NUR 256 Exam 4 Study Guide (2026) | Mental Health Nursing | Galen Nursing

NUR 256
EXAM 4 STUDY GUIDE
Concepts of Mental Health Nursing

Galen College of Nursing

, Review for Exam 4

Chapter 18 Feeding, Eating & Elimination Disorders

 Eating Disorders
o Anorexia nervosa
 Doesn’t eat, has a need for control and feels powerlessness
 Found in household that are more chaotic and relationships are strained.
 Always see themselves as overweight.
 Push it around the plate & over exercise.
 Laxatives or regurgitation.
 Fear of gaining weight
 Distorted body image
 Restricted calories and low BMI
 Comorbidities
 Bipolar
 Depressive
 Anxiety
 OCD
o Bulimia nervosa
 Eats a whole lot at one time and then purges via self-induced vomiting, often hasn’t achieved a status in life
that person had hoped to achieve, feels powerlessness.
 As coping
 More normal weight in appearance.
 Recurrent episodes of uncontrollable binging
 Inappropriate compensatory behaviors, vomiting, laxatives, diuretics, or exercise
 Self image largely influenced by body image
 Etiology
o Biological factors
 Genetics – strong genetic link 60% inheritiable
 Neurobiological – altered use of serotonin, perfectionists traits & OCD
o Psychological factors – currently, some say it is a learned behavior that has (+) reinforcement
 Symptoms as a defense against a feeling of ineffectiveness and powerlessness
o Environmental factors – culture and how we see beautiful women as tall and thin
o This represents the diathesis stress model where the disorder can be caused from genetic disposition and/or
environmental stressors
 Anorexia Nervosa Nursing Process
o Assessment

Box 18.2 Thoughts & Behaviors Associated with Anorexia
 Terror of gaining weight
 Preoccupation with thoughts of food
 View of self as fat even when emaciated
 Peculiar handling of food, cutting food into small bits
 Pushing pieces of food around plate
 Possible development of rigorous exercise regimen
 Possible self induced vomiting, use of laxatives and diuretics
 Cognition so disturbed that individual judges self worth by their weight

 weight loss of 30% or more in 6 months, rapid decline in weight.
 Hypothermia, decreased HR, low systolic criteria for admission.
 Electrolytes and arrhythmias and become suicidal or hurting themselves.
 Must gain 2 lbs a week and then things may have things taken from them.
o Nursing diagnosis
o Outcomes identification
o Planning

,  Immediate medical stabilization if experiencing extremem fluid electrolyte imbalance
 Weighs below 75% of ideal body weight
 Less than 10% fat
 HR less than 50 bpm
 Systolic less than 90
 Temp less than 96 and arrhythmias
o Implementation
o Evaluation – is it effective?
 Assessment: Clinical Picture
o Under-nourished
o Under-weight
o Sunken eyes
o Sagging skin
o Poor skin turgor
o Amenorrhea
o Bradycardia
o Electrolyte Imbalance
o Disturbed Body Image
o Dehydration
 Addressing physiological needs FIRST
o Patient may need TPN & fluids
 May be resistant
 DO NOT DISCUSS WHAT THEIR WEIGHT IS
 Nursing Diagnosis
o Alterations in nutrition; less than body requirements
o Less Than Body Requirements r/t decrease intake
o Body Image Disturbance – takes longer
o Alterations in (or potential for) skin integrity r/t cellular starvation
o Ineffective Coping
 Outcome
o The client will gain a minimum of 2 pounds per week.
o Therefore, privileges and restrictions are based on compliance with treatment as evidenced by weight gain
 Anorexia Nervosa Interventions
o Acute care
 Medical Intervention- What has to be treated?
 Psychosocial interventions- What are the considerations?
 Pharmacological interventions- What might be ordered for this client?
 Integrative medicine- What does integrative mean?
 Health teaching and health promotion- Topics to discuss?
 Safety and teamwork- NPSG stick to menu
o Psychological needs need to be met first
o Psychosocial – investigate home life,
o No meds SSRI helpful with OCD part
o Yoga, acupuncture
o Understanding what is happening to their body that they are doing
o Monitor their bathroom
 Nursing Interventions
o Weigh each morning after 1st void with the same amount of clothing on each morning
o Small, frequent feedings (shift in electrolytes)
 Refeeding syndrome
o Provide protein shakes (muscle)
o Monitor intake
o Accompany to bathroom for at least up to 1 hour after meals
o Adm. meds as ordered
o Weigh daily/weekly/as ordered
o Participant in the milieu
o Participant in group
o Individual, family, and group therapy
o Health and nutrition teaching