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Physical Factors: Overeating and/or obesity has also been associated with lesions in the appetite and satiety centers of the hypothalamus discount accutane 20mg mastercard acne zones, hypothyroidism quality accutane 40mg acne 22 years old, decreased insulin production in diabetes mellitus, and increased cortisone production in Cushing’s disease. Lifestyle Factors: On a more basic level, obesity can be viewed as the ingestion of a greater number of calories than are expended. Weight gain occurs when caloric in- take exceeds caloric output in terms of basal metabolism and physical activity. Psychoanalytical Theory: This theory suggests that obe- sity is the result of unresolved dependency needs, with the individual being fixed in the oral stage of psychosex- ual development. The symptoms of obesity are viewed as depressive equivalents, attempts to regain “lost” or frus- trated nurturance and care. Common Nursing Diagnoses and Interventions for Anorexia and Bulimia (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Possible Etiologies (“related to”) [Refusal to eat] [Ingestion of large amounts of food, followed by self-induced vomiting] [Abuse of laxatives, diuretics, and/or diet pills] [Physical exertion in excess of energy produced through caloric intake] Defining Characteristics (“evidenced by”) [Loss of 15% of expected body weight (anorexia nervosa)] Pale mucous membranes Poor muscle tone Excessive loss of hair [or increased growth of hair on body (lanugo)] [Amenorrhea] [Poor skin turgor] [Electrolyte imbalances] [Hypothermia] [Bradycardia] [Hypotension] [Cardiac irregularities] [Edema] Eating Disorders ● 223 Goals/Objectives Short-term Goal Client will gain lbs per week (amount to be established by client, nurse, and dietitian). Long-term Goal By discharge from treatment, client will exhibit no signs or symptoms of malnutrition. If client is unable or unwilling to maintain adequate oral in- take, physician may order a liquid diet to be administered via nasogastric tube. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures. The client’s physical safety is a nursing priority, and without adequate nutrition, a life-threatening situation exists. In collaboration with dietitian, determine number of cal- ories required to provide adequate nutrition and realistic (according to body structure and height) weight gain. Explain to client details of behavior modification program as outlined by physician. Explain benefits of compliance with prandial routine and consequences for noncompliance. Behavior modification bases privileges granted or restricted directly on weight gain and loss. Without a time limit, meals can become lengthy, drawn-out sessions, providing client with attention based on food and eating. This time may be used by client to discard food stashed from tray or to engage in self-induced vomiting. Client may need to be accompanied to bathroom if self- induced vomiting is suspected. Client care, privileges, and restrictions will be based on accurate daily weights. Do, however, offer support and positive reinforcement for obvious improvements in eating behav- iors. Client must understand that if, because of poor oral intake, nutritional status does not improve, tube feedings will be ini- tiated to ensure client’s safety. Staff must be consistent and firm with this action, using a matter-of-fact, nonpunitive ap- proach regarding the tube insertion and subsequent feedings. As nutritional status improves and eating habits are estab- lished, begin to explore with client the feelings associated with his or her extreme fear of gaining weight. Vital signs, blood pressure, and laboratory serum studies are within normal limits.

Consumer psychologists study the Approximately two-thirds of American psycholo- preferences and buying habits of consumers as well as gists work in applied fields generic accutane 5 mg without a prescription acne and diet. Many are involved in clinical their responses to advertising order 30mg accutane mastercard acne 101e, often working together or counseling psychology, diagnosing and treating indi- with advertising copywriters, public relations experts, viduals with various problems of adjustment. They are employed not only by business mately one-third of the psychologists in practice in the but also by government agencies such as the Food and United States today are clinical psychologists, and most Drug Administration and the Federal Trade Commission. These professionals use a human behavior to the design of machines, tools, jobs, wide range of therapies, ranging from Freudian psycho- and work environments to provide the best possible analysis to Rogerian client-centered therapy to newer match with the abilities and limitations of the human be- cognitive approaches. It is part of a broader area private practice, either alone or in groups, or work in hos- known as human-factors engineering (also called er- pitals or clinics. They may also practice in a variety of gonomics) that has links to anatomy, anthropometry, en- other settings, including community mental-health cen- vironmental medicine, and toxicology. One very specific ters, university medical schools, centers for the mentally work environment that provides the arena for another and physically handicapped, prisons, state institutions specialization is the military. A plying psychological research to the operations of the subfield within clinical psychology is community psy- armed forces are involved in personnel selection, testing, chology, which investigates environmental factors that and training; evaluating morale; analyzing job perfor- contribute to mental and emotional disorders. Health psy- mance; studying social interaction among troops; and chologists deal with the psychological aspects of physical exploring the dynamics of combat situations. Psycholo- illness, investigating the connections between the mind gy has also contributed to the exploration of space in and a person’s physical condition. They perform individualized which involves the application of psychology to law en- assessments of each child, consult with his or her par- forcement and the judicial system. Forensic psychologists may help create personality pro- Carl Jung began to evolve his theory of archetypes files of criminals; formulate principles for jury selection; around 1910 while working with patients at the Burghölzli hypnotize victims, eyewitnesses, or defendants to en- Mental Hospital. Noting the presence of universal sym- hance their memories; or study the problems involved in bols from religion and mythology in the dreams and fan- eyewitness testimony. Yet another emerging area is pro- tasies of uneducated patients, who would have had no gram evaluation, whose practitioners evaluate the effec- conscious way of learning them, he concluded that these tiveness and cost efficiency of government programs for images belonged to a part of the unconscious not derived the Congressional Budget Office, the General Account- from personal experience. Jung proposed that universal ing Office, and other government offices and agencies. Doctoral programs generally require conscious when called forth by appropriate experiences in completion of a four- to six-year program offered by a one’s life. The course of study in- supplemented his clinical observations with a comprehen- cludes a broad overview (including courses in such areas sive study of myths and symbols that later included inves- as statistics, personality theory, and psychotherapy), as tigations into the religions and mythologies of preliterate well as specialization in a particular subfield and comple- peoples in Africa and the southwestern United States. Some Jungian archetypes are like prototypes or molds that clinical psychologists hold a Psychology Doctorate each person fills in differently depending on his or her in- (Psy. For example, although the term Illinois in 1968 and is geared exclusively toward the train- “mother” has certain universal connotations that come to ing of clinicians rather than researchers. Offered at univer- mind for most people, the details of this archetype will be sities and at independent, “free-standing” professional different for everyone. He claimed that his patients improved and eliminates the dissertation requirement. Applying Psychology: Critical and Creative ber of possible archetypes: they are as varied as human Thinking. Jung considered four archetypes, in particular, im- portant enough to form separate systems within the per- sonality. These include the persona, the anima and ani- Aptitude tests mus, the shadow, and the self. The persona is a person’s public image, the self he or she shows to others (“per- sona” is derived from the Latin word for mask).

