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Lecture 4

NURS 3524 Lecture Notes - Lecture 4: Bulimia Nervosa, Body Dysmorphic Disorder, Binge Eating


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Lecture
4

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 4
HH/NUR 3524 6.0
Psychiatric & Mental Health Nursing For Canadian Practice
CONTENT COVERED
Anxiety; Child Abuse and Interpersonal, Violence, Trauma Informed Care, Loss and Grief
REQUIRED READINGS
Chapter 17, 34
RNAO www.rnao.org BPG -Woman Abuse: Screening, Identification and Initial Response
Test #1 Oct 4/18
On test next week:
o Mental Health Act
o Mood Disorders: Depression, Dementia and other neurocognitive disorders
o Anxiety, PTSD
o Eating Disorder
o Today’s class
60 multiple choice questions
Test starts at 9:30a. No class afterwards.
Anorexia Nervosa
Starts in early adolescence up to adulthood
o Give you a lot of excuses to why they can’t eat something
o Exercise a lot
o Body not good enough
Caused by stressful life transitions, likely anxiety
Chronic disease may take long periods for recovery
Many have another psychiatric diagnosis, often mood disorders
DSM V criteria: BMI <16.5
o : food restrictions, starvation
o : binge eating with use of diuretics, laxatives, enemas and vomiting
see pg. 526, Table 25-1, pg. 528, Table 25-2
Treatment
o Refeeding: target malnutrition and dehydration issues
o Therapy for body dysmorphia
o SSRIs with regaining of weight
Bulimia Nervosa
Early adolescence, adulthood onset
Binging and purging in secret; abuse of laxatives, diuretics, or fasting and over exercising
o Normally; minimal little underweight weight and overweight
Many rules and preoccupation with food; anxiety, mood disorder
Leads to guilt and self loathing
See pg. 550, Table 25-5
Treatment
o Intake diary
o Manage electrolyte imbalance
o Cognitive behaviour therapy
o Fluoxetine (Prozac) effective
o Monitor if they went to the washroom

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 4
HH/NUR 3524 6.0
o See pg. 556, Figure 25-6 and Box 25-13
Binge Eating D/O
Ingesting large amounts of food, short period of time, loss of control, distress and feelings of guilt and
depression after
DSM V:
o binge eating once a week X 3 months
o occurs after a period of restraint, hunger or feeling low
Type 2 Diabetic, mood or anxiety disorder, substance use
Starts in adolescence
See pg. 559, Table 25-6
Treatment
o Psychotherapy
o Nutrition counseling
Ensure
o Topiramate: antiepileptic medication, controls binge eating
o Orlistat: GI lipase, breaks down triglycerides to prevent breaking down into free fatty acids
o Fluoxetine
IMPORTANT!!
Abuse, trauma and violence affect a large number of people of all ages and in all socio-economic
spheres
o Trauma harmful experience that they can’t cope
Don’t trust you
Choice and collaboration pt. must have a choice
Look at the pt. strength and build from it
Respect pt. preference
Self awareness
Many of you will have personal knowledge and experience of abuse, trauma, and violence
Self awareness is a key aspect of practising effectively as a nurse
Self Care essential
Please utilize student health services as needed
History of Child Maltreatment
Children have been in some cultures “sacrificed to the gods”
ill children have been deemed possessed
“Rights” of the child non-existent
“Discipline” seen as “beating sense into” rather than “teaching”
Child labour laws are very recent
Early marriage of girls acceptable in case of pregnancy
Child Abuse question about child abuse
Also known as child maltreatment
Refers to harm or threats of harm in which a child or youth may experience when in the care of a
person they trust and/or depend on, a family member, parent, sibling, teacher, caregiver or guardian

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 4
HH/NUR 3524 6.0
Harm may occur with direct action by the person or through the person’s act of neglect to provide
the care necessary for healthy child growth and development
Violence against children encompasses sexual abuse, emotional abuse, physical abuse and neglect
exposure of children to family violence was considered to be a form of emotional harm
Legislation on child maltreatment now defines family violence as a form of abuse, even if the child is
not the recipient
o How would you asses a pt. you think sexual abuse (type of child maltreatment might do play
therapy to get the pt. trust;
the pt. might have sexual behaviours way to old for them
might abuse other children
might be withdrawal or aggressive
pain during urination
broken harem/vagina bleeding/itchness
butt pain
boys might touch their genitals
Child Abuse Prevalence
Sexual abuse-under age 18 yrs
o 5%-62% of females, 3%-31% of males
o In populations with mental illness, 44%-88%
o Most studied form of abuse
Physical Abuse-under age 18 yrs
Emotional Abuse-under age 18 yrs
Neglect-under age 18 yrs
Few endure only one form of abuse
Types of Child Maltreatment and Examples of Abusive Behaviours
Category
Definition
Examples of Abusive Behaviours
Physical
abuse
(assault)
Application of unreasonable physical force by
an adult or a youth to any part of a child’s body
Harsh physical discipline, forceful shaking,
pushing, grabbing, throwing, hitting with a
hand, punching, kicking, biting, hitting with an
object, choking, strangling, stabbing, burning,
shooting, poisoning, excessive use of restraints
Sexual
abuse
Involvement of a child, by an adult or youth, in
an act of sexual gratification, or exposure of a
child to sexual contact, activity or behaviour
Penetration, attempted penetration, oral sex,
fondling, sex talk, voyeurism and sexual
exploitation
Neglect
Failure by a parent or caregiver to provide the
physical or psychological necessities of life to a
child
Failure to supervise, leading to physical harm
or to sexual harm; permitting criminal
behaviour; physical neglect; medical neglect;
failure to provide psychological treatment;
abandonment; and educational neglect
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