Eating Disorders, Substance Abuse, and End-of-Life Care, Exercises of Public Health

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Mental Final Exam Review Chapter 18: Eating and Feeding Disorders. Anorexia : Restricting calories. Panic/fear of gaining weight Want to have control, perfectionist (school, work). Treatment: When talking to them, do not make comments about weight. Best results when in multiple therapies, individual, group, couples, family therapy. When stable (goal weight)- antidepressant Fluoxetine. Criteria : Restrictions in calories leading to underweight, intense fear of gaining weight that interfere with gaining weigh even though they are already underweight, disturbance in way they view their own body Bulimia : Depression, chaotic homelife, not much control, poor self-esteem. Binges then will have some type of behavior to "cancel out the calories" - purging, intense exercise, laxatives, diuretics. Can have history with anorexia. Clinical signs- dental erosion, Russel Signs, callouses on knuckles. Fluoxetine prescribed right away, usually higher starting dose. Criteria : Recurrent episodes of binge eating, recurrent episodes of compulsivity behaviors to cancel out what they’ve ate, must happen at least once a week for 3 months, self-evaluation is based on body image, does not happen only when anorexia is present. Binge Eating Disorder: Binge eat but no behavior to counteract food. Depression, poor self-esteem. Comments like they feel like they're losing control, when they're eating something takes over, can't control it, shame, and guilt. Poor coping, use binge eating as coping mechanism. Binge eating to make them feel better, then they feel negative thoughts and feelings about themselves. Criteria : Eat in private, secretive, no control over how much they eat, doesn’t happen with bulimia or anorexia. Chapter 22: Substance related and addictive disorders. Psychoactive: Effect the brain. Opioids: Intoxication: Everything is s lowed down, slurred speech. OD: Pinpoint pupils, gurgling/resp distress= Narcan, open airway. Withdrawal: Feel really bad, headache, diarrhea, muscle cramps. Treatment to treat symptoms, Tylenol, warm pack/ icepack, antidiarrhea. Naltrexone (Vivitrol): Long-acting injection, can be used for opioids and alcohol. Has some Narcan in it. Must be off opioids for 10 days before starting. Alcohol: Intoxicated: Withdrawal: Tremor, hallucination delirium, seizures. Open airway. Antabuse : Aversion therapy, will not keep them from craving or help with withdrawal. Makes them vomit, patients need to be aware of it. Mouthwash can cause them to vomit. Inhalants: Can be gas, paint. Major damage on patients’ brain, tech that it is deadly to the brain/ kills brain cells. Motivational Interviewing (page 424): Based on the stages of change. Precontemplation : They don’t think they have a problem; we are trying to convince they are. May not be simple, may have to try and show them how bad off they are. “I know you don’t think you have a problem but let’s talk about it. When you were brought in by the police, how many DUI’s have you had, how many times has this happened?”

Contemplation: Acknowledge they have a problem but may not be ready to do the work to get better. They may have a plan, or they may commit to something/cutting back. Encourage cutback but motivate them to do more. Preparation: When they are very aware of their problem and are preparing to make big changes- rehab, hospital for medical detox. Action: When they get help. Rehab, getting on meds. Maintenance Phase: When they have been sober for a prolonged period of time. Continuum of Care Criteria (Page 425-427): Who would be appropriate for each? Detox : Individual quits using a psychoactive substance known to cause withdrawal or when the individual is already in withdrawal. Rehab : For those individuals with either medical or psychiatric comorbid conditions. Halfway Houses : Individuals continue the work started in other treatment programs, usually in a long-or short-term residential rehabilitation center. The focus is on extending the period of sobriety. Intensive Outpatient : Outpatient : Chapter 27: Anger, Aggression, Violence. Seclusion Restraints- Absolutely last resort. All other interventions have been tried, de-escalations, meds, quite room have failed. Must be monitor very closely, how patient is monitored can depend on facility (in room or through glass). May sneak something in that can harm them, also need to watch for medical reasons (heart attack from being worked up, low blood sugar, seizures). Keep patient safe. Documentation : What led up to seclusion? Must be very detailed, exact events that led up to seclusion (banging fist on table, nurses offered a,b,c, tried ___ failed, patient tried to hit someone, then placed in seclusion/restraint/chemical restraint). How are they reacting to restraint, are they calming down, is it making it worse? Chemical- allergic reaction, respirations? Predictors of violence (Page 504). Tense shoulders, tense jawline, clenched fist, loud speaking, walking fast/hard. De-escalation techniques (Page 506). Decrease stimuli, try to get them away from other patients for safety (audience can also fuel anger). Remember safety and be aware of self. No dangling earrings. Do you have a past where violence can affect you/ make you anxious? Weaknesses. Chapter 28: Child, older adult, and intimate partner violence. Abusive Parent (Page 518). Over expectations of child (want 2-year-old to act like 15-year-old), history of abuse themselves, anger issues, drug usage. Cycle of Violence: As relationship goes on, phases get shorter and shorter, which means more violence. Tension building: both can feel the tension rising. Battering phase: Some kind of violence happens (peak). Honeymoon phase: Everything is fine, never going to do it again, very loving.

