Final- Mental Heath- Ch 22-28

Front 1

Prioritizing nursing interventions in general

3 steps

Back 1

1. alliance first

2. recognize need for control

3. contract to increase control and increase compliance

Front 2

slide 7:

what kind of disorders are the psychiatric disorders that uniquely require holistic approach by nurse that encompasses physiological expertise

Back 2

eating disorders

Front 3

slide 7:

-persons with eating disorders may be found in any health care eating

true or false

Back 3

true

Front 4

slide 10:

-every single meal is with a group: that is therapy (esp. with staff)

true or false

Back 4

true

Front 5

slide 10:

-direct supervision of eating meals and behaviors with food such as

Back 5

excessive condiment use and deliberate tampering to make food taste offensive, hiding food, condensing, over/under-serving, hoarding

Front 6

slide 10:

-why may people tamper with their food:

Back 6

to make it taste bad, so they can throw up, the food is their enemy, they are trying to suppress their appetite.

Front 7

slide 10:

what about the staff is essential?

Back 7

consistent expectations among staff essential (they try to make deals with staff at meals. the dietician is the
one in charge of the meal plan so the patients can not attack the staff to make deals.

Front 8

slide 10:

post prandial bathroom restriction and supervision (purging) –how long is the restriction?

Back 8

a lot of rooms don’t have bathrooms in them or they are locked. the restriction can be 2 hours

Front 9

slide 10:

control access to drinking water, why?

Back 9

– water shows a positive weight gain to throw the scale off (hydroloading)

water intoxication can also be caused which creates a low electrolyte imbalance (arrhythmias)

Front 10

slide 10:

-before they get weighed what must the nurse ask them to do?

Back 10

ask to use the bathroom before they get weighed.

Front 11

slide 10:

what can drinking too much water cause?

Back 11

water intoxication can also be caused which creates
a low electrolyte imbalance (arrhythmias)

Front 12

slide 10:

blind weights in gowns -what do you have them do?

Back 12

blind weights in gowns -step on scale backwards so they don’t know their weight every day because they will
focus on the number so much. sometimes they tell them their weight because they over estimate, or to see their response

Front 13

slide 10:

if indicated, activity restriction to conserve energy –if they are an inpatient, what can the nurse do?

Back 13

if they are in pt, some were in wheel chairs b/c they are
so fragile and have no energy reserves. they can be so driven to move all the time to burn calories that they will exercise in their room or bathroom

Front 14

slide 11:

psychosocial interventions: what can a nurse do to give a sense of control

Back 14

mutually developed goals including the use of behavioral contracts

Front 15

slide 11:

-assist pt to adopt what?
-what should we try to build with the patient?

Back 15

-assist pt to adopt a realistic view of body
-self esteem building

Front 16

slide 11:

-assist to develop what?
-challenge what?

Back 16

-assist to develop coping strategies,

challenge distorted thoughts, and expression both verbally and nonverbally (yoga, non-activity, art

Front 17

slide 11:

-feel like they don’t have a voice so how can the nurse engage them?

Back 17

in activity (passive) like yoga, art

Front 18

slide 11:

-predictor to developing eating disorder:

Back 18

to be liked

Front 19

slide 8: nursing interventions

most urgent intervention:

Back 19

correct nutritional and electrolyte imbalance which can result in death (flushing out K in the body can lead to arrhythmias,

Front 20

slide 8:nursing interventions

tell me bout the suicide rate?

Back 20

suicide is 6-7x the rate of other populations).

Front 21

slide 8:nursing interventions:


what should the nurse try to obtain an accurate dietary pattern

Back 21

as a baseline for the dietician to develop a step wise progressive to increase the diet

Front 22

slide 8: nursing interventions

-what is done to detect developing complications early in these pts?

Back 22

frequent through head to toe physical assessment to

Front 23

slide 9

-care planning requires the nurse to recognize that the dynamic focus of the pt with anorexia is

Back 23

being in control of everything

Front 24

slide 9

what is the first step the nurse should do with the pt

Back 24

first step is to create a therapeutic alliance (1st priority for NCLEX) b/w a nurse and a pt with an eating disorder is to formulate a nurse-patient contract

Front 25

slide 9
first step is to create a therapeutic alliance, what does this facilitate?

Back 25

engagement and willingness to adhere to the treatment plan because ac contract is a form of agreement by the patient and helps them maintain a feeling of control

Front 26

slide 29: normal adolescent developmental tasks

what are the 5 tasks

Back 26

self identity

-individuation

-independence/autonomy

-gender/sexual identity

-role development

Front 27

slide 32:

the normal developmental tasks of adolescence even in the best of envts and family health are negotiated with great difficulty as youths begin when?

