Psychological factors affecting medical condition - ANSWER Fred is
overweight, has diabetes, and recently had a mild heart attack. The
doctor told him that he must make changes in his diet, or he will have
another, more serious heart attack from which he may not recover. Fred
ignores his doctor's advice, and states, "There's not anything wrong with
the way I eat!" The psychiatric home health nurse develops a care plan
for Fred.
Factitious disorder - ANSWER Phyllis lives alone. She has no close
relatives or friends, and she is very lonely. She presents to the
emergency department with blood in her urine. She reported to the
admitting nurse that she has had a rare bleeding disorder since
childhood. On her third hospital day, she is recognized by a consulting
physician from another hospital who tells the nurse that Phyllis was seen
for the same reason at his hospital just 3 weeks ago. A search of
Phyllis's belongings revealed a large container of anticoagulant
medication, which, when questioned, she admitted to having taken a
large dose. She has been transferred to the psychiatric unit.
Conversion disorder - ANSWER Franklin is assigned to secure a
contract for his company. The boss tells him, "If we don't get this
contract, the company may have to fold." When Franklin wakes up on
the morning of the negotiations, he is unable to see. The doctor in the
emergency department has ruled out organic pathology. Franklin is
transferred to the psychiatric unit.
Somatic symptom disorder - ANSWER Sarah has had what she calls a
"delicate stomach" for years. She has sought out many physicians with
complaints of nausea and vomiting, abdominal pain, bloating, and
diarrhea. No organic pathology can be detected. She has been admitted
to the psychiatric unit and says to
the nurse, "This is ridiculous. I don't belong here with these crazy
people. I need to be on the
,medical floor!"
Illness anxiety disorder - ANSWER John's father died of a massive
myocardial infarction when John (now age 34) was 15 years old. The
two of them were playing basketball at the time. Since then, John
becomes panicky when
he feels his heart beating faster than usual. He takes his pulse several
times a day and seeks out
a physical exam from his physician several times a year. He has been
referred to the psychiatric
nurse practitioner in the mental health clinic.
(Dx criteria for) anorexia nervosa - ANSWER Restriction of energy
intake relative to requirements leading to significantly low body weight;
intense fear of gaining weight; disturbance in body image.
Restricting/binge eating and purging - ANSWER Subtypes of anorexia
nervosa?
(Clinical course/epidemiology of) anorexia nervosa - ANSWER Onset:
early adolescence, chronic condition with relapses - body image
distortion, drive for thinness, interoceptive awareness, perfectionism;
females affected 10 times more often than males; more common among
hispanics and whites; possible medical complications.
(Tx for) anorexia nervosa - ANSWER Nutritional rehabilitation; conflict
resolution related to body image; effective coping; healthy family
functioning and communication; hospitalization if needed; intensive
therapy; family therapy; pharmacologic management - fluoxetine.
(Care for) anorexia nervosa - ANSWER Hospitalization - focus on
refeeding, going to be angry, forcing them to eat, monitor intake and
output; emergency care; family assessment and intervention; outpatient
treatment.
(Dx criteria for) bulimia nervosa - ANSWER Recurrent episodes of
binge eating and compensatory behaviors - purging: vomiting or use of
laxatives, diuretics, or emetics and nonpurging: fasting or
, overexercising; episodes occurring at least twice a week for at least 3
months; no severe weight loss as with anorexia nervosa.
(Epidemiology of) bulimia nervosa - ANSWER Lifetime prevalence - 1%
to 2.3% (more prevalent than anorexia nervosa); onset is between 18
and 24 years (older than anorexia nervosa); females to males - 10:1;
higher rates in Hispanic and white women; comorbid conditions,
including substance abuse, depression, and OCD.
bulimia nervosa - ANSWER Initially thought to be a type of anorexia
nervosa, now a distinct disorder; few outward signs, binging and purging
in secret; typically, normal weight; overwhelmed and overly committed
individuals; "Social butterflies", difficulty setting limits and appropriate
boundaries; shame, guilt, and disgust about binging and eating; also
impulsivity in other aspects of life.
(Tx for) bulimia nervosa - ANSWER Stabilization and then
normalization of eating; restructuring of dysfunctional thoughts or
attitudes; education about healthy boundary setting; conflict resolution
about separation-individuation; cognitive behavioral therapy (CBT) or
interpersonal therapy (IPT); antidepressants -
SSRIs; nutrition counseling; group psychotherapy and support groups.
(Nursing management for) bulimia nervosa - ANSWER Assessment -
current eating patterns, number of times per day of binging and purging,
dietary restraint practices, sleep patterns, exercise habits;
Nursing diagnoses - Imbalanced Nutrition: Less Than Body
Requirements, Disturbed Sleep Pattern; Interventions - strict monitoring
of food intake, supervision of bathroom visits, sleep management,
pharmacologic interventions - SSRIs, monitoring and administration of
medication. Care - hospitalization (extreme dehydration and electrolyte
imbalance), outpatient treatment, recovery groups and support groups.
