Test #3 Focal Concepts
Chapters- 21, 22, 23, 24 (657-670), 25, & 26 - Units 9-12
Eating Disorders
Anorexia:
Etiology- morbid fear of obesity
Interventions- correct malnutrition, dehydration, electrolyte imbalances, dysrhythmias, bradycardia,
hypothermia, hypotension, and suicidal ideation
Treatment- behavior modification, individual psychotherapy, CBT, and family treatment
S/S- gross distortion of body image, preoccupation with food, and refusal to eat; reduced food intake,
extensive exercising, self-induced vomiting, and abusive laxatives; excessive weight loss, hypothermia,
bradycardia, hypotension, edema, lanugo, and amenorrhea; hoard food
Bulimia:
Meds- antidepressants, particularly Prozac (fluoxetine), meds ending in “ine” such as Tofranil, Norpramin,
Elavil, Aventnyl, and Nardil
S/S- binging episodes, self-induced vomiting, use of laxatives and diuretics, excessive concern with
personal appearance, and weight fluctuations
Interventions- correct malnutrition, dehydration, electrolyte imbalances, dysrhythmias, bradycardia,
hypothermia, hypotension, and suicidal ideation
Treatment- behavior modification, individual psychotherapy, CBT, family treatment, and
psychopharmacology (antidepressants)
Children & Adolescents
Autism (ASD):
S/S- abnormal or impaired development social interaction and communication; Restricted repertoire of
activity and interests; infants may have an aversion to affection and physical contact; language may be
absent; headbanging or biting may be evident
Outcome goals- patient exhibits no evidence of self-harm; interacts appropriately with at least one staff
member; Demonstrates trust in at least one staff member; Able to communicate that they can be
understood by at least one staff member; demonstrate behavior that indicate they have begun the
separation process
Interventions- work with child on one-to-one basis; protect child when self-mutilating behaviors occur;
Assign limited number of caregivers; Provide child with familiar objects; Give positive reinforcement for
eye contact
Conduct disorder:
Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate
societal norms or rules are violated; Physical aggression is common; comorbidities include ADHD, mood
disorders, learning disorders, and substance use disorders
Predisposing factors- rule breaking and aggression; stealing and hurting animals; irritable temperament,
poor compliance, attentiveness, and impulsivity; poor attachment; decreased gray matter, high levels of
serotonin, low levels of CSF; parental rejection, neglect, or physical/verbal aggression; inconsistent or
harsh discipline; Lack of parental supervision
, ADHD:
In attention and or hyperactivity and impulsivity Siri call children are highly distractible and unable to
contain stimuli; Motor activity is excessive, and movements are random and impulsive; associated with
frontal lobe abnormalities
Onset difficult to diagnose in children younger than four; usually not recognized until child enters school
Stimulants are first line treatment; meds elevate dopamine and norepi levels
Etiology of children’s behaviors and how do we best treat disruptive children?
Behavior therapy- rewards are given for appropriate behaviors and withheld when behaviors are
disruptive or otherwise inappropriate
parents should be involved in designing and implementing treatment plan for child and should be involved
in all aspects of treatment
group therapy provides children and adolescents with opportunity to interact within association of their
peers; appropriate social behavior is often learned from positive and negative feedback of peers
medication should never be sole method of treatment; Medication alone is not as effective as a
combination of medication and psychosocial therapy
Intellectual Disability (IDD):
Characteristics of levels
o Mild intellectual developmental disorder- capable of developing social skills and independent
living with assistance; IQ 50-70
o Moderate IDD- capable of academic skill to 2nd grade level; IQ 35-49
o Severe IDD- may be trained in elementary hygiene skills; Requires complete supervision; IQ 2-34
o Profound IDD- no capacity for independent functioning; IQ below 20
Interventions include ensure small items are removed, pad rails and headboard, prevent physical
aggression, identify aspects of self-care that may be within patient's capabilities, maintain consistency of
staff assignment, and remain with patient during initial interactions with others on the unit
Expected outcomes include has pt experienced no physical harm, has self-care needs fulfilled, interacts
with others in a socially appropriate manner, maintains anxiety at a manageable level, is able to accept
direction w/o becoming defensive, and demonstrates adaptive coping skills in response to stressful
situations
Abilities
Nursing diagnosis include risk for injury r/t altered physical mobility or aggressive behavior, self-care deficit
r/t altered physical mobility or lack of maturity, impaired verbal communication r/t to developmental
alteration, impaired social interaction r/t speech deficiencies or difficulty adhering to conventional social
behavior, delayed growth and development r/t isolation from the significant others, inadequate
environmental stimulation, genetic factors, anxiety r/t hospitalization and absence of familiar
surroundings, defensive coping r/t feelings of powerlessness and threat to self-esteem, and ineffective
coping r/t to inadequate coping skills secondary to developmental delay
Oppositional Defiant Disorder (ODD):
Persistent pattern of angry mood and defiant behavior occurring more frequently than others of same
social, educational, and occupational level; begins around 8 years old; common comorbidities include
ADHD, anxiety, depression, conduct disorder, and substance abuse disorders; characterized by passive
aggressive behaviors such as stubbornness, procrastination, disobedience, carelessness, negativism,
