Sept 10, 2022 – Eating Disorder. Mr. Rex Yangco 4.

AN: deal with ↓ self-esteem / Body Image

Disturbance
Anorexia Nervosa – common in female. Starts during your BN: deal with anxiety
adolescent years. (Puberty Years).
- Decrease self-esteem 5. SSRI
- Very high superego - ↑conscience AN: give once weight is stabilized
- BN: SSRI from the start
2 Types of Anorexia Nervosa
1. Restrictive Type – person with a ↓ food Sexual Disorder
intake & would even go for strenuous Phases of Sex:
exercise. 1. Excitement Phase – desire for sex
2. Purging – vomiting, use of diuretics, and use 2. Plateau – foreplay
of laxatives. 3. Orgasm – climax
4. Resolution
Criteria: DSM V
1. Resistant to Eat – energy foods (fats, Sexual Desire Disorder – the one who have less, or no
carbohydrates) desire for sex.
2. Insist to lose weight even if they’re underweight. 1. History of abuse/rape
3. Body Image Disturbance
2. Aversion for sex due to side effect of medications
Signs & Symptoms:
• Pathognomonic sign: Amenorrhea * 3 episodes. Sexual Arousal Disorder
No menstruation for 3 consecutive months (for • Male: Erectile Dysfunction – Impotence (inability
regular months). Hormonal imbalance due to of penis to erect)
malnutrition. • Female - ↓ / no lubrication
• Severe weight loss - muscle wasting, may develop
cachexia – skin and bones. Sexual Orgasm Disorder
• Lanugo – growth of fine hairs. Body’s 1. Premature Ejaculation – early ejaculation
compensation to fat deposition loss. Fat is needed 2. Prolonged Ejaculation – substance abuse, delayed
for thermoregulation. ejaculation
• Fluids & Electrolyte Imbalance – presence of U-
wave. Sexual Pain Disorder
o Hypokalemia – cardiac arrest 1. Dyspareunia (painful sexual intercourse)
• Dehydration • Vaginismus - Vaginal lock or spasm of
vaginal muscle.
*Object represent: Mirror Ø Female: Stress / Anxious
Ø Tx: Benzodiazepines / Muscle
Bulimia Nervosa – common in females. Common than Relaxants
anorexia.
• Extrovert and Social Paraphilia: sexual desires and behaviors that are not
• Normal or near normal weight socially/morally acceptable.
• Starts with anxiety à will provoke binge eating - 6 months or more
(excessive eating for 2 hours). Will be replaced by
guilt à purging (vomiting, laxatives, diuretics). 1. Exhibitionistic Disorder – expose genitals to
strangers. Try to wear jackets or raincoat. ↑ sexual
Symptoms: desire once stranger is frightened.
• Russel’s Sign – scars at the knuckles.
• Chipmunk’s Face – swelling of parotid gland. 2. Voyeuristic Disorder “Peeping Tom” – observing
• Discoloration of the teeth – acidity of the vomitus others without permission.
• Gastric and esophageal ulceration • Getting dressed/naked
• May even have MARKED FOOD • Sexual Intercourse
• F & E Imbalance – hypokalemia • Bathing

