Mental Health
Cognitive Disorders, Dissociative Disorders,
Personality Disorders and Eating Disorders
Cognitive Disorders
These are disorders that distort one’s thought

process.
Not traditionally considered mental disorde...
Factors That Influence Cognition
Factors that my influence cognition
Sensory changes/diseases associated with age can
cau...
Cognitive cont’d
Major losses that individuals face with aging
Physical and cognitive functioning
Societal changes
Empl...
Cognitive cont’d
Intrinsic factors that influence aging clients ability to
cope with stress
Personality
Attitude
Past l...
Cognitive cont’d
Extrinsic factors that influence the aging clients ability
to cope with stress
Financial status
Family ...
Cognitive cont’d
Most common psychiatric problem among the

elderly is depression, suicide and substance abuse
Depressio...
Dementia
This is a progressive irreversible loss of cognitive

functioning that impairs a person’s ability to function
in...
Aphasia- deterioration of language function.
Apraxia- impaired ability to perform motor function

even though motor abil...
Sundowning
A term used to describe the increase confusion noted

in patients with Alzheimer’s disease (AD)
Usually occur...
Dementia Types
Alzheimer’s disease is the most common type of

dementia
Symptoms begin gradually with impaired memory
th...
Phases of Alzheimer’s
Early stage-may go unnoticed, many may mistake for

“normal part of aging”, lasts 2-4 years, charac...
S&S dementia
Dementia – impairments in memory, judgment,

ability to focus, and ability to calculate
Impairments do not ...
Risk of Developing Alzheimer’s
Person’s age- usually occurs over 65, by 85 years of

age risk of developing Alzheimer’s i...
Dementia/Alzheimer’s-Nursing Considerations
Avoid sensory overload-sundowning
Speak calmly and slowly
Provide nonthreat...
Delirium
Delirium acute/temporary condition that develops

quickly
Often in response to prescription medications,
alcoho...
S&S-Delirium
Impairments in memory, judgment, ability to focus,

calculate, may fluctuate throughout the day
LOC is usua...
Conditions That Can Cause Delirium
 Untreated hypothyroidism
 Cushing’s syndrome
 Malnutrition
 Dehydration
 Infectio...
Contrast Delirium/Dementia
Differentiate between dementia and delirium
 Dementia-chronic, progressive deterioration –usu...
Contrast Delirium/Dementia
Delirium – caused secondary to another medical

condition, such as infection or to substance a...
Outcome: delirium/dementia
Delirium – reversible if diagnosis and treatment are

prompt
Dementia – Irreversible and prog...
Amnestic disorder
Group of disorders that involve loss of memories

previously established/loss of the ability to create
...
Amnestic disorders
Characterized by problems with memory function
Problems remembering previously learned

information v...
Substance-induced amnestic disorder
Can be caused by alcoholism, long-term heavy drug

use, exposure to toxins such as le...
Symptoms
Often disoriented with respect to time and space
Lack insight into their loss of memory
Undergo a personality ...
Diagnosis
Mini- mental state examination or MMSE
Treatment – No treatments have been proved

effective. Many patients re...
Dissociate Disorders
Very rare
Believed that ideas split off from the personality and

become buried in the unconscious....
Cause
Believed anxiety or severe psychological trauma is

the underlying cause.
People who develop the ability to dissoc...
Types of dissociate disorders
Psychogenic amnesia
Sudden inability to recall personal information as a
result of some phy...
Psychogenic Fugue
Suddenly will leave town/take new identity
Does not appear confused or disoriented
Usually short live...
Depersonalization disorder
Usually affects people under 40
Remains oriented to person, place, time but

perception of re...
Multiple Personality disorder aka Dissociative
Identity Disorder
2 or more completely separate personalities exist

withi...
Multiple Personality Disorder
Current thinking is that cause is some horrible

trauma early in live that caused the other...
Medical treatment
Antianxiety, sedatives, mood elevators,

antidepressants, psychotherapy, hypnotherapy
Nursing interven...
Nursing Interventions
Keep communication open, encourage pt to

verbalize thoughts feelings and concerns; observe
for sig...
Personality Disorders
 Personality disorders are not considered to be the same as

mental disorders
 Diagnosing these re...
Types of Personality Disorders
ParanoidSchizoidSchizotypal
AntisocialBorderlineHistrionicNarcissisticAvoidantDepe...
Histrionic
 Excessive emotionality and attention-seeking
 Need to be center of attention
 They will create scenes to dr...
Histrionic
These people do not often seek mental help
They develop a negative self concept
Treatment is based on focusi...
Borderline Personality Disorder
 Quite common seen more frequently in females, 75%
 Display erratic behavior
 Behaviora...
Borderline Personality Disorder
No medication available
Commonly associated with depression-Treat the

