD
no apparent symptoms
When a person is forgetful, losing things...but compensate by keeping structure in their life
Stage 2 of AD
What stage of AD is there a decline in cognition, lose train of thought mid sentence, driving difficulties, sleep pattern changes and problems with $$
Which stage of AD is it a good time to get an Advanced Directive and Power of Attorney in place?
What stage of AD does the person start to forget major events, have confabulation, becoming depressed and socially withdraw.....see delirium here
At what stage of AD does the p erson lose the ability to perform ADL's and are disoriented to time and place?
What stage of AD is the person forgetting family members names, losing language skills, needing assistance with AD, starting to wander
aphasia, agraphia, agnosia
What stage of AD is the person bedfast, have bladder and bowel incontinence
What will a person with AD die from?
What causes alzheimers?
- aging brain
- poor diet
- stress...increased cortisol
- low education
- increased amyloid
Nursing interventions for a person with AD
- reality reorientation
- pics of family
- keep explanations simple
- talk about relative events and people
- monitor med side effects
- simple structured environment
- Provide assistance.....but encourage independence
Interventions for the family members of a person with AD
- discuss nature of the illness....what caused it and what to expect
- teach ideas of how to manage....safety, reality orientation, assistance with ADL's and nutrition
- make sure they know support services available to them...financial, legal, support, respite and home health
Medication for dementia that increases ACh...which is needed for memory
What drug with used with Cognex, Aricept, Rivastigmine and Exelon in the early stages of AD?
What drugs are given to assist with behavioral problems associated with AD
- Anti depressants
- Anti Anxiety
inability to carry out a skilled purposeful movement
examining objects by placing them in the mouth
repetitive behavior that has no purpose or meaning...continued repetition of meaningless words or phrases
Compulsive toughing of objects....especially dangerous when they don't recognize them as being too dangerous to touch
loss of ability to understand and use language...both receptive and expressive
inability to write
inability to recognize familiar objects, situations and people
unable to recognize things when you see them
unable to recognize things when you touch them
BMI for an obese person
Diagnositc criteria for a binge eating disorder
- eating in a discrete period of time (2 hrs) an amount of food that is definitely larger than most would eat in a similar period of time
- a sense of lack of control over eating during the episode....cant stop
Which behavioral strategies are useful in treating the patient with anorexia or bulimia?
They MUST perceive they are in control of their treatment
Cognitive therapy WITH behavior modifications
phenomenon in dementia in which symptoms worsen in the late afternoon and evening
Abuse to elderly by female vs. male
- female = neglect
What makes an elderly person most susceptible to abuse?
Their amount of dependency
Which disorder do you see dirurnal fluctuations?
Which disorder will you see unstable vital signs?
Dementia or Delirium?
delirium....cuz caused by an underlying medical condition
unpurposeful, repetitive behavior
When do you see physiologic issues with AD?
Not till stage 7!!
What is pseudomentia?
How do you decrease your likelihood of mental disorders?
- vitamin E
- fish oil
How do you assess pain on a person that is cognitively impaired?
visual pain scale with smiley faces....
put a pen in their fingernail!!
What mental disorder can polypharmacy cause?
Diagnostic tests for dementia
- Lumbar puncture for amyloids in CSF
Diagnostic tests for Delerium
- urine....testing obth of infection
Diagnostic tests for depression
How do you manage aggressive behavior in a patient with dementia?
- assess if needs are being met? frustrated
- remain calm and soothe them
- minimize stimuli...soft music
- avoid physical contact/confrontation
- or give antipsychotics
Remember antipsychotics have a black box warning for.....
increased death risk
How can you decrease the incidence of sundowning?
- play soft music
- decrease stimuli
- reduce afternoon naps
- encourage activities...ball toss/exercise
- low carb snacks at bedtime
- avoid alcohol/nicotine
How do you improve meal time behavior with a person who has AD?
- reduce distractions...TV
- sit in a chair at a table
- arrange tray to encourage self feeding
- wearing glasses/dentures
- serve one food at a time/finger foods too
- verbal cueing
With a person with AD, make sure what sort of evaluation is done regularly?
How do you help a person with AD get dressed?
- encourage independence
- give enough time
- snaps, Velcro garments
How must the environment be modified in order to provide safety for the client with dementia?
- arrange furniture to facilitate movement
- bed in lowest position
- assist with ambulation
- find a safe place to wander
- night light
- stimuli low
- remove throw rugs