Object: Toilet / CR 3. Fetishistic Disorder – sexual desire usually with

non-living / inanimate objects.
Management: • Panty
1. To develop insight – awareness of the condition. • Bra
2. Physiologic before psychological – correct • Socks
electrolyte imbalance, malnutrition, ulceration. • Lingerie
3. Close monitoring
AN: during & after eating
BN: after eating
 4. Frotteuristic Disorder – rubbing of genitals to 4. Dissociative Fugue – element of travel. Memory
unconsenting individuals. Happen usually in loss. Once they travel, they will try to assume new
crowded places. personality. Loss of ability to remember the past.
5. Sadistic Disorder – inflicts pain
6. Masochistic Disorder – receives pain
7. Transvestic Disorder - ↑ sexual desire once cross-
dressing Dementia Delirium
• Gradual and • Acuteà hours to
Other Forms: progressive days
• Zoophilia – sexual desires with animals • Months to years • Reversible à due
• Bestiality – sex with animals à 10 yrs. to a medical
• Necrophilia – desire or behavior for the dead • Permanent / condition
• Hypoxyphilia – strangulated - ↓O2 irreversible • Symptom of a
• Sadomasochism – sadistic & masochistic certain disease
• Pedophilia – sexual desire/ behavior with children
esp. minors LOC: Normal level of LOC: Deteriorating Level of
Ø Victim – 13 years old and ↓ consciousness. Consciousness
Ø Perpetrator – 16 years old and ↑ Speech: Normal à Speech: Incomprehensible
Gap: 5 years Aphasia
Ø Pedophile: ↓ self- esteem Orientation: Normal à Orientation: Disoriented
has an occupation close to children disorientation
e.g., pre-school & elementary teachers, Memory: Loss of Recent Memory: Short-term
coaches (sports), social welfare officers, à Distant Memories. memory loss à reversible
priests/pastors. Permanent memory loss
• Incest – related by blood, consanguinity, or any Perception: Normal Perception: Hallucinations
form of affinity.
Common: Penetration

Management: Alzheimer’s Disease – is a form of irreversible dementia.

Discovered by: Alois Alzheimer.
• Cognitive Behavioral Therapy
• Deal with Suppressed / Childhood Trauma Cause: Unknown
• Safety of the Victim Factors:
• Anti-androgen Drugs 1. Genetic / Hereditary
2. Advanced Age
Dissociative Disorder: separation from self-reality and 3. Neurofibrillary Tangles Formation – chemical
environment. reactions
4. Beta-Amyloid Plaque Formation
1. Depersonalization – detachment from self or 5. Brain Atrophy - ↓ function - fronto-temporal lobe
reality (memory)
Derealization – detachment from environment 6. Biological Cause: ↓ of Acetylcholine.
2. Dissociative Amnesia – memory loss 2 Main functions of ACTH:
• Retrograde Amnesia – memory loss of 1. Muscle Stimulation
distant past. Can form new memories. 2. Memory
• Anterograde Amnesia – memory loss of
the recent past. Can’t form new Sign & Symptoms:
memories. Remembered everything from 1. 1st early sign à Forgetfulness
the past. 2. Defense Mechanism: Confabulation – making up
• Ordinal Amnesia – memory loss of the stories. In order to fill in memory gaps. To save the
sequence of events self-esteem.
• Global Amnesia – both retrograde & 3. Word Finding
anterograde. 4. Misidentification
5. Sundowning - ↑ restlessness & agitation at night.
3. Dissociative Identity Disorder – multiple à couple with wandering.
personality disorder. Two or more personalities/
identities. With an average of 10 to 15 4 A’s of Alzheimer
personalities. 1. Aphasia – difficulty in communication.
• Alters – other personalities • Expressive aka Motor / Broca’s Aphasia –
• Switch – changing of personalities speech, use pen & paper or any visual
aids in communication, sign language. Let
the patient finish the conversation.
 • Receptive Aphasia / Sensory / Wernicke’s 5. Delirium Tremens – tremors/ seizure, delirium
Aphasia – problem is on comprehension 6. Alcohol Hallucinosis – alcohol withdrawal
& understanding. Use visual aids, use syndrome. Starts 24 to 48 hours – with no alcohol
short, simple & concise example, specific CNS Excitability – tremors, diaphoresis, ↑ craving
instruction.
• Limit - 2 choices. Management:
• Global – both 1. Total Abstinence – most effective
2. Deal with Defense Mechanism:
2. Amnesia – memory loss • Denial
• Retrograde • Projection
• Anterograde • Rationalization
• Ordinal 3. Support Group:
• Global • AA – Alcoholic Anonymous – alcoholics
• Al Anon – spouse
Management: • Ala Teen – children of the alcoholic

