EATING DISORDERS ANOREXIA NERVOSA ---------------BULIMIA NERVOSA - Eat, eat, eat --------------------------- Eat, eat, vomit - Less 85%

expected body weight ------- Normal weight - 3 months amenorrhea --------------- Irregular menstruation

BULIMIA NERVOSA Metabolic alkalosis (vomiting results to decrease hydrochloric acid) Metabolic acidosis (diarrhea results to decrease bicarbonate) Dental caries Wound in knuckles

MANAGEMENT Fluid and electrolyte imbalance Meal contract Weight gain for client After eating stay with client for 1 hour and accompany when going to the comfort room
PHARMA NOTES: ANTI PSYCHOTIC DRUG Stelazine Serentil Thorazine Trilafon Clozaril Mellaril Haldol Prolixin SCHIZOPHRENIA Ego disintegration Impaired reality perception Genetic vulnerability Stress Diathesis Model Biological theory increase dopamine level Exact cause unknown

ASSESSMENT Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete) Ambivalence: pulled into 2 opposing forces Autism Looseness, no idea, not related to one another
ASSESSMENT NEGATIVE ------------------------POSITIVE Hypoactive ------------------------ Hyperactive Withdrawn ------------------------- Sociable Thought Blocking ------------------Flight of ideas Apathy I. ASSESS Content of thought

NURSING DIAGNOSIS Disturbed thought process PLANNING/IMPLEMENTATION Present reality Provide safety EVALUATION Improved thought process
II. ASSESS Hallucinations/Illusions

NURSING DIAGNOSIS Disturbed sensory perception PLANNING/IMPLEMENTATION Present reality Safety EVALUATION Improved sensory perception
III. ASSESS Suspicious

NURSING DIAGNOSIS Risk for other directed violence PLANNING/IMPLEMENTATION Present reality Safety EVALUATION Eliminate/minimize risk for other directed violence
IV. ASSESS Suicidal

NURSING DIAGNOSIS Risk for self directed violence PLANNING/IMPLEMENTATION Present reality Safety EVALUATION Eliminate/minimize risk for self directed violence
LOOSENESS OF ASSOCIATION Thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between one thought and the next FLIGHT OF IDEAS Jumping from one topic to another AMBIVALENCE Pulled between 2 strong opposing forces MAGICAL THINKING acting like magician ECHOLALIA Client repeats what you say

ECHOPRAXIA Client repeats what you do WORD SALAD Just words no rhyme CLANG ASSOCIATION Words that rhyme NEOLOGISM Formation of new words (needs clarification) DELUSION: PERSECUTORY The NBI is out to get me DELUSION: RELIGIOUS I am Jesus Christ the savior DELUSION: GRANDEUR I am the queen of the world DELUSION: IDEAS OF REFERENCE The nurses are talking about me CONCRETE ASSOCIATION Also known as pilosopo THOUGHT BLOCKING Unable to think -----------------------HALLUCINATIONS------ ILLUSIONS STIMULUS ------------ ABSENT------------ PRESENT VISUAL ----------------ABSENT------------ PRESENT AUDITORY ----------- ABSENT------------ PRESENT TACTILE ABSENT --ABSENT------------ PRESENT Present reality to clients experiencing hallucinations Technique in handling clients with hallucinations Hallucinations Acknowledgement I know the voices are real to you Reality orientation I know the voices are real but I dont hear them Diversion Lets go to the garden 10% of schizophrenic clients hear voices PARKINSONS DISEASE If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch) ANTI-PSYCHOTIC Decrease dopamine level Parkinson like effect Extra pyramidal side effect With akathesia Restless, inability to rest AKINESIA Muscle rigidity DYSTONIA Torticollis (wryneck) OCULOGYRIC CRISIS Fixed stare OPISTHOTONU S Arched back Lips smacking Tongue protruding Cheeks puffing The 3 are irreversible and called tardive dyskinesia Neuroleptic malignant syndrome hyperthermia ANTI PARKINSON Anticholinergics Dopaminergics (Decrease Ach) (Increase Dopa) Artane, Akineton Parlodel Benadryl Larodopa Cogentin Eldepryl Symmetrel OTHER SIDE EFFECTS OF DECREASE DOPAMINE Photosensitivity Agranulocytosis decrease WBC Clients prone to infection due to decrease WBC First sign for infection is sore throat TYPES OF SCHIZOPHRENIA

DISORGANIZED SCHIZOPHRENIA - Sad but smiles (inappropriate affect) - No reaction (flat affect) - Flight of ideas (disorganized speech) - Giggling (hebephrenic giggle) - Combination of positive and negative signs and symptoms

CATATONIC SCHIZOPHRENIA - Ambivalence - Waxy flexibility - Favorite word is No - Negativism (client do not follow what you tell them to do) Nursing management : meet needs PARANOID SCHIZOPHRENIA - Suspicious - Mistrust, scared, withdrawn Nursing managemen t: - Gain trust by 1 to 1 short interaction but frequent - Foods should be in a sealed container - Medications should be in tamper resistant foil. Violent: - Keep door open - Position near door - Dont touch client - Call for reinforcement - One arms length away from the client. PARANOID SCHIZOPHRENIA - No more positive symptoms just withdrawn UNDIFFIRENTIATED SCHIZOPHRENIA - Mixed classification, cant be classified

PHAMRA NOTES: BI-POLAR, MANIC Lithium: undergo first kidney test and check for blood levels Level: .6 1.2 meq/L Increase urination Tremors, fine hand Hydration of 3L/day Increase Uu (diarrhea) Mouth dry

Signs of Lithium toxicity Nausea, vomiting, diarrhea Increase sodium * Wait for 2 4 weeks before lithium therapy takes effects
BIPOLAR DISORDER/MANIC PROFILE 20 years old Female Stress Obese