depression
The f...
Paranoid Personality
Behaviors of suspiciousness and mistrust
Seem “normal” in speech/activity but feel they are

treate...
Paranoid Personality
Seem cold and calculating in their relationships
Take comments, events and situations very seriousl...
Paranoid Personality
Difficult to treat because personalities are resistant

to change
Many with this disorder lack the ...
Schizoid Personality
Schizoid Personality
Do not want to be involved in interpersonal or social
interactions
Very few if...
Schizoid Personality
Believed ineffective/unemotional parenting may

lead to this
So quiet that the disorder often goes ...
Schizoid Personality
They experience little positive emotion and want to

isolate themselves
Its unrealistic to think th...
Dependent Personality
Is defined as a pervasive pattern of dependent

and submissive behavior
Want others to make decisi...
Dependent Personality
Inordinate amount of fear. Cold be of criticism that

brings about the inability to have meaningful...
Dependent Personality
Help the patient make decisions for themselves

without giving advice how to act
Long term psychot...
Narcissistic Personality
Behaviors almost opposite to those with schizoid

personality disorder
Display an exaggerated i...
Narcissistic Personality
For example, may be bus driver of NY Yankees, but

they present themselves as part of the actual...
Narcissistic Personality
People are only seen for this when they are admitted

for something else
Nurses find it hard to...
Passive-Aggressive Personality
Presents with passive type behaviors
Procrastinators
Pout/irritable when asked to perfor...
Antisocial/Sociopathic Personality
High risk for substance abuse
Grow from family life with few or inconsistent limits,
...
Antisocial/Sociopathic Personality
Causes greatest amount of trouble for society
Often in trouble with law/in prison
Ha...
Antisocial/Sociopathic
…exhibited as “flashers” or serial killers
Frequently highly intelligent
Very difficult to treat...
Obsessive Compulsive Personality Disorder
 Characterized by a preoccupation with orderliness, perfectionism, and

mental ...
Obsessive Compulsive Personality Disorder
Long term therapy is the only effective therapy
Patients with this disorder wi...
OCPD vs OCD
 Key differences
 OCD symptoms change with severity over time, OCPD

reflects and overly rigid personality t...
Eating disorders
Serious/can be fatal d/t malnutrition /electrolyte

disturbances
May be related to emotional/physical c...
Anorexia Nervosa
Aversion of food, desire to avoid something can

cause death and malnutrition
Preoccupied with food, ri...
Anorexia Nervosa
Sleeping very little
Distorted body image
Occurs more in women than men, men are not

exempt!
Also ty...
Bulimia Nervosa
Binge eating. Can consume up to 50,000 calories

per day, followed by forced vomiting
Extreme dieting
U...
Bulimia Nervosa
Thoughts of harming self, possibly suicide
Impulsiveness
Erosion of teeth enamel or hoarseness from

vo...
Risk factors
Family genetics
Interpersonal relationships, parental pressure
Psychological influences-rigidity, ritualis...
Nursing Care of Patients with Eating
Disorders
 Promote positive self concept, gain trust and give positive

reinforcemen...
Nursing Care for Patients with Eating Disorder
 Check and be aware of electrolyte levels, hypokalemia,

anemia, possible ...
6.cog  dis-per-eat disorder
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6.cog dis-per-eat disorder