1. Introduce yourself regularly 4. Do Aversion Therapy – Disulfiram (Antabuse) –

2. Reminiscence Therapy* - old photo albums, there must be no alcohol or any alcohol containing
videos, or music. products.
5. Give your thiamine supplement / Vitamin B1
3. Agnosia – difficulty in identifying objects / supplement
difficulty in identifying the use of an object. 6. Alcohol Withdrawal Syndrome:
• Benzodiazepine (Librium, Ativan, Valium)
Anomia – difficulty naming 7. Naltrexone (Revia) - Decrease craving for alcohol
8. Acamprosate - Return to pre-alcoholic state
• Introduce yourself regularly
• Label all important items, specifically à Electroconvulsive Therapy (ECT)
Medicines - Induction of electrical impulse to the brain.
• Cover mirror if necessary - Unitemporal or Bitemporal
- Done only for .2 to .5 seconds only
4. Apraxia – difficulty in movement, motor ability, or - 2 to 3x a week à maximum of 12 to 15 treatments
performing ADL. - Grand Mal seizure – tonic-clonic seizure
• Give simple non-complicated task.
• Side rails & a well-lit area. Pre- ECT Preparation:
• MATS – must be fixed on the floor 1. Consent – can’t be signed by the patient
2. Cardio-pulmonary clearance
Management 3. Remove all jewelries & dentures
4. Let the patient void
1. Sundowning – less stimulating environment 5. 3 Medications
Let the patient wear ID Bracelet: name, address, 1. Atropine – ↓ salivation, to prevent
and contact details. aspiration
2. Pharmacologic Intervention – anticholinesterase 2. Succinylcholine (Anectine) – muscle
à to ↑acetylcholine level. relaxant, to prevent injuries
• Cognex Watch out for: RD; diaphragmatic
• Aricept muscle weakness
• Rimenyl 3. Brevital – anesthetic agent; to ↓
seizure threshold
• Exelon
Indications:
Alcohol Use Disorder (Alcoholism) – CNS depressant
1. Severe psychotic / affective symptoms
Addiction
2. Risk for violence to self & others
↑
3. Anti-psychotic medications no longer effective
Substance use – abuse – tolerance – dependence
4. There is already resistance to medication
↓
5. More serious side effect to antipsychotics
↑ in dosage
- Form of: ineffective coping
Post- ECT:
1. Hyper-oxygenate the patient
Effects:
2. Orient the patient – short-term memory loss
1. Disinhibition
3. Assess for any injuries
2. Black-out à memory loss – reversible
4. Documentation
Cause: Vit. B, Deficiency (3,4)
3. Wernicke’s Encephalopathy – motor à ataxia
4. Korsakoff Syndrome à cognition à memory loss
Opioids – CNS depressants 2. Disproportionate & excessive worry and anxiety
• Codeine related to the somatic symptom
• Morphine Sulfate
• Heroines – synthetic opioids
Excessive worry on:
Toxicity - everything is low & slow • The seriousness of the symptom
WOF: Diaphragm muscle weakness • High level of anxiety
• Pinpoint pupil • Maladaptive Coping or behavior

