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Huge hurtle for treating anorexia?
they don't realize they have a problem....
EGO SYNTONIC
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Concomitant Disorders with Anorexia
- Major Depression
- OCD
- Panic/Phobia Disorders
- Substance Abuse
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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
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Cognitive signs of anorexia
- Distortions of body image
- Perfectionist
- OCD with food
- Food is control
- Cognitive slowing
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Physical signs of anorexia
- CONSTIPATION
- Hypotension/Bradycardia
- Hypothermia
- Peripheral Edema
- Abnormal CBC
- Lanugo
- Amenorrhea
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What is Bulimia?
- Recurrent episodes of binge eating followed by compensatory behaviors:
- purging
- laxatives
- diuretics
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Describe the bulimic
- may be overweight....but weight fluctuates
- skip meals
- binge eat
- purge
Once was extroverted....becomes introverted
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Person with Bulimia is EGO
Dystonic
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Physical signs of bulimia
- loss of teeth enamel/cavities
- enlarged salivary glands
- Russell signs
- menstrual irregularities
- electrolyte imbalances
- cardiac arrhythmias
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Serotonin and Bulimia and Anorexia
Bulimia-decreased serotonin, decreased satiety....eat and purge
Anorexia-increased serotonin, increased satiety...don't eat.
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What causes eating disorders?
genes.....NOT FAMILY!!
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alexithymia
denial of hunger
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Planning for person with Eating Disorder
- improved nutritional status
- improved coping behavior
- improved perception of body image
- improved self esteem
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Nursing intervention for eating disorders
- multidisciplinary
- nutritional counseling
- behavior modification
- counseling
- FAMILY Counseling and INTERVENTION KEY!
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Drugs given to Bulemics....and why?
Prozac or Zoloft
they increase serotonin and increase satiety so they don't binge eat.
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Drugs given to anorexics and why?
- Prozac or Zoloft
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- given to help with depression and OCD
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What is given to the anorexic to manage delusional thinking?
Abilify
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What kind of therapy do anorexics/bulimics receive?
psychotherapy
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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
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When they are starting to eat again....what kind of foods should be restricted?
fats/carbs...hard to digest
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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
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Where should people with Eating Disorders eat?
in the dining room with other people....make it a social situation
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Which herb exacerbates mania and precipitates acute anxiety and insomnia?
Ginseng
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Which herb exacerbates mania?
Evening Primrose
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Which herbs help with nervousness, insomnia and irritability?
Yohimbe and Ephedra
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Which herb improves a persons memory?
But what's the bad part?
Gingko.....decreases clotting time
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Which herb is good for mild depression?
Details
St. John Wart
MAOI....don't take with other anti depressants or anticonvulsants
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What does vitamin E do?
delays the development of Dementia....recommended for patients with Tardive Dyskinesia
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Dementia
Aging brain....characterized by a loss of intellectual abilities involving personality changes and impairment of memory, judgment and abstract thinking
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Describe signs of dementia
- slow and progressive onset
- difficulty with recent events
- confabulation
- impaired attention
- irreversible
- sundowning
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Delirium
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
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Describe signs of delirium
- sudden and reversible onset
- clouded state of consciousness with fluctuating arousal
- restlessness
- impaired memory/poor attention
- HALLUCINATIONS
- fear suspicious anxiety depression
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What causes delirium?
- Any disruption to CNS
- electrolyte imbalances
- problems with kidneys, liver, heart, lungs
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Depression
person who has a pervasive, pessimistic doomed attitude about life.....which can be linked to a date of onset
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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
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Stage 1 of AD
no apparent symptoms
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When a person is forgetful, losing things...but compensate by keeping structure in their life
Stage 2 of AD
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What stage of AD is there a decline in cognition, lose train of thought mid sentence, driving difficulties, sleep pattern changes and problems with $$
Stage 3
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Which stage of AD is it a good time to get an Advanced Directive and Power of Attorney in place?
Stage 3
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What stage of AD does the person start to forget major events, have confabulation, becoming depressed and socially withdraw.....see delirium here
Stage 4
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At what stage of AD does the p erson lose the ability to perform ADL's and are disoriented to time and place?
Stage 5
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What stage of AD is the person forgetting family members names, losing language skills, needing assistance with AD, starting to wander
hyperorality
sundowning
aphasia, agraphia, agnosia
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What stage of AD is the person bedfast, have bladder and bowel incontinence
Stage 7
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What will a person with AD die from?
immobility complications
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What causes alzheimers?
- aging brain
- poor diet
- stress...increased cortisol
- smoking
- low education
- increased amyloid
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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
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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
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Medication for dementia that increases ACh...which is needed for memory
- Cognex
- Aricept
- Rivastigmine
- Exelon
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What drug with used with Cognex, Aricept, Rivastigmine and Exelon in the early stages of AD?
Namenda
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What drugs are given to assist with behavioral problems associated with AD
- Antipsychotics
- Anti depressants
- Anti Anxiety
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inability to carry out a skilled purposeful movement
apraxia
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examining objects by placing them in the mouth
hyperorality
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repetitive behavior that has no purpose or meaning...continued repetition of meaningless words or phrases
Perseveration
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Compulsive toughing of objects....especially dangerous when they don't recognize them as being too dangerous to touch
Hyperetamorphosis
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loss of ability to understand and use language...both receptive and expressive
aphasia
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inability to write
agraphia
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inability to recognize familiar objects, situations and people
agnosia
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unable to recognize things when you see them
alexia
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unable to recognize things when you touch them
astereognosia
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BMI for an obese person
30+
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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
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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
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Sundowning
phenomenon in dementia in which symptoms worsen in the late afternoon and evening
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Abuse to elderly by female vs. male
- female = neglect
- male=violence/rape
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What makes an elderly person most susceptible to abuse?
Their amount of dependency
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Which disorder do you see dirurnal fluctuations?
Delirium
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Which disorder will you see unstable vital signs?
Dementia or Delirium?
delirium....cuz caused by an underlying medical condition
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perseveration
unpurposeful, repetitive behavior
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When do you see physiologic issues with AD?
Not till stage 7!!
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What is pseudomentia?
depression
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How do you decrease your likelihood of mental disorders?
- exercise
- vitamin E
- fish oil
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How do you assess pain on a person that is cognitively impaired?
visual pain scale with smiley faces....
OR
put a pen in their fingernail!!
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What mental disorder can polypharmacy cause?
delirium
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Diagnostic tests for dementia
- CT
- MRI
- Lumbar puncture for amyloids in CSF
- EEG
- PET
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Diagnostic tests for Delerium
- blood
- urine....testing obth of infection
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Diagnostic tests for depression
NONE
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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
- distract
- or give antipsychotics
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Remember antipsychotics have a black box warning for.....
increased death risk
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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
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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
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With a person with AD, make sure what sort of evaluation is done regularly?
swallow
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How do you help a person with AD get dressed?
- encourage independence
- give enough time
- snaps, Velcro garments
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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
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