  1. 1. Mental Health Cognitive Disorders, Dissociative Disorders, Personality Disorders and Eating Disorders
  2. 2. Cognitive Disorders These are disorders that distort one’s thought process. Not traditionally considered mental disorders, however, they are included; many signs and symptoms are similar to those found in mental illness These disorders include:    Delirium Dementia Amnesic disorders
  3. 3. Factors That Influence Cognition Factors that my influence cognition Sensory changes/diseases associated with age can cause misinterpretation of information Pain from chronic diseases Sleep deprivation make it difficult to perform routine tasks Medications side effects
  4. 4. Cognitive cont’d Major losses that individuals face with aging Physical and cognitive functioning Societal changes Employment status Societal and family roles Shift from independence to dependence
  5. 5. Cognitive cont’d Intrinsic factors that influence aging clients ability to cope with stress Personality Attitude Past life experiences Desire to adapt to change
  6. 6. Cognitive cont’d Extrinsic factors that influence the aging clients ability to cope with stress Financial status Family support Support provided by those who directly care for the patient
  7. 7. Cognitive cont’d Most common psychiatric problem among the elderly is depression, suicide and substance abuse Depression can be reversed with prompt identification and treatment Dementia a more permanent progressive deterioration of mental functioning
  8. 8. Dementia This is a progressive irreversible loss of cognitive functioning that impairs a person’s ability to function in social or occupational situations. All dementias are characterized by multiple cognitive deficits In order to diagnose dementia, memory impairment plus one other evidence of cognitive function must be present.
  9. 9. Aphasia- deterioration of language function. Apraxia- impaired ability to perform motor function even though motor abilities and sensory functions are intact. Agnosia- failure to recognize or identify familiar common objects despite having intact sensory function. Disturbance of executive function- inability to think abstractly or to use critical thinking to plan, initiate, sequence, monitor, and stop complex behavior.
  10. 10. Sundowning A term used to describe the increase confusion noted in patients with Alzheimer’s disease (AD) Usually occurs in the late afternoon or evening. Increased pacing and irritability The dimming of light perceptual problems worsendimming of light casts shadows and may make the patient frightened. Patient is tired at the end of the day and does not handle stress well.
  11. 11. Dementia Types Alzheimer’s disease is the most common type of dementia Symptoms begin gradually with impaired memory that progresses to language and motor function losses Physical changes can be seen in the brain Primary goal of any type of dementia is to maintain and OPTIMAL LEVEL OF FUNCTIONING with physical and emotional safety…………………….
  12. 12. Phases of Alzheimer’s Early stage-may go unnoticed, many may mistake for “normal part of aging”, lasts 2-4 years, characterized by mild forgetfulness Middle stage- usually the longest, 2-10 years. Memory loss and confusion increase. Difficulty recognizing family and friends. May be restless in the afternoon, and may start to wander. Late stage- may last 1-3 years. Patient is disoriented to self and family. Speech is nonsensical. Infantile behavior, may forget how to swallow. Death.
  13. 13. S&S dementia Dementia – impairments in memory, judgment, ability to focus, and ability to calculate Impairments do not change throughout day LOC is usually unchanged Restlessness, agitation common, sun downing may occur but behaviors usually remain stable  Personality change is gradual VS stable unless other illness is present
  14. 14. Risk of Developing Alzheimer’s Person’s age- usually occurs over 65, by 85 years of age risk of developing Alzheimer’s increases 50% Family history- especially if family member is a 1 st degree relative------1.5 to 2 times as likely to develop disease. History of Down syndrome, head injury, low educational status, and occupational level. Being female History of small strokes, Parkinson’s, African American heritage, environmental toxins, high fat diet, lack of exercise, and stress.
  15. 15. Dementia/Alzheimer’s-Nursing Considerations Avoid sensory overload-sundowning Speak calmly and slowly Provide nonthreatening therapeutic touch Attempt reality orientation or validation Make sure patients exercise Don’t give caffeine products in the evening Listen attentively Watch for risk of wandering Help with self care such as bathing
  16. 16. Delirium Delirium acute/temporary condition that develops quickly Often in response to prescription medications, alcohol, exposure to some toxic environmental substances, fever of systemic illness. People may feel frightened, anxious and confused, and they may also experience hallucinations Delirium may cause other problems increasing the rate of morbidity May progress to the point where patients need to be put into long term care
  17. 17. S&S-Delirium Impairments in memory, judgment, ability to focus, calculate, may fluctuate throughout the day LOC is usually altered Restlessness agitation common, sun downing, personality change is rapid, hallucinations and illusions may be present VS may be unstable and abnormal due to medical illness
  18. 18. Conditions That Can Cause Delirium  Untreated hypothyroidism  Cushing’s syndrome  Malnutrition  Dehydration  Infections  Hypoxia  Falls  Pain  Terminal illness  Drug or alcohol abuse  Grief  Relocation to an unfamiliar environment