Management: 3. All these may be present in 6 months

• Naloxone (Narcan) Ø Symptom becomes the identity. *Pain
may or may not be part of the symptom.
Withdrawal:
• 48 to 72 hours à no intake
Hypochondriasis aka Doctor Shopper– old name,
preoccupation that they thought they have a serious
Early Sign & Symptoms Late illness.
New name: Illness Anxiety Disorder -Persistent and
• Myalgia • ↑ BP excessive worry
• Anxiety • Vomiting /
• Restlessness diarrhea Symptom: May or may not be present – less severe.
• Irritability • Piloerection • All these will all be present for 6 months
• Rhinorrhea • Dilated Pupil • High level of anxiety
• Yawning
DOC: Benzodiazepines Factitious Disorder “Munchausen Syndrome” – trying to
• Lacrimation
fabricate or exaggerate symptoms.
• Impose injury to self
Antidepressant – no 2 antidepressants at the same type • Has no secondary gain
- Monitor the patient closely • *Assume: Sick Role
- 2 months – follow-up check up
- Clinical Improvement à energy to commit suicide Factitious Disorder Imposed to Others: (Munchausen
Syndrome by Proxy)
Conversion Disorder / New name: Functional Neurologic • Other people: Children, Elderly
Symptom Disorder • No secondary gain
- DSM V: Part of OCRD
- DSM IV- TR: Somatoform Disorder Malingering
- No organic cause - Intentional fabrication of symptom and most likely
- Loss of body function – neurologic the purpose of this is secondary gain.
- Element of Trauma - ↑ Anxiety
- Body Dysmorphic Disorder Substance Use Disorder

Common Conversion Disorder: Substance: affects biological & physical well-being.

• Loss of sight (blindness) • Natural – derived form the plants.
• Loss of Hearing (deafness) Ø Cannabis Sativa (marijuana)
• Paralysis
• Paresthesia – numbing sensation • Synthetic – process in the laboratory
Ø Shabu, MDMA (ecstasy), Cocaine
La belle Indifference – there is no or little concern over the
symptom. I. CNS Depressants aka Downers
• Alcohol
Day 2 – Sep 11, 2022 – Psych Nursing – Mr. Rex Yanco • Benzodiazepines – anxiolytics
Ø Librium lorazepam
Somatic Symptom Disorder Ø Oxazepam
Ø Alprazolam
Old Name: Ø Diazepam
• Somatization Disorder • Barbiturates
• Pain Disorder Ø Phenobarbital (Phenytoin/
Dilantin) – seizure, anti-
DSM V: convulsant / anti-epileptic
1. 1 or more Somatic Symptom - significantly disrupt drug.
daily living *Most Common S/E: Gingival Hyperplasia
• Opioids
 3. Symptoms: Early Childhood
II. CNS Stimulants “Uppers” - diagnosed before 3 years old, 18 – 30 months
1. Cocaine “rock” - common in boys
2. Shabu (methamphetamine)
4. Symptoms – limit and impair everyday functioning
Effect: new environment- uncomfortable à temper
1. ↑ Sympathetic nervous system response - ↑ ❤ tantrums
rate à arrhythmia
2. Euphoria – highest form of happiness “cloud 9” Management:
3. Alertness - ↓ need for sleep, commonly used by 1. Cognitive Behavioral Therapy
drivers 2. SPED – they can develop both cognitive & their
4. Increasing Libido (cocaine) social skills
5. Suppression of Appetite 3. Time-out – discipline
4. Pharmacologic Intervention
Abuse: Hyperactive: give Ritalin ADHD
1. Nasal Septum Perforation - sniffing Destructive: Antipsychotic à Thorazine
2. Psychosis – hallucination
Most common hallucination: Asperger’s Disorder – impairment in communication &
Ø Formication – bugs crawling language skills. Common in boys.
on the skin. - Limited & repetitive thoughts and behavior
3. MDMA “Ecstasy / Escstano” - Poor social interaction, *no eye contact
methylenedioxymethamphetamine – colored or - Poor coordination – motor skills à clumsiness
party drugs
- Hallucinogen à hallucination Childhood Disintegrative Disorder – child normal
4. Caffeine development from birth.
- A very rare condition
III. Hallucinogen - Changes: 2 to 4 years old
• LSD Lysergic Acid Diethylamide
• PCP Phencyclidine 1. They lose ability to interact / interest in play.
• Marijuana à Mary Jane can be upper 2. Regress – loss motor skills mastered
or hallucinogen. Asthma – Respiratory 3. Communication Skills – disappear à stop talking
Ø Cardinal Sign of Toxicity:
o Blood Shot Eye Rett’s Disorder – common in girls
- Rare & progressive