Back 27

when they start to move away from the security of childhood, and become more autonomous and responsible for self

Front 28

slide 32:

the normal developmental tasks of adolescence is accomplished when?

Back 28

with successful formation of one’s identity, individuation from others, and new role developments

Front 29

slide 32:

-eating disorders can interfere with these developmental skills.. how?

Back 29

as the developing teen becomes more entrenched in an eating disorder, dependence on others grows

Front 30

slide 42 psychological/personality factors:

most pts with eating disorders have problems with rigidity, ritualism, meticulous behavior, often originating in childhood. obsessive need for perfectionism, exactness, symmetry with risk avoidance, self restrain (anorexia or bulimia)

Back 30

anorexia

Front 31

slide 42 psychological/personality factors:

most pts with eating disorders have problems with rigidity, ritualism, meticulous behavior, often originating in childhood. obsessive need for perfectionism, exactness, symmetry with risk avoidance, self restrain (anorexia) and impulse control provide the context for the eating disorder behavior (bulimia)

Back 31

bulimia

Front 32

- slide 42 psychological/personality factors:

these disturbances may be the result of

Back 32

dysfunctional parents from parents that have these same disturbances


a heavy value and reward for practicing these behaviors by parents reinforces the development of them

Front 33

Slide 53: black and white thinking:


what ability does it affect?
-4

Back 33

the ability to accept:
- personal imperfection,
-impairs decision making,
-imapirs ability to perform a task,
-impairs ability to feel an emotion as these activities require integrating the ‘shades of gray’ encountered in every day life

Front 34

Slide 53:Magnification

what does it do to one's thought?

Back 34

-Thoughts become distorted and place excessive emphasis on minor events

Front 35

gaining 2 lbs may lead to fear of gaining 100 lbs, or lead to refusal to wear certain types of clothing

example of:

Back 35

Slide 53:Magnification

Front 36

fears of getting fat from eating one dessert, believing that the moment eating begins, fat is being formed in the body, or as one girl told me “If I eat this my stomach will blow up

example of:

Back 36

Slide 53:Magnification

Front 37

slide 54:personalization

what is it?

Back 37

an egocentric interpretation of impersonal events or over-interpretation of events related to the self

Front 38

interpretation of events related to the self

Back 38

slide 54:personalization

Front 39

ex: I heard people laughing behind me in the checkout line at the store. I know they were laughing because I gained 2 lbs last week

Back 39

slide 54:personalization

Front 40

slide 55: cognitive distortions

what is it

Back 40

inappropriate sense of self-reference

Front 41

slide 55: cognitive distortions

people have extreme sensitivity to what?

Back 41

the reactions of others leads to distorted perceptions that others are continually appraising their body, their eating, etc.

Front 42

slide 55: cognitive distortions

what is their thinking like?
-what does it lead them to do?

Back 42

paranoid thinking that others are talking about them leads to more and more severe withdrawal and isolation

Front 43

slide 55: cognitive distortions


-secrecy of eating disorder behavior leads to

Back 43

inability to eat in public at all

Front 44

slide 55: cognitive distortions


-the need to plan for binging and purging limits the persons to

Back 44

eating in isolation

Front 45

slide 56: cognitive distortions: perfectionism

-results from reinforced what?

-what does it lead to?

Back 45

- reinforced shame/guilt


-leads to intense self loathing (disgust)

Front 46

example: where efforts to be perfect in one fail, the determination to be ‘perfect’ at controlling food intake can substitute for this ‘deficiency’ leading to increasing levels of preoccupation and obsession with food, weight, exercise, and self denial

Back 46

slide 56: cognitive distortions: perfectionism

Front 47

slide 71- damaged body cues

an interesting phenomena that develops is that the teen actually loses the ability to do what?

Back 47

interpret their body’s natural hunger, satiety, thirst, and fatigue cues through long term overriding of these cues

Front 48

slide 71- damaged body cues

an effective strategy is to :

Back 48

-have an individualized meal plan developed with a dietician that considered preferred foods as much as possible

Front 49

slide 71- damaged body cues

-this meal plan is structured as a method to________ which relieves the teen of trying to interpret or override these cues, because the meal plan is designed to

Back 49

‘eat by the clock’



prevent and length lapse of time usually between meals that would lead to hunger pangs

Front 50

slide 71- damaged body cues

usually, the meal plan is how many meals and how many snacks?

