chapter 33 /chapter 27

a subjective concept of one’s physical appearance based on the personal perceptions of self and the reactions of other.

a direct result of perceived body image disturbances. Eating disorders have a deep rooted psychological aspect. Intervention is imperative

occurs predominantly in females between the ages of 12 to 30. The peak period is in adolescent. Only 5 to 10% of the case are male

a fear of obesity.

• -weight loss is severe
• -reduction of fluid intake
• -may see hoarding of food
• -depression
• -hypotension/low blood pressure
• -possibly hyperthermia

-issue developing autonomy

• -family are over protective
• -set a lot of rules
• -rigidity

- is an episodic, uncontrolled, compulsive rapid ingestion of large quantities of food over a short period of time (binging), following by extreme measures to rid the body of excess calories.

• -Laxatives
• -Diuretic
• -Enema
• -Vomiting
• -Exercise

common, however most bulimics are WITHIN normal weight range.

• -Eruption of teeth and enemas
• -Electro light imbalance
• -Dehydration

-going to see separated issue

-Loss/No family boundaries

1.When conducting a personal history on a client with an eating disorder, you will find that the client with anorexia and bulimia are often described as perfectionists with above-average interlligence and being achievement oriented. They are focused on pleasing others.

• Anorexia- slow and fatigue; slow respond to question
• Bulimia- normal

• Anorexia-worry, sad, anxiety, seldomly laugh, smile, and serious
• Bulimia- seems cheerful and pleasant but is screed (cover up)

• Anorexia-really limited insight and poor judgment about help static and denial
• Bulimia- feeling of shame and outta control

Anorexia- low self esteem Bulimia- low self esteem

• Nursing Actions:
• -Determine needed nutritional requirement
• -Explain behavior modification plan
• -Weights and I & O daily
• -Assess skin turgor and mucous membranes
• -Stay with client during meals and for 1 hr following meals
• Outcomes:
• -Client gains 2-3lb/wk
• -No signs of malnutrition/dehydration
• -Consumes adequate calories
• -does not stash food or self-induced vomiting

• Nursing Actions:
• -Develop trusting relationship; give positive regard
• -Don’t bargain; explain how privileges and consequences are based on compliance with therapy and weight gain
• -Encourage client to verbalize feelings and unresolved issues
• Outcomes:
• -Client verbalizes that eating behaviors are maladaptive
• -Client uses more adaptive coping strategies to maintain control in life

• Nursing Actions:
• -Help client develop realistic perception of body image
• -Allow client independent decision-making
• -Give positive feedback
• -Help client accept self
• -Convey knowledge that perfection is unrealistic
• Outcomes:
• -Client acknowledges that image of body as “fat” is a misperception
• -Client verbalize self- attributes

• -Widely accepted treatment
• -The importance is to ensure that the program does not “control” them
• -In order for the program to be successful, the client must perceive that he or she is in control of the treatment
• -Is allowed to contract for privileges based on weight gain
• -The client has input into the care plan and can clearly see what the treatment choices are.
• -The client has control over eating, over the amount of exercise pursed, and, in some instances, even over whether or not to induce vomiting.
• -Goals of therapy, along with responsibilities of each for goal achievement, are agreed on by the client and staff
• -Staff and client agree on a system of reward and privileges that can be earned by the client, who is given ultimate control.
• -He or she has a choice whether or not to gain weight –a choice of whether or not to earn the desired privilege
• -The method of treatment gives a great deal of autonomy to the client. It must be understood, however that cognitions about body image and eating behaviors
• -Cognitive techniques techniques such as cognitive restructuring and problem solving help the pt. deal with distorted and overvalued beliefs about food and thinness and cope with life’s stresses

• -Not the therapy of choice for eating disorders
• -Can be helpful when underlying psychological problems are contributing to the maladaptive behaviors
• -In supportive psychotherapy, the therapist encourages the client to explore unresolved conflicts and to recognize the maladaptive eating behaviors as defense mechanisms used to ease the emotional pain
• -the goals are to resolve the personal issues and establish more adaptive coping strategies for dealing with stressful situations

• -Aims at finding solutions to help the healing process for everyone in the family
• -Eating disorder may be considered family disorders, and resources cannot be achieved until dynamics within the family have improved.
• -Family therapy deals with education of the members about the disorders manifestations, possible etiology, and prescribed treatment.
• -Support given to family members as they with feelings of guilt associated with the perception that they may have contributed to the onset of the disorder
• -Support is also given as they deal with social stigma of having a family member with emotional problems
• -When the dysfunctional family dynamics are related to conflict avoidance, the family may be noncompliant with therapy, as they attempt to maintain equilibrium by keeping a member in the sick role
• -When this occurs, it is essential to focus on the functional operations within the functional operations within the family and to help them manage conflict and create change
• -Referral are made to local support groups for families of individuals with eating disorders
• -Resolution and growth can sometimes be achieved through interaction with others who are experiencing, or have experienced, the numerous problems of living with a family member with an eating disorder

