Crisis
What are the goals of crisis intervention?
Return patient to pre-crisis level of functioning. People are open to help and guidance during a crisis. Crisis intervention does not deal with past issues but here and now immediate situations. Nurse takes an active and directive role versus a passive role.
Describe anorexia nervosa, bulimia nervosa, and binge eating
*BONUS: What are some priority concerns?
AN: Intense, irrational beliefs about shape and weight. Engage in self starvation, intense fear of gaining weight, feel hunger and attempt to gain control over the feeling.
Subtypes: Binge - consumption of large amounts of calories in one sitting, Purge - vomiting (Non-binge and purge)
** Complications: heart failure, arrhythmia, resp failure, muscle breakdown, death
BN: repeated episodes of binge eating (large amount of calories, 5000+), followed by inappropriate compensatory behaviors. purge -> vomiting, laxatives, diuretics... Non-purge -> excessive exercise, stimulants, fasting, strict diet
- struggle w impulsivity/compulsivity, Compensatory behaviors used to “un-do” eating and relieve guilt of bingeing and relieve anxiety, Post-purging: may feel sense of relief, calm or may feel depressed, Does not appear ill, close to ideal weight ** Diagnosed when episode at least once a week for 3 months
**Complications: bradycardia, dysrhythmias, electrolyte imbalance, esophageal tears
BE: engage in repeated episodes of binge eating followed by significant distress... NO compensatory behaviors, Compulsive overeating in 2-hour period, Recurrent episodes of consuming large amounts of foods with a feeling of loss of control, Eating rapidly, uncomfortably full, eats alone, Eats to ease stress and comfort self, Most are overweight, Tendency to sedentary behavior, Feel depressed, guilty, disgusted with self after binge
*B: medical/physiologic stabilization, LABS: electrolytes, ECG, thyroid, glucose, CBC, lipids, cholesterol... Psych eval/risk assessment, assess use of diet aids, problems r/t nutrition, vomiting, dehydration
**** Body shifts from CATABOLIC state to an ANABOLIC state, causing shift in FLUIDS and ELECTROLYTES
What are the levels of nursing care in a crisis intervention?
Name some physical signs and symptoms seen in anorexia nervosa, bulimia nervosa, and binge eating
*BONUS: what is the name of the deadly complication?
AN: low body weight, cachexia (muscle wasting), laryngo (fine hair on neck and face), dizziness, fainting, amenorrhea/menstrual irregularities, GI disturbance, Osteopenia, Chronic constipation, delayed gastric emptying and bloating, Dehydration, hypotension, hypothermia (mottled, cool skin on the extremities), bradycardia
*** Often rigid and perfectionistic, meticulous, compulsive
BN: Dental caries, erosion, swollen parotid gland, russells sign - calluses on knuckles, skin problems, dehydration related issues, bad breath, red sclera, abdominal bloating
BE: heartburn, bloating, abdominal pain, obesity
*B: Refeeding syndrome: deadly complication of the refeeding process
Name some of the factors that have an affect on a persons ability to cope
Stressful life events/situations, mental illness, substance use, hx of poor coping skills, diminished cognitive abilities, pre-existing physical health problems, limited social support network
Resilience: learned through past successful experience w and resolution of crisis... coping skills (how they deal w a situation)
What are interventions for anorexia nervosa, bulimia nervosa, and binge eating
*BONUS: what are the cognitive distortions in eating disorders
AN: acknowledge emotional and physical difficulty, assess for SI/risk for harm, monitor physiological signs, education, and assist to identify strengths, MANTRA
BN: monitor physiological signs (vitals, electrolytes), monitor weight as needed, explore dysfunctional thoughts r/t binge-purge cycle, education, monitor before and after means, encourage journaling of thoughts, acknowledge pt POV w/o challenging or minimizing, MANTRA
BE: assess mood, risk factors, determine treatment objectives, provide nutrional counseling - weight program, provide psychosocial treatment
*B:
What are some signs and symptoms of someone in crisis?
Depressed mood, hopelessness, confusion, increased anxiety, difficulty w interpersonal relationships, isolation, problems at work/completing task, insomnia, nightmares, fear, crying
What would be apart of the treatment plan for anorexia nervosa?
*BONUS: why does BN have a better prognosis than AN pts?
weigh pt regularly at same time each day, observe while eating, food choices made in collaboration w nutritionist/dietician, time limited meals, supervise/observe after meals, increase privileges r/t weight gain, liquid supplements/tube feedings (PRN)
*B: easier to establish a therapeutic alliance and they know their behaviors are unhealthy
What are the 3 main areas to focus on during an assessment? (after determining safety/risk)
1. pt perception of event - whether or not something is a crisis can depend on the person/their outlook
2. pts available support - help identify available resources (or lack of)
3. pts usual coping skills - what is their level of anxiety? suicidal? homicidal?
What is the criteria for someone to be hospitalized?
*BONUS: what is the drug that can be used for treatment of OCD/Depressive symptoms in AN... but in BN used for treatment (has a significant decrease in binge/purge behavior)
Weighs below 75% of ideal body weight, Heart rate less than 50 beats/minute, Systolic blood pressure less than 70 mm Hg, Arrhythmias, Hypokalemia, Severe hypothermia – less than 96.8 F
Psychiatric criteria: suicidal, self injury, overuse of laxatives, street drugs, severe depression, psychosis…
*B: Fluoxetine (SSRI)
- Anticonvulsant: topiramate (topamax) can be used for OCD
- Stimulant: lisdexamfetamine (vyvanse) inhibits hunger