BEHAVIORAL HEALTH PROBLEMS OF

ADOLESCENT
MIDTERM – 2nd SEMESTER
LICEO DE CAGAYAN UNIVERSITY – COLLEGE OF NURSING
LECTURE V | DATE: 02/13/25 | LECTURER: MA’AM SOCCORO OLEDAN
BEHAVIORAL HEALTH PROBLEMS OF ADOLESCENT

OUTLINE: ▪ Can be killed with over-the-counter lotions such

I. SEXUALLY TRANSMITTED DISEASES as Permethrin cream (1%)
II. AMENORRHEA ▪ Pubic lice are transmitted primarily through
III. DYSMENORRHEA sexual contact, but they can also spread
IV. OBESITY through infested bedding, towels, or clothing.
V. ANOREXIA NERVOSA ▪ Symptoms include itching (due to allergic
VI. SUBSTANCE ABUSE reactions to the bites), visible lice or eggs (nits)
VII. SUICIDE in the hair, and sometimes small blue or red
spots on the skin where the lice have bitten.

GENITAL WARTS (HUMAN PAPILLOMA VIRUS)

▪ The virus family that causes genital warts
SEXUALLY TRANSMITTED DISEASES ▪ Usually are harmless, but others may lead to
▪ STD stands for Sexually Transmitted Disease. It cervical or anal cancer
refers to infections that are passed from one ▪ Vaccines can protect genital warts
person to another through sexual contact. Some ▪ Signs: Pink or flush-colored warts raised flat or
common STDs include HIV/AIDS, chlamydia, shaped like a cauliflower. There are often no
gonorrhea, syphilis, and herpes. symptoms
▪ Teenagers and young adults acquire STD more
easily than older people
▪ By age 25 half of sexually adults get an STD
▪ Having multiple sex partners causes STD
▪ For men who have sex with men (MSM), certain
STDs, such as HIV, syphilis, and gonorrhea, tend
to be more prevalent.

TYPES OF SEXUALLY TRANSMITTED DISEASES

CRABS (PUBIC LICE)

GONORRHEA (THE CLAP)

▪ Gonorrhea, also known as the clap, is a sexually
transmitted infection (STI) caused by the
bacterium Neisseria gonorrhoeae.
▪ Spreads easily and can lead to infertility in men
▪ Antibiotics such as cephalosporins stop the
infection
▪ Symptoms:
o In men
✓ Painful or burning sensation during
urination.
▪ This creature crawls from one person to another ✓ Discharge from the penis (usually
yellow, white, or green)

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✓ Swollen or painful testicles CHLAMYDIA

o In women ▪ Chlamydia is a bacterial infection caused by the
✓ Painful urination. bacterium Chlamydia trachomatis. It is one of
✓ Abnormal vaginal discharge (often the most common sexually transmitted
yellow or green). infections (STIs) worldwide.
✓ Pelvic or abdominal pain. ▪ Can lead to infertility, it clears up with
✓ Pain during sex azithromycin or doxycycline
▪ Can also affect the rectum and throat
▪ Symptoms:
SYPHILIS o In men
▪ Syphilis is a sexually transmitted infection (STI) ✓ Painful urination (a burning sensation
caused by the bacterium Treponema pallidum. when urinating).
It can affect both men and women and ✓ Discharge from the penis (often clear or
progresses in stages if left untreated. It can cloudy).
cause long-term health problems, including ✓ Pain or swelling in the testicles (though
organ damage, and increase the risk of HIV less common).
transmission. ✓ Itching or irritation inside the penis.
▪ Most people don't notice the early symptoms ✓ Urethritis (inflammation of the urethra,
which can lead to paralysis, blindness, and causing discomfort).
death o In women
▪ Can be cured with benzathine, penicillin ✓ Painful urination.
injection and azithromycin ✓ Abnormal vaginal discharge (which
▪ Signs and symptoms: firm and round painless may be watery, yellow, or have a strong
sore on the genital or anus. It spreads through odor).
direct skin contact. ✓ Pain during sex.
✓ Abdominal or pelvic pain (especially in
the lower abdomen)
✓ Bleeding between periods or after sex.
✓ Vaginal itching or discomfort.

HERPES SIMPLEX VIRUS TYPE 1

▪ Herpes Simplex Virus Type 1 (HSV-1) is a common
virus that primarily causes oral herpes, although
it can also cause genital herpes. It belongs to the
herpesvirus family and is highly contagious,
typically spread through close personal contact
like kissing or sharing items like towels or eating
utensils.
▪ There is no cure.
▪ Antiviral medicines such as:
✓ Acyclovir
✓ Valacyclovir
✓ Famciclovir
▪ Can spread through oral or genital contact

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HERPES SIMPLEX VIRUS TYPE 2 o Clay-colored stools.