• 1.Is not considered a psychiatric disorder
• 2.Genetics:
• -When both parents are obese, there is an 80% chance that the offspring will be obese

• Nursing Actions:
• -Encourage client to keep food dietary
• -Discuss feeling associated with eating
• -Establish healthy, low-calorie food plan
• -Set realistic weight loss goals
• -Plan exercise program
• -Discuss possibly of plateaus
• -Instruct about medication
• Outcomes:
• -Client has established healthy eating healthy pattern
• -Client is losing 2lb per week
• -Client verbalizes plan for future maintenance of weight control

• Nursing Actions:
• -Assess attitude and feelings about weight
• -Ensure privacy
• -Explore past eating behaviors
• -Assess source and level of motivation
• -Focus on strengths and past accomplishments unrelated to physical appearance
• -Refer to support/therapy group
• Outcomes:
• -Client verbalize self-attributes not associated with physical appearance
• -Client attends regular support group for assistance with weight management

the DSM-IV-TR identifies substance abuse as a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of the substance.

• a maladaptive pattern substance use leading to clinically significantly impairment or distress as manifested by one (or more) of the following, occurring within a 12 month period
• 1.Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absence, suspensions, or expulsion from school; neglect of children or household).
• 2.Recurrent substance in situations in which it is physically hazardous (e.g.; driving an automobile or operating a machine when impaired by substance use).
• 3.Recurrent substance- relating legal problem (e.g;. arrests for substance-related disorderly conduct).
• 4.Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substances (e.g.; arguments with spouse about consequences of intoxication, physical fights).

To use wrongfully in a harmful way. Improper treatment or conduct that may result injury

A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled

- A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor

The psychological and mental readjustment that accompanies the discontinuation of an addictive substance

• -Alcohol
• -Amphetamines and related substance
• -Caffeine
• -Cannabis
• -Cocaine
• -Hallucinogens
• -Inhalants
• -Nicotine
• -Opioids
• -Phencyclidine (PCP) and related substances
• -Sedatives, hypnotics, or anxiolytics

• Genetics: Children of alcoholics are 3 times more likely than other children to become alcoholics.
• Personality Factors: Substance abuse has been associated with antisocial personality and depressive disorders.

1.Death rate from alcoholism among Native American are more than seven time the national average. 2.The incidence of alcohol dependent is higher among northern European then southern Europeans

behavioral and mood changes.2. Most states consider that an individual is legally intoxicated with a blood alcohol level of 0.08 to 0.10%.

A 12 ounce beer contains 0.5 ounce of alcohol. The concentration of alcohol in the brains is proportional to the concentration of alcohol in the blood

liver cirrhosis.

• -small head circumference
• -small eye opening
• -thin upper lip
• -skin fold at the corner of the eye

• -most widely prescribed
• -can be addicting
• -Benzodiazepines
• Clonazepam(klonopin), diazepam (Valium),Alprazolam(Xanax), and lorazepam (Ativan)

Dexies, uppers, truck drivers, Meth, speed, crystal, ice, Adam, Ecstacy, Eve, and XTC

• activity of the sympathetic nervous system: what are some of the SX:
• -uncontrolled desire to sleep
• -hyperactivity
• -disorders in children
• -certain case of obesity
• Meth Labs read

• -Caffeine
• -Nicotine

begins as early as 9 to 12 years of age

a procedure in which a rag soaked with the substance is applied to the mouth and nose and the vapors breathed in.

in which the substance is placed in a paper or plastic bag and inhaled from the bag by the used. It may also be inhaled directly from the container or sprayed in the mouth or nose.

An example is Mescaline which is found in peyote cactus

• 1.This is when a person has a substance disorder and a mental illness.
• 2.Most dual diagnosis programs take a more supportive and less confrontational approach
• 3.Peer support groups are an important part of treatment
• 4.Individuals with dual diagnosis should be encouraged to attend 12-step recovery program such as AA. or NA.

• -have a long history of focusing thought and behavior on other people
• -are “people pleaser” and will do almost anything to get the approval of others
• -seem very competent on the outside but actually feel quite needy, helpless, or perhaps nothing at all
• -have experience abuse or emotional neglect as a child
• -are outwardly focused toward others, and know very little about how to direct their own lives from their own sense of self
• -ALL OF THE ABOVE