A patient is diagnosed with an eating disorder when they experience severe disruption in normal eating and disturbance in perception of their body shape and/or weight

Anerexia Nervosia

(restricting)

when a the patient reports no recurrent episodes of bingeing or purging in the last 3 months

Anorexia Nervosa

(bindge eating type)

when the patient reports recurrent episodes of bingeing or purging in the last 3 months

There are multiple causes 

*genetics 

*neurobiology

*Intrapersonal Factors

~low self esteem

~Harsh self judgement

~Adolescent turmoil

~addictive Behaviors

~difficulty/ delayed maturation

~low tolerance for change.

*Gender

*age

*dieting, weight control behaviors

*sports and artistic endevors

*societal influneces

*incidence is difficult to determine.

Individuals from families with eating disorders are 5-10 times more likely to develop an eating disorder 12 times as likely for female relatives

Family Dynamics

of anorexia

*controlling family system

*emphasize perfection, achievememnt and compliance

Are eating disorders more common with females or males?

true or false athletes have more eating disorders

Clinical manifestations of 

Anorexia Nervosa

remember that eating disorders have a _________ component; Assessment findings may not be primarily ________

Disturbed body image: 

Clinical Manifestations
 Anorexia Nervosa

(labs)

Sunken eyes, skeletal appearance

Peripheral edema with advanced starvation

Emaciated/Cachetic

Lanugo growth

Bradycardia, hypotension, arrhythmias

Delayed gastric motility

Hypothyroid-like state

In addition to these physical assessment findings, patients with anorexia nervosa may have a low BMI, mottled cool skin, hypothermia, and prominent parotid glands from bingeing and purging

Generally these patients are obese

The binge eater consumes large amounts of food in one sitting and usually feels guilt for his or her actions later

May be considered a variant of compulsive overeating

May be related to depression as overeating is frequently a sign/symptom of depression

The patient reports binge eating as being soothing and helpful with mood regulation

Diagnosing Binge-Eating Disorder

Episodes are associated with at least three of the following:

modification of the disorder eating and associated mood changes. 

Through cognitive therapy alone and medcation therapy

Eating disorder assessment

( questions)

How often do you get your period?

What changes have there been in your periods?

Anorexics May _____ treatment

Bulimics  _________ eating behavior as abnormal.

If the patient leads you to an eating disorder assessment, then ask questions specifically for that eating disorder.

  diuretics, or diet pills to

  lose weight?

These questions can be asked after initial screening questions leads to the probable diagnosis of an eating disorder

Goals  for eating disorders

Use of highly structured setting with close monitoring to prevent

throwing food away,

falsely increasing weight,

purging

During meals

During weighing

During bathroom visits

Relies on interdisciplinary team approach

Work for normalization of eating patterns

Work toward addressing psychological issues

Nursing Interventions

 an opportunity record thoughts in diary

Diminishes errors in patient thinking/perceiving related to eating disordered behaviors

 Addresses underpinnings of disorder

Group therapy: 

is the drug of choice for treatment of bulimia nervosa but has a black-box warning of increased risk of suicidal ideation

• loss of memory, judgement, and visospatial perception and change in personality

Depth perception

poor judgement

Age :over 65

Family :gene has been identified

Gender: more women than men

Education: lower education higher risk

Race: more Blacks, early for latinos

Head trauma, metabolic disorders , lakc of social net work

Enviroment: toxic metal, zinc and copper, herpes zoster and herpes simplex

Able to compensate for cognitive losses.

severe

very lax facials.

Loss of recognizion of their own belongings.