Back 50

-usually it is 3 meals and 3 snacks

Front 51

slide 73- starting at the head

what happens with ones hair?

Back 51

-hair becomes dry and brittle and falls out

Front 52

slide 73- starting at the head


-facial contours?

Back 52

can become skeletal with protruding facial bones

Front 53

slide 73- starting at the head

why does lanugo develop?

Back 53

as a compensatory mechanism for body heat loss

Front 54

slide 73- starting at the head

what happens to one's skin?

Back 54

-skin becomes pale and dry

Front 55

slide 73- starting at the head


in bingers: what happens to tooth enamel ?

Back 55

may become eroded (permanent) leading to abscesses and loss of teeth

Front 56

slide 73- starting at the head


what happens to the parotid glands

Back 56

become enlarged with frequent binging and a “chipmunk cheek” appearance is telltale

Front 57

slide 73- starting at the head

-vomiting is reversible or irreversible

Back 57

reversible

Front 58

slide 73- starting at the head


-purging causes what electrolyte imbalance?

Back 58

low K+

Front 59

slide 76- cardiovascular

the heart can be affected In may ways:
- actual atrophy of the myocardium causes

Back 59

reduced cardiac output creating a risk for CHF and chronic heart disease, esp those who engage in excessive exercise

Front 60

slide 76- cardiovascular
-a weakened myocardium also predisposes the person to

Back 60

CHF with rehydration and refeeding, as fluid retention is frequent during early refeeding stages of recovery, due to low serum proteins and other altered fluid regulatory processes

Front 61

slide 76- cardiovascular

-____from frequent purging is possible

Back 61

pericarditis

Front 62

-slide 77-cardiovascular

what is the most lethal risk is

Back 62

that of cardiac arrhythmias due to potassium and other electrolyte disturbances

Front 63

-slide 77-cardiovascular

what kind of activties cause people to be the most lethal at risk?

Back 63

-those who hydroload and engage in strenuous exercise are particularly at risk

Front 64

-slide 77-cardiovascular


distance runners mistakenly believe what?

Back 64

that if they drink large quantities of water, they will be safe to run, but the effect is that same as hyponatremia, due to dilution, and places them at risk of arrhythmia while running

Front 65

-slide 77-cardiovascular

anemia, from iron deificency can further impact what?


what is it possible to develop?

Back 65

the heart.


it is even possible to develop irreversible bone marrow fibrosis

Front 66

thoughts and behaviors associated with anorexia nervosa.

what do they have a terror of:

what do they have a preoccupation with?

Back 66

terror of gaining weight

-preoccupation with thoughts of food

Front 67

thoughts and behaviors associated with anorexia nervosa.

-peculiar handling of food, such as:

Back 67

(cutting into small bits, pushing pieces of food around plate)

Front 68

thoughts and behaviors associated with anorexia nervosa.

possible development of

Back 68

-rigorous exercise regimen

Front 69

thoughts and behaviors associated with anorexia nervosa.

-possible self-induced vomiting, and use of (2)

Back 69

laxatives, and diuretics

Front 70

thoughts and behaviors associated with anorexia nervosa.

-cognition so disturbed that individuals judges self-worth by

Back 70

his or her weight

Front 71

Possible signs and symptoms of anorexia nervosa -clinical presentation / cause

-amenorrhea =

Back 71

low weight

Front 72

Possible signs and symptoms of anorexia nervosa -clinical presentation / cause


-lanugo =

Back 72

starvation

Front 73

Possible signs and symptoms of anorexia nervosa -clinical presentation / cause

cardiovascular abnormalities (hypotension, bradycardia, heart failure) = (3)

Back 73

starvation,
dehydration,
electrolyte imbalance

Front 74

Possible signs and symptoms of anorexia nervosa -clinical presentation / cause

-hypokalemia (low K) =

Back 74

starvation

Front 75

Thoughts and behaviors associated with bulimia nervosa

often self-induced vomiting (or laxative or diuretic use) after bingeing

true or false

Back 75

true

Front 76

Thoughts and behaviors associated with bulimia nervosa

-history of anorexia nervosa in ¼ to 1/3 of indivudals


true or false

Back 76

true

Front 77

Thoughts and behaviors associated with bulimia nervosa

also convey what kind of disordes s/s?