Trans fat is also found in cookies purchase accutane 10 mg with amex skin care doctors edina, crackers 40 mg accutane overnight delivery skin care vegetables, french fries, baked goods, and other snack foods. When trans fats were first introduced into our food supply, they were thought to be a healthier alternative to saturated fats. Trans fats elevate cholesterol levels, increasing the risk for heart disease and heart attack, and are also linked to cancer, particularly breast cancer. The Institute of Medicine has stated that there is no safe limit for trans fats in the diet and that we should reduce consumption of these dangerous fats. It is manu- factured in the liver and also obtained from consuming saturated and trans fats. Cholesterol is not all bad—the body requires it to produce sex hormones, maintain cell membranes, and for a healthy nervous system. It is possible for triglycerides to be high even when blood cholesterol is normal, so get your levels checked regularly. These macronutrients provide us with the energy and nutrients needed for proper growth, development, and many body processes. In a later chapter I will outline principles for a healthy diet—my top recommendations for a nutritional plan for optimal health and disease prevention. They assist in energy-producing reactions, growth and development, protect against free radical damage, and perform many vital functions. Micronutrients are essential for health, and a deficiency can lead to health problems and disease. In this chapter I have outlined the essential vitamins, minerals, and trace elements; their functions in the body; their role in disease prevention and treatment; deficiency symptoms; drugs that deplete; and supplement guidelines. The table at the end of this chapter summarizes food sources, recommended in- take levels, and possible side effects and toxicity for the various nutrients. There are many factors that cause nutrient depletion, such as poor diet, stress, exer- cise, use of prescription drugs, environmental toxicity, and excessive alcohol intake. This is why supplements are so important in making up for short- comings in the diet and preventing deficiencies. The B-vitamins and vitamin C dissolve in water and are easily eliminated from the body. Adverse reactions, even with high-dose supplements, are rare with these vi- tamins. Fat-soluble vitamins (A, D, and E) are not readily excreted from the body and have the potential to accumulate in the tissues and cause adverse effects at high doses. Vitamin A • Found in animal foods and converted from beta-carotene in plant foods. To avoid this risk, choose a multivitamin that contains beta-carotene, which is converted to vitamin A in the liver, but is not as- sociated with health risks. Vitamin B1 (Thiamine) • Required for energy production, nerve and muscle function, enzyme reactions, and fatty acid production. Micronutrients | 15 • Drugs that deplete vitamin B1: furosemide, antibiotics, oral contraceptives, and phenytoin. Vitamin B2 (Riboflavin) • Required for energy metabolism, enzyme reactions, vision, and skin/hair/nail health; functions as an antioxidant; activates vitamin B6, niacin, and folate. Deficiency may impair iron absorption and increase risk of pre-eclampsia in pregnant women. Vitamin B3 (Niacin) • Required for energy metabolism, enzyme reactions, skin and nerve health, and digestion. Vitamin B5 (Pantothenic Acid) • Required for carbohydrate metabolism, adrenal function, enzyme reactions, and production of fats, cholesterol, bile acids, hormones, neurotransmitters, and red blood cells. Pregnant women with deficiency have increased risk of giving birth to a child with neural tube defects.

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