  19. 19. Contrast Delirium/Dementia Differentiate between dementia and delirium  Dementia-chronic, progressive deterioration –usually severe memory loss disorientation, impairments with attention judgment, inability to take in and use new information.  Symptoms severe enough to interfere with pts ADLS. Not part of normal aging. Involves physical changes in brain and damage usually irreversible Onset: delirium – rapid over short period of time (hrs or days) Dementia/Alzheimer’s – gradual deterioration of function over months or years
  20. 20. Contrast Delirium/Dementia Delirium – caused secondary to another medical condition, such as infection or to substance abuse Dementia – generally caused by chronic disease/Alzheimer's or result of chronic alcohol abuse; May be caused by permanent trauma, such as head injury
  21. 21. Outcome: delirium/dementia Delirium – reversible if diagnosis and treatment are prompt Dementia – Irreversible and progressive
  22. 22. Amnestic disorder Group of disorders that involve loss of memories previously established/loss of the ability to create new memories; loss of the ability to learn new information Results from two basic causes: general medical conditions that produce memory disturbances and exposure to chemical
  23. 23. Amnestic disorders Characterized by problems with memory function Problems remembering previously learned information vary widely according to location and the severity of the brain damage Amnestic disorder due to general medical condition can be caused by head trauma, tumors, stroke or other cerebrovascular disease.
  24. 24. Substance-induced amnestic disorder Can be caused by alcoholism, long-term heavy drug use, exposure to toxins such as lead, mercury, carbon monoxide, certain insecticides. Amnestic disorder caused by alcoholism, the thought is the root of the disorder is a vitamin deficiency that is commonly associated with alcoholism, known as Korsakoff’s syndrome.
  25. 25. Symptoms Often disoriented with respect to time and space Lack insight into their loss of memory Undergo a personality change Some confabulate (they fill in memory gaps with false information that they believe to be true). Not to be confused with intentional lying TGA (transient global amnesia) often appear confused or bewildered
  26. 26. Diagnosis Mini- mental state examination or MMSE Treatment – No treatments have been proved effective. Many patients recover slowly over time
  27. 27. Dissociate Disorders Very rare Believed that ideas split off from the personality and become buried in the unconscious. Results in overuse of the defense mechanism of dissociation. Not aware that they have until it is brought to their attention
  28. 28. Cause Believed anxiety or severe psychological trauma is the underlying cause. People who develop the ability to dissociate are thought to have created the other personalities or condition in an effort to separate from their severe emotional pain.
  29. 29. Types of dissociate disorders Psychogenic amnesia Sudden inability to recall personal information as a result of some physical or psychological trauma Symptoms include: wandering, confusion, and disorientation Condition is usually temporary
  30. 30. Psychogenic Fugue Suddenly will leave town/take new identity Does not appear confused or disoriented Usually short lived Lasts a few hrs to few days Usually follows some sort of severe stress/is often triggered by ETOH use Reverses quickly with therapy most of x Rare for condition to recur
  31. 31. Depersonalization disorder Usually affects people under 40 Remains oriented to person, place, time but perception of reality has changed Perceptual change may relate to person’s identity or to parts of the body Quite possible for pt to attempt suicide Can coincide with other disorders such as schizophrenia, personality disorders and seizure disorders
  32. 32. Multiple Personality disorder aka Dissociative Identity Disorder 2 or more completely separate personalities exist within one body Usually quite opposite from the dominant or primary personality so differently that they can be different sexes, different medical diagnosis Primary personality has no knowledge of the other parts, or “Alters” but other personalities are aware of and know each other well even the primary personality
  33. 33. Multiple Personality Disorder Current thinking is that cause is some horrible trauma early in live that caused the other parts to develop Frequently this trauma is r/t physical or sexual abuse/ split developed as mechanism to escape the pain and guilt of what happened Goal of tx to integrate the personalities into one personality or into as few as possible. This can take years to work
  34. 34. Medical treatment Antianxiety, sedatives, mood elevators, antidepressants, psychotherapy, hypnotherapy Nursing interventions – Develop therapeutic relationships; consistent, recognize mood and behavior, safe, structured environment; educate pt and family about disorder; focus on short term goals as it is believed that several small successes will help integrate the personality into a better, healthier state.
  35. 35. Nursing Interventions Keep communication open, encourage pt to verbalize thoughts feelings and concerns; observe for signs of suicidal behavior; document any changes in behavior. Careful nursing assessment and communication skills are important tools
