Anorexia Nervosa
What is a formal assessment tool used for Anorexia Nervosa?
Sick
Control
One stone (lost 14 lbs. in 3 months.)
Fat
Food
Varcarolis, pages 193-194
What are possible signs of Bulimia Nervosa?
Bing-eating, fasting, self-induced vomiting or laxative or diuretic use after binging, s/s of depression, problems with interpersonal relationships, self-concept, impulsive behaviors, anxiety and compulsivity, comorbid Substance abuse, binging triggered by feelings of emptiness or attempts to feel less depressed.
Varcarolis, page 193
Who are mandated reporters of abuse for children, elderly, and vulnerable adults?
Teachers, clergy, nurses, and other healthcare providers. (Must report to Child Protective Services-CPS and Adult Protective Services)
Varcarolis, page 354
What are the phases of abuse and characteristics of the abuser?
Honeymoon Phase: loving, may be generous with gifts, or doing special things.
Tension-building Phase: Edgy, minor explosive episodes
Serious Battering Phase: The incident occurs
Delerium is secondary to another condition, what is the memory tool used to screen for delirium?
M-Medications
I-Infection
N-Number of cooccurring conditions
D-Disorder of SA or alcohol
S-Surgery and/or procedures
P-Pain
A-Age
C-Cognitive Impairment
E-Emotional or mental illness
S-Sleep disturbances
Varcarolis, page 287
What are the stages of Alzheimer's Disease?
Stage 1 - Mild - Forgetfulness
Stage 2- Moderate - Confusion
Stage 3 - Moderate to Severe - Ambulatory Dementia
Stage 4 - Late - End Stage
Varcarolis, pages 235-236
This coping or defense mechanisms is defined as the polarization of beliefs, actions,objects, or persons into good and bad. Sometimes it is known as black and whit thinking and is typical seen in borderline and other PDs.
Splitting
Varcarolis, page 175
What are the physical signs of low body weight?
Malnutrition, menstrual/endocrine problems, GI issues, Cachectic, Lanugo
Varcarolis, page 194
What are some medical complications of Bulimia Nervosa?
Varcarolis, page 194
This type of abuse includes the inconsistent provision of food, water, shelter, sanitation, or basic needs.
Neglect.
Varcarolis, page 353
What are the phases in the cycle of abuse and what are the characteristics of the victim?
Honeymoon Phase: Trusting, hoping for change, wants to believe partner's promises.
Tension-building Phase: Feels tense "walking on eggshells," helpless, becomes submissive and accepts blame.
Serious Battering Phase: Incident occurs - Victim may try to cover it up the injury (sunglasses, make-up) or may look for help
Varcarolis, Page 358
What are the cognitive and or perceptual disturbances of delirium?
Illusions (errors in accurate perception of sensory stimuli, ie. crumbs on bed are bugs). Hallucinations (false sensory stimuli)
Varcarolis, pages 287-288
What would the nurse expect to find when doing an assessment of a patient with Alzheimer's Disease?
Confabulation - making up stories to maintain self-esteem and to fill in memory gaps
Perseveration - repetition of phrases or behaviors which are intensified under stress.
Varcarolis, pages 297-298
These PDs are part of cluster B PDs in which the patient may appear to share emotional reactivity, such as dramatic, erratic, flamboyant behavior, poor impulse control, and an unclear sense of identity. Manipulation is a common behavioral mechanism.
Antisocial Personality Disorder
Borderline Personality Disorder
Narcissistic Personality Disorder
Varcarolis, pages 177-178
What are complications of anorexia nervosa?
Bradycardia, hypotension, orthostatic changes, murmur, prolonged QT interval, bluish color of hands and feet, leukopenia, lymphocytosis, elevated carotene levels (yellow skin), hypokalemic alkalosis (laxatives/diuretics), electrolyte imbalances, osteoporosis, elevated LFTs, elevated cholesterol levels, amenorrhea, abnormal thyroid functioning, hematuria, proteinuria.
Varcarolis, page 194
What are interventions for Bulimia Nervosa that are expected by the nurse on the plan of care?
Assess mood and for SI, Monitor VS and lab values, monitor weight, explore dysfunctional thoughts, educate that fasting can lead to continuation of binge eating, monitor patient after meals to prevent throwing away food and/or purging, acknowledge patient thoughts about body shape and size without challenging or minimizing, encourage patient to keep a journal.
Varcarolis, page 201
What are characteristics of abusive parents?
H/O violence, neglect, or emotional deprivation as a child. Low self-esteem. Poor coping skills. Socially isolated. Few friends. Involved in crisis situation. H/O mental illness. Violent outbursts. Projects blame to others. Lack of parenting skills. Inability to seek help from others. H/O drug/alcohol abuse. Loss of control. Frustrates easily. Poor impulse control.
Varcarolis, page 356, Box 21.2
Why does the abused person stay?