Back 77

-depressive s/s

Front 78

Thoughts and behaviors associated with bulimia nervosa

-problems with (3)

Back 78

: interpersonal relationships,
self-concept,
impulsive behaviors

Front 79

Thoughts and behaviors associated with bulimia nervosa

-increased levels of ___ & ___

Back 79

anxiety and compulsivity

Front 80

Thoughts and behaviors associated with bulimia nervosa

possible can result in ___ and ____

Back 80

possible chemical dependency

-possible impulsive stealing

Front 81

Possible s/s of bulimia nervosa clinical presentation / cause

-dental caries, tooth erosion =

Back 81

vomiting (HCl reflux over enamel)

Front 82

Possible s/s of bulimia nervosa clinical presentation / cause

-parotid swelling =

Back 82

increased serum amylase levels

Front 83

Possible s/s of bulimia nervosa clinical presentation / cause

abnormal laboratory values (electrolyte imbalance, hypokalemia, hyponatremia) =

Back 83

purging: vomiting, laxative and/or diuretic use

Front 84

assessing suicide risk and predictor of risk

-suicide is the ___ leading cause of death in adolescence

Back 84

2nd

Front 85

assessing suicide risk and predictor of risk

-the number one predictor of suicidal risk is

Back 85

a past suicidal attempt

Front 86

assessing suicide risk and predictor of risk

areas to explore when assessing suicidal risk include:

Back 86

-past suicidal thoughts, threats, or attempts

-existence of a plan, lethality of the plan, and accessibility of the methods for carrying out the plan

-feelings of hopelessness, changes in level of energy

-circumstances, state of mind, and motivation

-viewpoints about suicide and death (has a family member or friend attempted suicide?)

-depression and other moods or feelings (anger, guilt, rejection)

-history of impulsivity, poor judgment, or decreased decision making

-drug of alcohol use

-prescribed meds and any recent adherence issues

Front 87

assessing suicide risk and predictor of risk

additional questions may be asked about these areas for teens, including:

Back 87

acting out behaviors, artwork with a violent theme, listening to music or books with morbid themes, recent changes in behavior or social life (eating, sleeping, isolating, loss of a relationship)

Front 88

assessing suicide risk and predictor of risk

-why is assessing lethality is a young child’s suicide plan is complicated

Back 88

because the distorted concept of death, immature ego functions, and an immature understanding of lethality

-for instance, a child who is highly suicidal may believe a few aspirin will cause death but the incorrect judgment does not diminish the seriousness of the intent

another child simply seeking attention may threaten to jump of f a bridge believing this would not be fatal

Front 89

assessing suicide risk and predictor of risk

some teens make a pact to kill themselves or become upset after a friend has committed suicide or died accidentally.

true or false

Back 89

true

Front 90

assessing suicide risk and predictor of risk

early intervention is essential and parents need to understand that suicidal thoughts or self-threatening behavior such as:

Back 90

(cutting, reckless driving, binge drinking) must be taken seriously and evaluated as an emergency

Front 91

The client with bulimia differs from the client with anorexia nervosa by
A) maintaining normal weight.
B) holding a distorted body image.
C) doing more rigorous exercising.
D) purging to keep weight down.

Back 91

A)maintaining normal weight

Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight.
Text page: 346

Front 92

A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is
A) lanugo.
B) hypotension.
C) 25-lb weight loss.
D) fear of gaining weight.

Back 92

D) fear of gaining weight.

This option is the only subjective data listed and it is universally true.
Text page: 349

Front 93

During assessment of a client with anorexia nervosa it is not likely that the nurse would note indications of:
A) introversion.
B) social isolation.
C) high self-esteem.
D) obsessive-compulsive tendencies.

Back 93

C)
Most clients with eating disorders have low self-esteem.
Text page: 349

Front 94

Biological theorists suggest the cause of eating disorders may be
A) normal weight phobia.
B) body image disturbance.
C) serotonin imbalance.
D) dopamine excess

Back 94

C) serotonin imbalance.

The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse.

Front 95

A nursing diagnosis for a client who is 16 years old, 5 foot 3 inches tall, and 80 pounds who eats one tiny meal daily and engages in a rigorous exercise program would be
A) death anxiety.
B) ineffective denial.
C) disturbed sensory perception.
D) imbalanced nutrition: less than body requirements.

Back 95

D

Front 96

A coping mechanism used excessively by clients with anorexia nervosa is
A) denial.
B) humor.
C) altruism.
D) projection.

Back 96

A

Denial of excessive thinness is the mainstay of the client with anorexia nervosa.
Text page: 350

Front 97

A client reveals that she induces vomiting as many as a dozen times a day. The nurse would expect assessment findings to reveal
A) tachycardia.
B) hypokalemia.
C) hypercalcemia.
D) hypolipidemia.

