Nursing 212

Health Differences Across the Lifespan 2 Study Guide mutilating behavior and may have suicidal ideations or suicide attempts. Weight is often normal or near normal. Electrolyte imbalances, cardiac disease, hypertension, tooth decay with loss of enamel (from vomiting), stomach ulcers, rectal bleeding, esophageal varices (vomiting) and possible rectal bleeding are other symptoms. Nursing interventions: Prevent the patient from using the bathroom for two hours after eating to prevent vomiting; help patient with coping mechanisms; promote self-esteem and daily weights; develop a therapeutic, nonjudgmental relationship with the patient to foster sharing or precipitating factors to eating disorder and feelings about it; perform baseline and periodic assessments of nutritional status, including fluid and electrolyte balance and daily food intake; with severe malnutrition, reseeding protocols and tube feedings may be used; set a limit for meals, provide a pleasant environment for meals, and observe the patient during meals and following meals; record intake and output and daily weight (post void, same clothing, same time, and same scale); monitor elimination patterns; monitor and limit activity level; assess risk for suicide and implement suicide precautions as necessary PICA PICA is the eating of substances with no significant nutritive value such as earth or ice. Complications may occur due to the substance consumed. For example, lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction and Toxoplasma or Toxocara, and infections may follow the ingestion of feces or dirt. Treatment techniques include: • Presentation of attention, food, or toys, not contingent on pica being attempted • Differential reinforcement with positive reinforcement if pica is not attempted, and consequences if pica is attempted • Discrimination training between edible and inedible items, with negative consequences if pica is attempted • Visual screening, with eyes covered for a short time after pica isattempted • Aversive presentation, contingent on pica being attempted • Examples of aversions include oral taste (lemon), smell sensation (ammonia), and physical sensation (water mist in face) PTSD (Post-Traumatic Stress Disorder) PTSD is a group of symptoms that develop after a traumatic event. Ordinary coping behaviors fail to relieve the anxiety. Witnessing a traumatic event happen to a loved one may precipitate PTSD. Symptoms may be experienced acute, chronic, or delayed. Signs and symptoms include flash backs, nightmares, decreased outside involvement, hyper alertness, sleep pattern changes, guilt, difficulty concentrating, avoidance, depression, and anxiety.

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