Types of Abuse: Physical Emotional Sexually Neglect Economical: Controlling money and finances. Safety plan (Page 527 ): Important for people who are in domestic violence relationship to have a plan to get away from abuse. Gathering things up and having them in one place (drivers license, social, birth certificates). Don’t have to go back and get important documents, or they have those documents to abuse more (holding overhead, open accounts). Levels of Prevention: Primary : Prevent abuse/aggravation from happening period. Educational classes for teen mom, skill building with parent that may be disabled to make sure they know how to feed baby/holding/burping/changing baby. Teach that babies will cry when they need something, they are not trying to annoy you. Secondary: Early intervention and identification. Screenings, yearly training identifying abuse. Tertiary: Abuse has occurred, person is in recovery. Preventing further victim abuse/ damage. Encourage victim to be a part of advocacy group. Therapy. Older Adults Chronic illness, dementia, Alzheimer’s, brain injury, single caregiver, makes them more vulnerable. If they were abusive to child, they are at increased risk of abuse. Education on communication, routine, schedule will help decrease risk of abuse. Adult daycares, cleaning/sitting services. Abuse Myths and Facts (Page 524): Lots of them, read over them, common sense. Interview Guidelines (Page 521) Let them tell the story, don’t keep interrupting. Nurses are mandated reporters. If abuse is suspected, you must report it. Nurses need to have safe/trusting relationship with patient, even if it is the perpetrator/abuser. If you have someone who is violent or doesn’t want to speak with you, keep trying to build therapeutic relationship with them. Chapter 29: Sexual Assault Don’t be judgmental, keep the patient safe , keep them well informed, don’t violate their rights, offer support. Don’t let anyone else violate their rights. SANE Nurse : forensic exam, collecting data. We both should be explaining what we are doing and why we are doing it. Always make sure its okay to do parts of exanimation. If they refuse, make sure they are well informed but don’t make them feel bad. If they want to quit, encourage them not to quit but its their decision. If they don’t want certain part done, don’t do it. Everything is up to them.

Myths and Facts about rape (Page 540): Lots of them, read over them, common sense. Care of rape/ sexual assault victim (Page 541)  Sexual assault patients are provided a safe and private environment upon arrival in an emergency care setting, with access to a community-based advocate.  Emergency nurses use a trauma-informed approach throughout the sexual assault patient's complex plan of care.  Sexual assault patients receive consistent, objective, immediate medical care as well as options for the collection of evidence by emergency nurses and physicians who know the protocols for evidence collection.  Whenever possible, forensic nurses with specific training as SANEs are consulted or assigned to care for this patient population.Sexual assault patients receive medically appropriate sexually transmitted disease prophylaxis and emergency contraception. How do we know they are getting better? They no longer feel guilt or shame, intrusive thoughts are less. Date Rape Drugs: All of their symptom’s mimic alcohol intoxication. Don’t overlook it for alcohol intoxication. Assessment: shirt torn, bruises on wrist- draw labs to see if there are drugs in their system. Watch respiratory. Chapter 30: Dying, Death, and Grieving Palliative Care: More than 6 months to live. Decrease frustration, anticipatory care (what’s going to happen), better quality of life (dementia- routine), Hospice Care: Less than 6 months to live. Comfort care. Multidisciplinary approach. Stop doing things that are not necessary/ prolong life (insulin shots). Supporting family, letting them reminisce. Dying Process: Teach patient/family things they will see- weakness, no appetite, increased tiredness, processing information can slow, decreased attention, decreased circulation, mottling of skin, decreased urine output, changes in breathing. Grieving : The response to loss, feeling sad, angry, cold, blank. Mourning : What people do to cope with loss, having a funeral/ceremony. Tattoos. Bereavement : The grief that’s after the death. Complicated grief : Beyond 12 months. Let them talk about the person that died, good and bad. Self-care when caring for dying: You need to make sure you have boundaries, leave work at work. When caring for someone who is passing away, being there, paying attention and listening. Giving family time to reflect and reminisce. Assisted Suicide (Page 551)  voluntary = With help of healthcare professional, individual knows it will happen, to end pain and suffering.  passive = Withholding life sustaining support. Stopping tube feedings.  involuntary = Actively ending someone’s life, person who is a healthcare provider involuntary ends someone’s life, can also be family member. Individual doesn’t know it’s happening. Loved one doesn’t want to see them suffering. Phases of Death and Dying

Denial /isolation: Doesn’t believe that they are dying. Self-isolate. Anger : “I can’t believe this is happening to me”. Bargaining : Negotiating with higher power to live. Depression : Begin to realize that their bargaining won’t work, they become filled with depression and feeling of loss and guilt related to dying. Acceptance : Comes to terms with death, more peaceful.