Apraxia

Anomia

Aphasia

Agnosia

things that may help symptoms of AD

false

Seizures can be triggered by something such as flashing lights, certain smells, medications, and disorders

true or false 

Seizures are unprovoked

Generalized

Partial

Unclassified

Secondary

• Involve both cerebral hemispheres
• 6 types
• tonic/clonic
• tonic
• clonic
• myoclonic
• Atonic
• Absence

• involve one side of the cerebra hemishpere
• 2types
• simple 
• complex

contracting and relaxing with jerking motions

"tense/clicking"

tense still seizure

contracting and relaxing seizure

No jerking

"clicking"

The body goes limp

no tone

postical = confusion

• mostly found in children
• brief periods of LOC with blank stares. 
• if patient was talking he/she will either stop suddenly or slow down with speak dramatically and it won't make sense
• May have automatisms

These are also called local or focused seizures.

2 types

• complex 
• simple

• LOC (syncope) or a black out for 1-3 mins. 
• may occur during absent seizures.
• Patient is unaware of enviroment and may wander at the start of the seizure.
• Patient may experience memory loss
• Also called temoral lope seizure or psychomotor seizure.

• Patient is concious during this seizure
• During patient may experience unusual sensation, or autonomic symptoms (change in heart rate, skin flushing, and epigastric discomfort)

seizure results from underlying brain lesion , most commonly a tumor or trauma. Also could be cause by 

• Metabolic disorders
• Acute alcohol withdrawl
• Electrolyte disturbances ( hyperkalemia, H2O intoxification, hypoglycemia)
• high fever
• CVA
• Head trauma
• Substance abuse
• heart disease

(not caused by epilepsy) 

• O2
• suction
• stable Airway
• IV access
• side rails up ( if facility policy)
• NO tongue blades

• depends on type of seizure
• observations and documention
• Patient safety
• side- lying position
• NO restraints
• NO tongue blades

-PAMS [Lorazepam (ativan), Diazepam (valium)]

-Diastat

-IV pheytonin(dilantin) or fosphenytoin( cerebyx)

Call 911 or Rapid response!!!!

what is the signifigance of these durin status epilepticus?

• IV push of lorazepam or diazepam
• rectal diazepam
• Loading dose IV phenytoin

Last ditch effort for seizures is what?

the most common psychotic diorder of the brain

• causes lengthy hospital stays.
• family distruction
• costs a lot of money.

• Genetics
• prenatal factors
• Advanced paternal age

• Identical twins have a higher riskof schizo.
• If mom or dad has it the child may have it 
• if both parents have it the child has a 50% chance of having schizo

• Brain atrophy over time
• Blod flow is decreased
• Blood glucose is decreased

• As many as 50 % of schizo's have problem with nicotine, ETOH and drugs
• Suicide (40-50% have suicidal ideations)
• Anxiety disorders ( very nervous and paprnoid)
• Late onset of Schizo = higher risk for alzheimer's

• Hallucinations(auditory)
• Delusions (disorganized thinking)
• Disprganized speech ( loose association)
• Bizarre behavior( hyperative, appearance ,suspiciousness ,hostility)

• behavioral 
• Affective
• sensory overload
• Social

somatic

Mixed

Presecutory

Jealous

Grandiose

Erotomatic

• Good premorbid adjustment
• Latter age at onset
• Being female
• Abrupt onset precipitated by a stressful event
• good inter-episode
• brief duration of active-phase symptoms

Extremes of behavior. Can be unable to move, speak or respond

- dramatic reduction in activity where virtually all movements stop ( catatonic stupor) 

- other end can be over excited or hyper active, mimicking sounds or movements around them. Often referred to (catatonic excitement)

residual type schizo

Thorazine , mellaril, proloxin, haldol

These drugs only effected the positive symptoms of schizo

what reverses EPS?

and is given IM

this drug treats the negative and positive symptoms of schizo.

Clorazil, geodon, risperda, serquel, zyprexa

• antipsychotics that end in done
• treat - and + schizo symptoms
• will gain weight in the first 6 weeks of treatment

• drug that end in pine for schizo
• treats - and+ symptoms of schizo
• weight gain in the first 6 weeks fo treatment 
• treats mood and cognition disturbances
• causes metabolic issues

The ACT team. 

This treatment is for chronic relapse patients

• they go where a patient needs them and when the patient needs them.