Exam 4

Question 1

somatic d/o examples (4)

Answer 1

-somatic symptom d/o
-illness anxiety d/o
-functional neurological symptom d/o
-factitious d/o (Munchausen’s)

Question 2

somatic symptom d/o pathway

Answer 2

1) anxiety leads to
2) chest pain leads to
3) thinking that they are having a heart attack

Question 3

somatic d/o nursing role

Answer 3

-take somatic complaints seriously
-pursue tx until medical issues are ruled out

Question 4

illness anxiety d/o pathway

Answer 4

1. saw a man cough at the grocery store
2. and I am deathly afraid of ebola
3. therefore, no more grocery store for me

Question 5

functional neurological symptom d/o (aka conversion d/o)

Answer 5

-neurological d/o w/unknown etiology
-symptoms manifest that affect nervous system

Question 6

factitious d/o / Munchausen

Answer 6

-symptom deception
-convincing others of illness or injury
-exaggerating sx
-making up hx
-faking sx
-self harm

Question 7

Munchausen by proxy

Answer 7

-projecting sx onto another
-usually children or family member
-identify potential for child abuse

Question 8

dissociative disorders

Answer 8

-disconnecting from reality
-re-experiencing trauma
-unconscious protection from the trauma

Question 9

dissociative d/o diagnoses examples (4)

Answer 9

-depersonalization
-derealization
-dissociative amnesia
-dissociative identity d/o

Question 10

dissociative amnesia (3)

Answer 10

-no recollection of traumatic event
-missing memories
-“blacked out”

Question 11

dissociative identity d/o

Answer 11

-protective mechanism
-belief of multiple people living in same body
-switching to different identities

Question 12

How dissociative identity d/o is protective

Answer 12

-individual is traumatized
-individual struggles w/ sx
-individual develops new identity that never experienced the trauma
-individual switches to new identity as coping mechanism

Question 13

depersonalization / derealization

Answer 13

• trauma-related
  -detachment from physical body
  -out-of-body expereinces
  -emotional disconnection

Question 14

Tx for somatic d/o

Answer 14

-psychotherapy
-psychopharm
-CBT/DBT

Question 15

What to focus on as a nurse

Answer 15

-ensure safety
-sx presentation
-differentiation of diagnoses
-therapeutic communication
-client education

Question 16

healthy eating (4)

Answer 16

-variety of foods
-response to hunger
-stop when full
-no guilt or anxiety

Question 17

eating d/o (5)

Answer 17

-disruption to any component of healthy eating
-binge eating
-not eating enough
-only eating certain foods
-experiencing guilt or anxiety related to eating

Question 18

warning signs for eating d/o (6)

Answer 18

-unexplained obvious weight loss/gain
-lying about food/eating
-secret eating/bingeing
-excessive exercise
-pre-occupation with weight and body image
-fear of fat

Question 19

major classes of eating d/o (3)

Answer 19

-anorexia nervosa
-bulimia nervosa
-binge eating d/o

Question 20

other eating d/o related d/o

Answer 20

-pica
-avoidant restrictive food intake d/o
-orthorexia
-rumination
-diabulimia

Question 21

eating d/o risk factors

Answer 21

-anxiety, depression, SUD, OCD
-avoidant personality d/o, borderline personality d/o
-family hx
-culture, occupation, abuse

Question 22

populations that tend to have eating d/o more often

Answer 22

-mostly female (10:1 female to male)
-transgender
-veterans

Question 23

eating d/o complications

Answer 23

-diabetes
-DKA
-electrolyte disruptions
-osteoporosis
-dental problems
-kidney failure
-cardiac dysfunction
-skin issues
-menstrual disruption

Question 24

anorexia nervosa characterized by:

Answer 24

-intentional starvation
-restriction of calorie intake relative to need
-decreased weight/BMI

Question 25

anorexia: mental components

Answer 25

-fear of weight gain -aversion to high calories foods -body image issues -inability to recognize low body weight

Question 26

anorexia presentation

Answer 26

-thin -emaciated -hypotension -bradycardia -dysrhythmias -dehydration -dry skin -decreased bone density -muscle weakness -menstrual irregularity or absence

Question 27

anorexia lab expectations

Answer 27

-electrolyte imbalance -anemia -neutropenia -hypoglycemia

Question 28

psych presentation of anorexia (7)

Answer 28

-negative, self-defeating patterns -polarized thinking -emotional reasoning -catastrophizing -control fallacies -mind reading -trouble concentrating

Question 29

bulimia nervosa characteized by:

Answer 29

episodes of purging -vomiting -use of laxatives -use of medications -excessive exercise on average at least once a week for 3 months

Question 30

bulimia presentation

Answer 30

-can have normal weight -GI issues -dental issues -lab values off -enlarged parotid gland -Russell's sign

Question 31

bulimia lab results (2)

Answer 31

-electrolyte imbalance -acid/base disturbance

Question 32

bulimia psych expectations

Answer 32

-secretive food practices -going straight to the bathroom after meals

Question 33

Binge Eating d/o characterized by:

Answer 33

-episodes of binge eating -at least once per week for 3 months -not associated with purging

Question 34

binge eating criteria (need 3 or more)

Answer 34

-eating much more rapidly than normal -eating until feeling uncomfortably full -eating large amounts of food when not feeling physically hungry -eating alone because of feeling embarrassed by how much one is eating -feeling disgusted with oneself, depressed, or very guilty afterwards -marked distress regarding binge-eating is present

Question 35

binge eating assessment

Answer 35

-nutritional deficiencies -GI disturbances -Weight gain/obesity -bowel issues -HTN -heart disease

Question 36

psych expectations with binge eating

Answer 36

-depression -anxiety -feelings of guilt, shame, and embarrassment -low self-esteem -global cognitive impairments -decreased inhibitory control -addictive style of thinking

Question 37

nurse considerations

Answer 37

-trust building -careful monitoring -consider physical manifestations

Question 38

nursing priorities for binge eating

Answer 38

-safety (risk for SI/SA) -medical stability -cardiac, neuro, etc. -psychosocial (mood, affect, socialization) -education (treatment options, meds, nutrition, resources)

Question 39

refeeding syndrome

Answer 39

-massive shift in electrolytes -CV decompensation -deadly

Question 40

eating d/o tx (6)

Answer 40

-typically specialized units -extended stay (30+ days) -specific to eating d/o -group meals -careful monitoring -special training to identify patterns in behavior

Question 41

monitoring meals

Answer 41

-meals must be eaten within a specific time frame -everything on tray should be eaten -supplements may be provided -strict calorie count -watch for smearing, hiding of food

Question 42

other behavior monitoring for eating d/o

Answer 42

-remain visible for 1-2 hrs after meals -daily weights

Question 43

therapy options for eating d/o

Answer 43

-CBT -DBT -Acceptance Commitment Therapy (ACT)