Back 97

B

Vomiting causes loss of potassium leading to hypokalemia.
Text page: 350

Front 98

A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is
A) an increase in red blood cell count.
B) disruption in fluid and electrolyte balance
C) elevated serum potassium.
D) elevated serum sodium.

Back 98

B
Disruption in fluid and electrolyte is usually the result of excessive use of enemas and laxatives.
Text page: 355

Front 99

A realistic short-term goal for the first week of hospitalization for a client with anorexia nervosa whose weight is 65% of normal weight would be: By end of week 1 the client will
A) gain a maximum of 3 lb.
B) develop a pattern of normal eating behavior.
C) discuss fears and feelings about gaining weight.
D) verbalize awareness of sensation of hunger.

Back 99

A
The critical outcome during hospitalization is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema.
Text page: 360

Front 100

Bupropion (Prozac) while seemingly effective is contraindicated in patients who purge because of:
A) historically poor patient compliance
B) an increased risk in seizures
C) long term effects on liver function
D) the potential to cause gastric ulcers

Back 100

B

Bupropion (Prozac) while seemingly effective is contraindicated in patients who purge because of an increased risk of seizures.
Text page: 357

Front 101

1. In contrast to the client with anorexia nervosa, the client with bulimia usually
A) uses greater denial.
B) is aware of the eating problem.
C) fits more easily into the family.
D) appraises his or her body more realistically.

Back 101

C) fits more easily into the family.

There is less family concern about the client with bulimia because these clients appear physically normal, the weight is at or near normal, they eat with the family, and the purging is done in secret. The anorexic client is noticed by the family for painful thinness and poor food intake.
Text page: 354

Front 102

A focus for the acute phase of treatment for anorexia nervosa would be
A) weight restoration.
B) improving interpersonal skills.
C) learning effective coping methods.
D) changing family interaction patterns.

Back 102

A) weight restoration.

Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status.
Text page: 352

Front 103

The nurse can determine that inpatient treatment for a client with an eating disorder would be warranted when the client
A) weighs 10% below ideal body weight.
B) has a serum potassium level of 3 mEq/L or greater.
C) has a heart rate less than 60 beats/min.
D) has systolic blood pressure less than 70 mm Hg.

Back 103

D) has systolic blood pressure less than 70 mm Hg.


Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise.
Text page: 349

Front 104

Which assessment question should be asked of a client suspected of having anorexia nervosa?
A) "Do you find yourself feeling hungry?"
B) "How would you describe your body?"
C) "How often do you force yourself to vomit?"
D) "Why do you choose to take laxatives?"

Back 104

B) "How would you describe your body?"

This question will reveal the cognitive distortion consistent with anorexia nervosa. Invariably the client will describe self as fat despite being excessively underweight.
Text page: 349

Front 105

Which statement is least likely to be made by a client with bulimia nervosa during the assessment interview?
A) "I eat three meals each day and purge every evening."
B) "I'm concerned about what others think about my binging and purging."
C) "I feel as though my eating and purging are out of my control."
D) "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."

Back 105

A) "I eat three meals each day and purge every evening."

Most clients with bulimia purge after each meal.
Text page: 346

Front 106

Assessment of a client with suspected bulimia nervosa calls for the nurse to perform
A) a range of motion assessment.
B) inspection of body cavities.
C) inspection of the oral cavity.
D) body fat analysis.

Back 106

C

Repeated vomiting often causes dental erosions and caries.
Text page: 354

Front 107

Which intervention would be least useful for accurate assessment of the weight of a client with anorexia nervosa?
A) Weigh two times daily, then three times weekly
B) Weigh fully clothed before breakfast
C) Do not reweigh client when client requests
D) Permit no oral intake before weighing

Back 107

B
Clients should be weighed wearing only bra and panties before ingesting any food or fluids in the morning.
Text page: 360

Front 108

Which intervention would be removed from the plan of care for a client with bulimia nervosa?
A) Teach that fasting sets one up to binge eat
B) Assist client to identify trigger foods
C) Support importance of avoiding forbidden foods
D) Teach client to plan and eat regularly scheduled meals

Back 108

c

No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.

Front 109

The nurse working with clients with eating disorders can help families develop effective coping mechanisms by
A) teaching the family about the disorder and the client's behaviors.
B) stressing the need to suppress overt conflict within the family.
C) urging the family to demonstrate greater caring for the client.
D) encouraging the family to use their usual social behaviors at meals.

Back 109

A

Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member