ASSESSMENT Decrease appetite (give finger foods) Decrease sleep (place in a private room) Hyperactive Increase sexual activity only means of addressing anxiety so decrease level of anxiety Risk for injury/other directed violence Impaired social interaction (care giver role: strain and stay with client) Self esteem decrease (to cover up their sadness there is compensation to cover defective doing) Because there is decreas e self esteem there will be increase compensation resulting to increase interference with ADLs and harm to oth ers Compensation is the culprit Managemen t: increase self esteem to decrease compensation and decrease interference with ADLs and harm to others
HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS T- no sports (basketball, volleyball), no fine motor skills only gross motor skills A lot energies toward more productive endeavors (sublimation) S - escorted walk outdoors K punching bag (displacement)

PHARMA NOTES: ANTI DEPRESSANTS Asendin Norpralamin Tofranil Sinequan Anafranil Aventyl Vivactil Elavil Prozac Paxil Zoloft ALCOHOL LEADS TO: Blackout: awake but unaware Confabulation: inventing stories to increase self esteem Denial: I am not an alcoholic Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is another term Tolerance: gradual increase in amount of stimuli to experience the same euphoria MANAGEMENT Detoxification: withdrawal with medical doctor supervision Avoid alcohol therapy Aversion therapy a more technical term for avoid alcohol therapy Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting Alcoholics anonymous Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension Alcoholism may result to Vitamin B1 (Thiamine) deficiency WERNICKES ENCEPHALOPATHY Problem with motor

KORSAKOFFS PSYCHOSIS Problem with memory 24 72 hours after last dose of alcohol expect: Delirium Tremens: sympathetic nervous system Prevent hallucinations/Illusions by placing client in a well lit room Formication: feeling of bugs crawling under the skin ALZHEIMERS DISEASE Axon (away) and Dendrites (toward) nerve Neurofibrillary tangles Neurotic plaques --------------------------ALCOHOL --- ALZHEIMERS ONSET -------------------- Abrupt -------- Gradual LEVEL OF CONSCIOUSNESS -- Fluctuating ----Unaffected DURATION ----------- Hours to days --- Progressive MEMORY -------------Short term ---Short and long term 5 As OF ALZHEIMERS 1. Amnesia memory loss 2. Anomia dont know the name 3. Agnosia sensory problems smell, taste, sight 4. Aphasia - expressive: cant say/express - frontal lobe is affected particularly brocas area - receptive: cant hear - temporal lobe is affected particularly wernickes area 5. Apraxia cant do simple things * Reminiscing Therapy talk about past Patients with alzheimers may experience hallucinations, illusions thus becomes restless and may wander As sun goes down client becomes restless, agitated, disoriented called sundowning Drug of choice is Cogn ex and Aricept a cholinesterase inhibitor that increases Ach causing delay in disease progression SEROTONIN Responsible for happiness Decrease serotonin clients becomes sad give anti-depressants SELECTIVE SEROTONIN REUPTAKE INHIBITOR Safest drug Side effects low R I to 4 weeks - Increases serotonin and affects only serotonin - Prozac, Paxil, Zol oft TRICYCLIC ANTI DEPRESSANT Two four weeks C A - Has higher incidence of side effects - Also increases norepinephrine - Asendin, Norpralamin, Tofranil, Sin equan, Anafranil, Aventyl, Vivactil, Elavil MONO AMINE OXIDASE INHIBITORS MAO kills serotonin Increased MAO results to decreased serotonin the more depressed the client becomes MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis Avoid tyramine rich foods Avocado, Alcohol Beer Chocolates, Cheese (aged) Fermented foods Pickles Preserved foods Soy sauce There is increase incidence of side effects after 2 6 weeks Marplan, Nardil, Parnate PERSONALITY DISORDERS 1. Schizophrenia - They avoid people because there is no enjoyment 2. Avoidant - They avoid people because they are afraid of criticisms - They have talent but has no confidence 3. Anti-Social - Constantly breaks law - Project charm - They are witty and articulate - Manipulative 4. Borderline - They perceive life as an empty glass - They like splitting friends - Sudden change in mood labile affect - Prone to suicide 5. Dependen t - Cant live if living is without you 6. Histrioinic - Constantly wants to be the center of attention - Excited, dramatic, manipulative 7. Narcissistic - I love myself - They get jealous even with achievement of family members 8. Obsessive Compulsive - I am so organized 9. Paranoid - Suspicious - May lead to domestic violence ANTI DEPRESSANT SIDE EFFECTS: Male erectile dysfunction, prone to impotence GRIEF PROCESS 1. Denial shock/disbelief 2. Anger question why me? 3. Bargaining if, then 4. Depression 2 weeks or more sign and symptoms becomes major clinical depression 5. Acceptance client acts according to situation ASSESSMENT Decrease self actualization Decrease self esteem Withdrawn: stay with client Suicidal: risk for self directed violence Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge Be sensitive to clients needs FOR SUICIDAL OBSERVE FOR Verbal I wont be a problem This is my last day on earth Ill soon be gone Non verbal Giving away of valuables Sudden change in mood WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO Direct: Do you plan to commit suicide? Irregular/interval visits Endorsement period, early morning clients are most likely to commit suicide DOWNERS Alcohol Barbiturate Opiates Narcotics Marijuana Morphine Codeine Heroine Resulting to: Bradycardia Bradypnea Moist mouth Pupils constrict Constipation Urinary retention Hypotension Coma Weight gain Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride) UPPERS Cocaine Hallucinogens Amphetamines Resulting to: Tachycardia Awake Tachypnea Dry mouth Pupils dilate Hypertension Seizures Weight loss