The abusive relationship about instilling fear and wanting to have power. (Varcarolis, page 357)
There are many reasons: attacks will become more severe, woman or child could be murdered, lack of financial security if they leave, lack of support system after being isolated, brainwashing and that it just feels normal, low self-esteem, religious values against divorce. (Varcarolis, page 358)
What action would the nurse take if the patient with delirium who are disoriented?
The physical environment should be simple and clear as possible. Objects such as clocks and calendars can maximize orientation to time, Eyeglasses, hearing aids, adequate lighting. The nurse interacts with the patient when they are awake. Short periods of interaction are beneficial.
Varcarolis, page 289
What are the medications that could be ordered in the plan of care with a patient with Alzheimer's Disease?
Galantamine hydrobromide, Rivastigmine, Donepezil hydrochloride, and Memantine hydrochloride.
Varcarolis, page 304
Borderline personality disorder has the following characteristics?
instability of mood, unstable self-image, alternating between idealization and devaluation, unstable sense of self, chronic feelings of being empty, avoidant of real or imagined abandonment.
Varcarolis, page 178
After the patient is stabilized medically and they are admitted to the mental health unit. What are the interventions to be expected by the nurse to implement for this patient?
Let the patient know that you are listening to them, assess for SI or self-harm, monitor VS, lab values, weight the patient same time of day with same amount of clothing on with back to the scale, monitor amount of food eaten, do minimize their challenges they are having, educate the patient about the complications of low weight, work with the patient to identify strengths. link weight gain with privileges.
Varcarolis, pages 196-197
What lab tests are included in the stabilization of a patient with bulimia nervosa?
electrolyte, glucose level, thyroid function tests, complete blood count, EKG.
Varcarolis, page 199
What is an intervention the nurse would expect to do for an abused child?
Be non-threatening. Understand the child does not want to betray the parents. Complete physical assessment. Use of dolls or drawing to help child tell how the injury or accident happened.
Varcarolis, page 356 Box 21.221.1
What type of care should be provided to a victim of sexual assault?
In the Emergency Department (ED) this patient takes priority, should not be left alone and be in a safe location (privacy). Compassionate, non-judgmental care should be provided, this is not the patient's fault, they did not ask for this. Try to preserve evidence for the SAFE or SANE nurse.
Varcarolis, page 37, review box 22.1
Dementia has a gradual progressive impairment with multiple cognitive impairments; Alzheimer's disease (not a normal part of aging) is a subtype of a major cognitive disorder. Who is at risk?
Age: incidence doubles after 65, 2/3 diagnosed are woman, higher risk if they have more than one first-degree relative with AD, heart and vessel health play a part in brain health, having genes related to certain genetic factors.
Varcarolis, pages 293-294
The clinical instructor is having a discussion with their clinical group about cholinesterase inhibitors. What are the most common side effects of these medications?
Gastrointestinal: nausea, vomiting, diarrhea, loss of appetite, and gastric hemorrhage (rare)
Varcarolis, page 304
This type of PD is characterized by a persistent disregard for the rights of others, and alack of remorse after hurting another. The personal has a sense of entitlement, disregard for the law, may engage in criminal behaviors.
Antisocial Personality Disorder
Varcarolis, page 177
What is the value for potassium that warrants criteria for admission to a hospital?
Less than 3 mq/L.
Varcarolis, page 194, Box 14.3
Binge eating disorder is when a patient eats a large amount of food in a short period to of time and then feel guilty or shameful after binging. What other mental health issue is this a symptom of?
Depression.
Varcarolis, page 202
This type of abuse occurs in the elderly population.
Financial abuse or exploitation.
Varcarolis, page 365, Box 21.4
Part of the nursing care plan is to develop a safety plan for an adult in an abusive situation. What should the nurse include in the teaching plan.
(Remember to work with a domestic violence advocate)
Move to a safe room, know quickest way out of home and workplace, keep a bag packed with essentials, tell neighbors to listen out for any altercations, have a code word for family, have a safe place to go (another location with support like family, or a shelter), use your instincts, leave when the abuser is not home unless danger is imminent, you have the right to protect yourself, the number to the hotline is, 1-800-799-7233.
Varcarolis, page 361
Is delirium a quick onset of symptoms?
Yes.
Varcarolis, page 287
The nurse would expect which NMDA agonist to be ordered for a patient in the moderate to severe stage of Alzheimer's Disease? What side effects would the nurse educate the family about?
Memantine hydrochloride
Side effects: dizziness, headache, and constipation.
*The benefits are time limited and minimal. *
Varcarolis, page 304
This personality disorder is a adaptive response characterized by a huge sense of self importance. The person considers themselves special and expect to be treated as such. Their attitude is arrogant, they lack empathy and may exploit others. 50 to 70% are males.
Narcissistic Personality Disorder
Varcarolis, page 179