Autism Spectrum Disorder (ASD) SX: 6 to 18 months

- Motor skills
1. Autistic Disorder - Pathognomonic sign: Apraxia – inability to
2. Asperger’s Disorder perform motor function
3. Childhood Disintegrative Disorder
4. Rett’s Disorder Attitude Therapy
5. Pervasive Developmental Disorder – not
otherwise specified 1. Active Friendliness – withdrawn
2. Kind firmness – depressed
Autistic Disorder 3. Passive friendliness – paranoid
4. Matter of fact – mania / manipulative
Cause: unknown à linked to genetics 5. No Demand - Aggressive
1. Persistent deficit
• Social Interaction Violent – safety of the patient & nurse.
• Communication skills No Demand – maintain distance
Ø Alone – self • Open posture
Ø Language – abnormal • Call for assistance / help
intonation, echolalia • Initial things to do: Verbal Command
• Go for restraint (last option/resort)
2. Restricted & Repetitive Patterns of Behavior,
interest, or activities – Restraint
• Pre-occupied with peculiar things • 5-to-6-person restraint (ideal)
Ø Fan, aircon • 6th TL
• Stereotyped behavior • 1 @ the head should be team leader (no demand)
Ø chair rocking
Ø hand flopping Nurse-Patient Relationship
Ø head banging
 • Interpersonal Relationship – Hildegard Diagnosed: at school
Peplau Symptom:
Tool: The therapeutic use of self à Self- • Interfere with social, academics, & occupational
awareness priority. functioning.
• Inattention
Center: Patient • Hyperactivity
Goal: Find meaning (learning) in the experiences. • Impulsivity

Phases of Nurse-Patient Relationship Management:

1. Behavioral Therapy
1. Pre-orientation / pre-interaction – for the nurse 2. Psychoeducation
alone 3. Lifestyle and diet
Goal: Self-Awareness à preparation of the nurse 4. Family Education
for the relationship.
Meds:
2. Orientation Phase – first meeting of nurse & • DOC: Stimulants
patient. Start and end of relationship, start of Ø *Methylphenidate: Ritalin
termination. (short-acting) – not priority
Goal: To establish mutually acceptable contract à drug
Trust / Rapport Ø *Amphetamine (Adderall) –
Relationship: Professional long acting, preferred.
• Non-stimulants
3. Working Phase – longest & the most productive Ø Guanfacine
phase. Identification & resolution of patient’s A2 Adrenergic Agonist
problem. Ø Atomoxetine
à Complete your nursing process Ø Clonidine – most common

4. Termination Phase – end of the relationship Abuse & Violence

Goal: always learning à growth facilitating Cycle:
• Tension Building à Feeling something is about to
Problems: happen
1. Resistance o Anger
• Orientation à establish rapport o Blaming
• Termination à review the contract o Arguing
• Crisis / Abuse – battering happens hear
2. Transference – once the patient is overly/ • Calm / Honeymoon – Love “never happened
emotionally attached to the nurse. again” “I will forgive you”, “I’ll get help”
3. Counter Transference – nurse to patient
Management: 6’S
DSM IV – TR: Mental Retardation 1. Social norms - to protect against violence, VAWC
2. Skills – to prevent violence
Normal IQ: 80 – 100 3. Support & empathy
Borderline: 70 – 80 4. Safe & Protect
à Subaverage Intellectual Functioning 5. Survivor environment
Mild mental retardation – 51 – 70 à Educable, mental 6. Strengthen Economic Support
capacity can reach up to 6th grade
Moderate: 36 to 50 à Trainable – 2nd grade
Severe: 21 to 35 à barely à simple à trainable
Profound – 20 ↓ - Custodial – Close supervision

DSM V: Intellectual Disability (ID)

3 Domains Diagnosis:
Conceptual à Academics
Social: Relationship of others
Practical: ADL

ADHD Attention Deficit Hyperactivity Disorder

Common: boys
Symptoms: 6 months, present/diagnosed before 12 years
old
DSM IV- TR: before 7 years old