  36. 36. Personality Disorders  Personality disorders are not considered to be the same as mental disorders  Diagnosing these requires and evaluation of the person’s long-term patterns of functioning  For a personality disorder to be present, the individual symptoms cannot be caused by a general medical condition or by substance abuse  The personality characteristic must have persisted since the patient was an adolescent or young adult  Personality traits and environmental experiences in childhood contribute to the development of personality disorders
  37. 37. Types of Personality Disorders ParanoidSchizoidSchizotypal AntisocialBorderlineHistrionicNarcissisticAvoidantDependentObsessive Compulsive
  38. 38. Histrionic  Excessive emotionality and attention-seeking  Need to be center of attention  They will create scenes to draw attention to themselves  Appearance is inappropriate and sexually provocative  Behave seductively at work and socially  Spent a lot of time/money on clothes, jewelry, grooming  Strong opinions such as “my dog is the greatest of his breed”, “that nurse is the most insensitive person in the world”  They may embarrass friends with being too intimate, sobbing uncontrollably, or having temper tantrums  Overly trusting of powerful people  Control others with emotional manipulation
  39. 39. Histrionic These people do not often seek mental help They develop a negative self concept Treatment is based on focusing on themselves for problem solving rather than expecting others to fulfill all their needs
  40. 40. Borderline Personality Disorder  Quite common seen more frequently in females, 75%  Display erratic behavior  Behavioral responses are unpredictable, difficult to approach as it is uncertain how they may interpret you.  Have a pattern of intense and unstable relationships  Unstable self image  Impulsiveness  Extreme fear of abandonment- may injure themselves to prevent abandonment  Unstable emotions- mood is very reactive
  41. 41. Borderline Personality Disorder No medication available Commonly associated with depression-Treat the depression The first priority in treatment is no self harm The treatment is long term treating behavior and dysfunctional mood.
  42. 42. Paranoid Personality Behaviors of suspiciousness and mistrust Seem “normal” in speech/activity but feel they are treated unfairly Hypersensitive to activity in their environment Difficulty maintaining focused eye contact, always looking around them Take themselves very seriously
  43. 43. Paranoid Personality Seem cold and calculating in their relationships Take comments, events and situations very seriously May not be people that endear themselves to nurses Do not confuse with paranoid schizophrenia Unlike paranoid schizo, do not have hallucinations or delusions, they are suspicious of other people and situations
  44. 44. Paranoid Personality Difficult to treat because personalities are resistant to change Many with this disorder lack the insight to know that they have a problem Long term goal is for the client to have increased flexibility and trust Long term psychotherapy People with paranoia are often aggressive, but that is only masking the fear and insecurity on the inside
  45. 45. Schizoid Personality Schizoid Personality Do not want to be involved in interpersonal or social interactions Very few if any social interactions
  46. 46. Schizoid Personality Believed ineffective/unemotional parenting may lead to this So quiet that the disorder often goes unnoticed Tend to be very intellectual/quite successful in their career partly because they become engrossed in their jobs as aversion to social interactions May appear to be shy and introverted Trouble developing friendships
  47. 47. Schizoid Personality They experience little positive emotion and want to isolate themselves Its unrealistic to think they will be socially active, instead focus on activities that will provide satisfaction for the patient
  48. 48. Dependent Personality Is defined as a pervasive pattern of dependent and submissive behavior Want others to make decisions for them/tend to feel inferior/suggestible with a sense of self doubt Avoid responsibility Take everything to heart/go out of their way to satisfy people they feel close to/try to change those personality traits that people criticize
  49. 49. Dependent Personality Inordinate amount of fear. Cold be of criticism that brings about the inability to have meaningful social interactions Inability to make decision could be severe enough to limit a person’s ability to have meaningful social interactions Nurses must be cautioned here because behaviors that have been discussed as symptomatic of dependent personality disorder are behaviors/conditions that are expected in certain cultures, especially among females
  50. 50. Dependent Personality Help the patient make decisions for themselves without giving advice how to act Long term psychotherapy is needed for treatment
  51. 51. Narcissistic Personality Behaviors almost opposite to those with schizoid personality disorder Display an exaggerated impression of themselves, not as bad as seen with bipolar disorder Appear very self centered/express need to feel grand self importance
  52. 52. Narcissistic Personality For example, may be bus driver of NY Yankees, but they present themselves as part of the actual team. Do not take criticism lightly. However, in reality deep feelings of anger, resentment and poor self-esteem are being repressed
  53. 53. Narcissistic Personality People are only seen for this when they are admitted for something else Nurses find it hard to relate to these patients because they are often arrogant Direct communication is needed with these patients with clear expectations and limits Treatment is developing coping skills that involve independent problem solving without exploitation of others