True (A disturbance in body image is one of the key diagnostic
characteristics for anorexia nervosa) - ANSWER T/F: Individuals with
anorexia nervosa experience a significant disturbance in body image.
overweight, has diabetes, and recently had a mild heart attack. The
doctor told him that he must make changes in his diet, or he will have
another, more serious heart attack from which he may not recover. Fred
ignores his doctor's advice, and states, "There's not anything wrong with
the way I eat!" The psychiatric home health nurse develops a care plan
for Fred.
Factitious disorder - ANSWER Phyllis lives alone. She has no close
relatives or friends, and she is very lonely. She presents to the
emergency department with blood in her urine. She reported to the
admitting nurse that she has had a rare bleeding disorder since
childhood. On her third hospital day, she is recognized by a consulting
physician from another hospital who tells the nurse that Phyllis was seen
for the same reason at his hospital just 3 weeks ago. A search of
Phyllis's belongings revealed a large container of anticoagulant
medication, which, when questioned, she admitted to having taken a
large dose. She has been transferred to the psychiatric unit.
Conversion disorder - ANSWER Franklin is assigned to secure a
contract for his company. The boss tells him, "If we don't get this
contract, the company may have to fold." When Franklin wakes up on
the morning of the negotiations, he is unable to see. The doctor in the
emergency department has ruled out organic pathology. Franklin is
transferred to the psychiatric unit.
Somatic symptom disorder - ANSWER Sarah has had what she calls a
"delicate stomach" for years. She has sought out many physicians with
complaints of nausea and vomiting, abdominal pain, bloating, and
diarrhea. No organic pathology can be detected. She has been admitted
to the psychiatric unit and says to
the nurse, "This is ridiculous. I don't belong here with these crazy
people. I need to be on the
,medical floor!"
Illness anxiety disorder - ANSWER John's father died of a massive
myocardial infarction when John (now age 34) was 15 years old. The
two of them were playing basketball at the time. Since then, John
becomes panicky when
he feels his heart beating faster than usual. He takes his pulse several
times a day and seeks out
a physical exam from his physician several times a year. He has been
referred to the psychiatric
nurse practitioner in the mental health clinic.
(Dx criteria for) anorexia nervosa - ANSWER Restriction of energy
intake relative to requirements leading to significantly low body weight;
intense fear of gaining weight; disturbance in body image.
Restricting/binge eating and purging - ANSWER Subtypes of anorexia
nervosa?
(Clinical course/epidemiology of) anorexia nervosa - ANSWER Onset:
early adolescence, chronic condition with relapses - body image
distortion, drive for thinness, interoceptive awareness, perfectionism;
females affected 10 times more often than males; more common among
hispanics and whites; possible medical complications.
(Tx for) anorexia nervosa - ANSWER Nutritional rehabilitation; conflict
resolution related to body image; effective coping; healthy family
functioning and communication; hospitalization if needed; intensive
therapy; family therapy; pharmacologic management - fluoxetine.
(Care for) anorexia nervosa - ANSWER Hospitalization - focus on
refeeding, going to be angry, forcing them to eat, monitor intake and
output; emergency care; family assessment and intervention; outpatient
treatment.
(Dx criteria for) bulimia nervosa - ANSWER Recurrent episodes of
binge eating and compensatory behaviors - purging: vomiting or use of
laxatives, diuretics, or emetics and nonpurging: fasting or
, overexercising; episodes occurring at least twice a week for at least 3
months; no severe weight loss as with anorexia nervosa.
(Epidemiology of) bulimia nervosa - ANSWER Lifetime prevalence - 1%
to 2.3% (more prevalent than anorexia nervosa); onset is between 18
and 24 years (older than anorexia nervosa); females to males - 10:1;
higher rates in Hispanic and white women; comorbid conditions,
including substance abuse, depression, and OCD.
bulimia nervosa - ANSWER Initially thought to be a type of anorexia
nervosa, now a distinct disorder; few outward signs, binging and purging
in secret; typically, normal weight; overwhelmed and overly committed
individuals; "Social butterflies", difficulty setting limits and appropriate
boundaries; shame, guilt, and disgust about binging and eating; also
impulsivity in other aspects of life.
(Tx for) bulimia nervosa - ANSWER Stabilization and then
normalization of eating; restructuring of dysfunctional thoughts or
attitudes; education about healthy boundary setting; conflict resolution
about separation-individuation; cognitive behavioral therapy (CBT) or
interpersonal therapy (IPT); antidepressants -
SSRIs; nutrition counseling; group psychotherapy and support groups.
(Nursing management for) bulimia nervosa - ANSWER Assessment -
current eating patterns, number of times per day of binging and purging,
dietary restraint practices, sleep patterns, exercise habits;
Nursing diagnoses - Imbalanced Nutrition: Less Than Body
Requirements, Disturbed Sleep Pattern; Interventions - strict monitoring
of food intake, supervision of bathroom visits, sleep management,
pharmacologic interventions - SSRIs, monitoring and administration of
medication. Care - hospitalization (extreme dehydration and electrolyte
imbalance), outpatient treatment, recovery groups and support groups.
True (A disturbance in body image is one of the key diagnostic
characteristics for anorexia nervosa) - ANSWER T/F: Individuals with
anorexia nervosa experience a significant disturbance in body image.