Chapters- 21, 22, 23, 24 (657-670), 25, & 26 - Units 9-12
Eating Disorders
Anorexia:
Etiology- morbid fear of obesity
Interventions- correct malnutrition, dehydration, electrolyte imbalances, dysrhythmias, bradycardia,
hypothermia, hypotension, and suicidal ideation
Treatment- behavior modification, individual psychotherapy, CBT, and family treatment
S/S- gross distortion of body image, preoccupation with food, and refusal to eat; reduced food intake,
extensive exercising, self-induced vomiting, and abusive laxatives; excessive weight loss, hypothermia,
bradycardia, hypotension, edema, lanugo, and amenorrhea; hoard food
Bulimia:
Meds- antidepressants, particularly Prozac (fluoxetine), meds ending in “ine” such as Tofranil, Norpramin,
Elavil, Aventnyl, and Nardil
S/S- binging episodes, self-induced vomiting, use of laxatives and diuretics, excessive concern with
personal appearance, and weight fluctuations
Interventions- correct malnutrition, dehydration, electrolyte imbalances, dysrhythmias, bradycardia,
hypothermia, hypotension, and suicidal ideation
Treatment- behavior modification, individual psychotherapy, CBT, family treatment, and
psychopharmacology (antidepressants)
Children & Adolescents
Autism (ASD):
S/S- abnormal or impaired development social interaction and communication; Restricted repertoire of
activity and interests; infants may have an aversion to affection and physical contact; language may be
absent; headbanging or biting may be evident
Outcome goals- patient exhibits no evidence of self-harm; interacts appropriately with at least one staff
member; Demonstrates trust in at least one staff member; Able to communicate that they can be
understood by at least one staff member; demonstrate behavior that indicate they have begun the
separation process
Interventions- work with child on one-to-one basis; protect child when self-mutilating behaviors occur;
Assign limited number of caregivers; Provide child with familiar objects; Give positive reinforcement for
eye contact
Conduct disorder:
Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate
societal norms or rules are violated; Physical aggression is common; comorbidities include ADHD, mood
disorders, learning disorders, and substance use disorders
Predisposing factors- rule breaking and aggression; stealing and hurting animals; irritable temperament,
poor compliance, attentiveness, and impulsivity; poor attachment; decreased gray matter, high levels of
serotonin, low levels of CSF; parental rejection, neglect, or physical/verbal aggression; inconsistent or
harsh discipline; Lack of parental supervision
, ADHD:
In attention and or hyperactivity and impulsivity Siri call children are highly distractible and unable to
contain stimuli; Motor activity is excessive, and movements are random and impulsive; associated with
frontal lobe abnormalities
Onset difficult to diagnose in children younger than four; usually not recognized until child enters school
Stimulants are first line treatment; meds elevate dopamine and norepi levels
Etiology of children’s behaviors and how do we best treat disruptive children?
Behavior therapy- rewards are given for appropriate behaviors and withheld when behaviors are
disruptive or otherwise inappropriate
parents should be involved in designing and implementing treatment plan for child and should be involved
in all aspects of treatment
group therapy provides children and adolescents with opportunity to interact within association of their
peers; appropriate social behavior is often learned from positive and negative feedback of peers
medication should never be sole method of treatment; Medication alone is not as effective as a
combination of medication and psychosocial therapy
Intellectual Disability (IDD):
Characteristics of levels
o Mild intellectual developmental disorder- capable of developing social skills and independent
living with assistance; IQ 50-70
o Moderate IDD- capable of academic skill to 2nd grade level; IQ 35-49
o Severe IDD- may be trained in elementary hygiene skills; Requires complete supervision; IQ 2-34
o Profound IDD- no capacity for independent functioning; IQ below 20
Interventions include ensure small items are removed, pad rails and headboard, prevent physical
aggression, identify aspects of self-care that may be within patient's capabilities, maintain consistency of
staff assignment, and remain with patient during initial interactions with others on the unit
Expected outcomes include has pt experienced no physical harm, has self-care needs fulfilled, interacts
with others in a socially appropriate manner, maintains anxiety at a manageable level, is able to accept
direction w/o becoming defensive, and demonstrates adaptive coping skills in response to stressful
situations
Abilities
Nursing diagnosis include risk for injury r/t altered physical mobility or aggressive behavior, self-care deficit
r/t altered physical mobility or lack of maturity, impaired verbal communication r/t to developmental
alteration, impaired social interaction r/t speech deficiencies or difficulty adhering to conventional social
behavior, delayed growth and development r/t isolation from the significant others, inadequate
environmental stimulation, genetic factors, anxiety r/t hospitalization and absence of familiar
surroundings, defensive coping r/t feelings of powerlessness and threat to self-esteem, and ineffective
coping r/t to inadequate coping skills secondary to developmental delay
Oppositional Defiant Disorder (ODD):
Persistent pattern of angry mood and defiant behavior occurring more frequently than others of same
social, educational, and occupational level; begins around 8 years old; common comorbidities include
ADHD, anxiety, depression, conduct disorder, and substance abuse disorders; characterized by passive
aggressive behaviors such as stubbornness, procrastination, disobedience, carelessness, negativism,