  54. 54. Passive-Aggressive Personality Presents with passive type behaviors Procrastinators Pout/irritable when asked to perform a task they do not wish to do ALWAYS have excuse for their behavior Believed this is result of ineffective parenting, result of overbearing and high expectations of the child. Child grows up resenting authority and compensates by being defiant to control environment.
  55. 55. Antisocial/Sociopathic Personality High risk for substance abuse Grow from family life with few or inconsistent limits, authoritarian parenting style that does not include guidelines for appropriate social behavior Usually gregarious, intelligent, likeable, will not have many satisfying sexual relationships which can lead to maladaptive behavior
  56. 56. Antisocial/Sociopathic Personality Causes greatest amount of trouble for society Often in trouble with law/in prison Have difficulty handling frustration and anger, seldom feel affection, loyalty, guilt, or remorse, showing very little concern for rights or feelings of anyone else
  57. 57. Antisocial/Sociopathic …exhibited as “flashers” or serial killers Frequently highly intelligent Very difficult to treat Medical Treatments for Pts with Personality Disorders Difficult to treat as they do not think they have a problem Often leave treatment if confronted with a problem Treatment should be focused on anger management and doing no harm to others
  58. 58. Obsessive Compulsive Personality Disorder  Characterized by a preoccupation with orderliness, perfectionism, and mental and personal control.  So controlled that they cannot be flexible, open, or efficient  Painstaking attention to rules, trivial details, lists, and schedules until main point of project is lost.  Hobbies are treated like jobs with meticulous detailed requirements  Play becomes work or a lesson  Unable to throw things away  Everything has to BE DONE THEIR WAY!!!!  Expression of emotion is tightly controlled, they are uncomfortable around people who are emotionally expressive
  59. 59. Obsessive Compulsive Personality Disorder Long term therapy is the only effective therapy Patients with this disorder will often seek help with anxiety Coping, sleeping, interpersonal relationships are a focus for the patient
  60. 60. OCPD vs OCD  Key differences  OCD symptoms change with severity over time, OCPD reflects and overly rigid personality that does not change much over a person’s lifetime  OCPD and OCD might both carry out repetitive behaviors, but the underlying motive is very different  OCD will repeatedly write out lists or organize items, OCPD will do these activities to increase their efficiency or productivity  OCD people want to get rid of their symptoms, OCPD see nothing wrong with their behavior and feel that other people are the problem
  61. 61. Eating disorders Serious/can be fatal d/t malnutrition /electrolyte disturbances May be related to emotional/physical causes Females who have anorexia seem to have negative feelings toward their mothers State mothers are overbearing and dominant Mortality rate for disorders is high and suicide is also a risk
  62. 62. Anorexia Nervosa Aversion of food, desire to avoid something can cause death and malnutrition Preoccupied with food, rituals of eating, voluntary refusal to ear Morbid fear of obesity Excessive weight loss usually >25% of body weight before dieting Obsessive thoughts Excessive exercising Absence of Menstrual periods
  63. 63. Anorexia Nervosa Sleeping very little Distorted body image Occurs more in women than men, men are not exempt! Also typically in adolescents
  64. 64. Bulimia Nervosa Binge eating. Can consume up to 50,000 calories per day, followed by forced vomiting Extreme dieting Use/abuse of laxatives, diuretics, ipecac Obsession with food and eating Extreme sensitivity to body shape and weight
  65. 65. Bulimia Nervosa Thoughts of harming self, possibly suicide Impulsiveness Erosion of teeth enamel or hoarseness from vomiting Purging type Non purging type – use excessive, laxatives, etc
  66. 66. Risk factors Family genetics Interpersonal relationships, parental pressure Psychological influences-rigidity, ritualism, feelings of ineffectiveness, helplessness, depression Environmental factors – pressure from society Family eating patterns and individual history Men-participation in athletes especially where lean body build is prized, wrestling
  67. 67. Nursing Care of Patients with Eating Disorders  Promote positive self concept, gain trust and give positive reinforcement for progress the pt makes.  Promote healthy coping skills.  Promote adequate nutrition.  Small, frequent meals are tolerated better  Nursing hx to include pt’s perception of problem, eating habits, hx of dieting, methods of weight control, value attached to specific shape and weight, interpersonal and social functioning, difficulty with impulsivity as well as compulsivity. 2 questions to ask, 1) do you eat in secret? 2) are you satisfied with your eating patterns.
  68. 68. Nursing Care for Patients with Eating Disorder  Check and be aware of electrolyte levels, hypokalemia, anemia, possible impaired liver function in anorexia. In bulimia, hypokalemia, hyponatremia  Cardiac dysrhythmias, severe bradycardia, hypotension may occur with malnutrition  Re-feeding syndrome-circulatory collapse when a pt completely compromises cardiac system is overwhelmed by a replenished vascular system after normal intake resumes, therefore implement re-feeding over at least 7 days and carefully monitor electrolytes
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