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256 mental exam 4 study guides

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 20 pages. Originally published on StudyMerit.

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20
Academic year
2025/2026
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English

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Exam 4 Study Guide – NUR 256 Mental Health (Unit 9, 10, 11/12) Unit 9 (Chp. 18, 22) Chapter 18 – Eating and Feeding Disorders - Anorexia Nervosa o Individual refuses to maintain a minimally normal weight for height and express an intense fear of gaining weight. o Chronic illness – requires long term treatment o 1 year – 50 % relapse o Factors that influence recovery:  Percentage of ideal body weight that has been achieved  The extent to which self-worth is defined by shape and weight  The amount of disruption existing in the client’s personal life o Combination of individual, group, couples and family therapy provides the client with the greatest change for a successful outcome. o Risk Factors:  Genetic Predisposition  Female Gender  Cognitive-Behavioral Theory – learned behavior with positive reinforcement  Cultural influence – Self Concept o Assessment  Health History – perception of the problem, history of dieting, value attached to weight, shape, size  Assess current health stability – Renal function, Electrolyte imbalances, anemia, dehydration, cardiovascular abnormalities  Severely underweight – may have growth of fine, downy hair on face and back (lanugo)  Cessation of menstruation (not a required sign)  Lower – BP, HR, Temp  Cool extremities with mottled look.  Thoughts and behaviors  Terror of gaining weight  Preoccupation with thoughts of food  View self as fat – even when emaciated  Peculiar handling of food, cutting into small bites, pushing pieces around on plate  Possible development of rigorous exercise regimen  Possible self-induced vomiting, laxative use, excessive exercise  Judges self-worth by size/weight  Multiple Medical complications o Assessment Guidelines  Determine the client’s perception of the problem  Perform a complete nursing assessment including review of systems  Gather psychosocial history Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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 Assess Nutritional pattern and Fluid intake  Assess Daily activities – including exercise  Review Labs: Electrolytes, Glucose, Thyroid function tests, Complete blood count, ECG  Identify client goals - Medical Stabilization – Priority o Hospitalization o Extreme Electrolyte imbalance or weight below 75% ideal body weight o Less than 10% body fat, a daytime HR less than 50 bpm, a systolic bp less than 90, temperature less than 96 and arrythmias o With prolonged starvation the body switches from glucose-based energy to fat and protein—based energy o Refeeding Syndrome  **Caution** Potentially lethal treatment complication  May result in fluid-balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia and hypokalemia  Thiamine Deficiency may also occur  Reintroduction of nutrients must be slow to avoid - Treatment – After Medically Stable o Address underlying issues with realistic goals o Weight Restoration program – Focus should be on the eating behavior and underlying feelings of anxiety, dysphoria, low self-esteem and lack of control o Approach discussions about physical appearance cautiously – client may misinterpret o Health promotion – learning more constructive coping skills, decision making skills, supervised grocery shopping. As client progresses, encourage eating in restaurants. o Therapy – Individual, group and family o Psychopharmacological Therapy  Occurs during different phases  No direct medication is prescribed for anorexia o SSRI – Fluoxetine (Prozac) – helps to reduce obsessive compulsive behavior but only AFTER the client has reached a maintenance weight. - Bulimia Nervosa o Repeated episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, misuse of laxatives, diuretics, excessive exercise, and fasting) o Significant disturbance in the perception of body shape and weight o History of Anorexia Nervosa in 1/4 - 1/3 of clients o Depressive signs and symptoms o Problems with interpersonal relationships, self-concept, impulsive behaviors o Increased levels of anxiety and compulsivity o Assessment Guidelines (P . 341) Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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 Normal to slightly low weight  Enlargement of parotid glands, dental erosion and caries  Family relationships are frequently chaotic and reflect a lack of nurturing  Lives reflect instability  Determine the client’s perception of the problem  Perform a complete nursing assessment  Assess nutritional pattern and fluid intake  Assess binging and purging patterns with direct questions  Assess daily activities including exercise  Review Labs: Electrolyte levels, glucose level, thyroid function tests, CBC, ECG  What are the client’s goals for treatment?  Multiple Medical complications o Planning  Medical Stability – Priority  Hospitalization  Syncope, low K+, low Chloride, esophageal tears, arrhythmias, intractable vomiting and hematemesis.  Suicide risk also requires hospitalization.  Structure to normalize eating habits  Therapy  Health Teaching and Promotion  Pharmacological Tx – Fluoxetine (Prozac) FDA approved for maintenance  Interventions for Management of Eating Disorders **BOX 18.4** - Binge Eating Disorder o Repeated episodes of binge eating after which they experience significant distress o May be normal weight but repeated binge eating inevitably results in obesity o Most common eating disorder o Tends to run in families – demonstrates addictive genetic influences o Asses the client health status and risk for co-morbidities of obesity (diabetes, hypertension, heart disease) o Treatment includes therapy and possible pharmacological interventions  FDA approved: Vyvanse – Central nervous stimulant (contraindicated for clients with substance use disorders)  Antidepressants - Feeding Disorders o PICA  Persistent eating of substances that have no nutritional value (dirt, paper, paint)  Institutionalized children - as high as 26% Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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