▪ Herpes Simplex Virus Type 2 (HSV-2) is the o Joint pain.
primary cause of genital herpes, although it can o Fever (in some cases).
also cause oral herpes in some cases, though
this is less common. HSV-2 is highly contagious HIV/AIDS
and is typically transmitted through sexual ▪ HIV attacks the immune system, specifically the
contact. CD4 cells (T cells), which help the body fight off
▪ There is no cure but antiviral drugs (Acyclovir, infections. If left untreated, HIV can lead to AIDS,
Valacyclovir, and Famciclovir) can help the final stage of HIV infection.
manage the infection by: ▪ While there is no cure for HIV, it can be managed
o Reducing the severity and duration of with antiretroviral therapy (ART).
outbreaks. ▪ Transmission: HIV is transmitted through direct
o Decreasing the frequency of outbreaks. contact with certain body fluids of an infected
o Lowering the risk of transmission to others person:
▪ Signs and Symptoms: o Blood (e.g., sharing needles, blood
o Painful sores or blisters around the genital, transfusions)
anal, or perineal areas (often in clusters). o Semen and vaginal fluids (e.g., through
o Itching, burning, or pain before sores appear. unprotected sexual contact)
o Painful urination if sores are near the urethra. o Breast milk (from mother to child)
o Flu-like symptoms (fever, swollen lymph o Rectal fluids (e.g., during anal sex)
nodes, body aches). ▪ Early Symptoms of HIV: In the early stages,
o Pain during sexual activity due to sores or some people may experience acute retroviral
irritation. syndrome (ARS), often referred to as primary HIV
infection.
HEPATITIS B ▪ Symptoms can appear 2 to 4 weeks after
▪ Hepatitis B is a liver infection caused by the exposure and may include:
hepatitis B virus (HBV). It is a highly contagious o Fever.
virus that can cause both acute and chronic liver o Fatigue.
disease. Hepatitis B is spread through contact o Swollen lymph nodes.
with the blood or other body fluids of an o Sore throat.
infected person. o Rashes.
▪ Hepatitis B is transmitted through direct contact o Muscle and joint aches.
with the infected body fluids, such as: o Headache.
o Blood (sharing needles or syringes, blood o Mouth sores
transfusions, needle-stick injuries in o Canker sores
healthcare workers). ▪ HIV Testing: HIV can be diagnosed through
o Seminal fluid and vaginal fluids (sexual blood tests, which detect the virus or the body’s
contact with an infected person). response to it (antibodies or antigens). The most
o Mother to child (from an infected mother to common tests include:
her baby during childbirth). o Antibody tests - Detect antibodies
o Unsterilized medical equipment (e.g., produced by the body in response to
tattooing or piercing equipment). HIV.
▪ There is no cure. o Antigen/antibody tests - Detect both
▪ Signs and symptoms: antibodies and antigens (the HIV virus
o Fatigue itself).
o Jaundice (yellowing of the skin or eyes) o Nucleic acid tests (NAT) - Detect the
o Abdominal pain (particularly in the upper actual virus and are used to measure
right side, where the liver is located) viral load or confirm HIV infection.
o Loss of appetite.
o Nausea and vomiting.
o Dark urine.

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TRICHOMONIASIS CHANCROID
▪ Parasites that spreads during sexual contact ▪ Chancroid is a bacterial sexually transmitted
and can be cured with prescription drugs such infection (STI) caused by the bacterium
as metronidazole Haemophilus ducreyi. It leads to the
▪ Signs and Symptoms: development of painful sores or ulcers, typically
o In men in the genital area, and is more common in
✓ Discharge from the Penis: A clear or areas with high rates of other STIs.
cloudy discharge from the urethra. ▪ Common in Africa and Asia but rare in the US
✓ Painful Urination: A burning ▪ Chancroid is treated with antibiotics. The most
sensation or discomfort when commonly prescribed antibiotics for chancroid
urinating. are:
✓ Irritation or Itching: Itching or o Azithromycin (single dose)
irritation inside the penis or urethra. o Ceftriaxone (single dose)
✓ Pain During Ejaculation: Discomfort o Ciprofloxacin (multiple doses)
or pain during ejaculation. o Erythromycin (multiple doses)
o In women ▪ Signs and Symptoms:
✓ Vaginal Discharge: Often the most o Painful Ulcers
noticeable symptom, which can be: o Swollen Lymph Nodes
Frothy or foamy. o Painful Urination
Greenish-yellow or grayish in color. o Discharge: There may be pus-like
✓ May have an unpleasant or fishy discharge from the sores or from the
odor. genital area.
✓ Vaginal Itching or Irritation: Itching o Fever and Malaise: In some cases,
or discomfort in the vaginal area chancroid can cause flu-like symptoms,
due to irritation. including fever, fatigue, and general
✓ Painful Urination: A burning discomfort.
sensation during urination.
✓ Pain During Sex: Discomfort or pain
during intercourse (dyspareunia).

Asymptomatic Infections:
Many people with trichomoniasis, especially men, may
not experience any symptoms. This is why it is possible
to spread the infection unknowingly.

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LYMPHOGRANULOMA VENEREUM (LGV) ▪ Signs and Symptoms:

▪ Common in men who had sex with men o Lower Abdominal or Pelvic Pain
▪ transmitted through sexual contact (vaginal, o Abnormal Vaginal Discharge
anal, or oral) with an infected person. It can also o Painful Urination (Dysuria)
be spread through contact with infected fluids o Pain During Sex (Dyspareunia)
from the genital area o Irregular Menstrual Bleeding
▪ Signs and Symptoms: o Fever and Chills
o Small, painless ulcer or bump at the site o Nausea and Vomiting
of infection (genital, rectal, or o General Malaise
sometimes in the mouth). o Cervical Tenderness
o Swollen lymph nodes (buboes), usually o Back Pain
in the groin or pelvic area. These can
become very tender and may rupture PREVENTING STD
and drain pus. ➢ Abstain from any sexual contact
o Painful urination or difficulty passing ➢ Monogamous relationships
urine, if the urethra or bladder is ➢ Ask your partner if he or she has an STD
affected. ➢ Ask your partner to be tested before sexual
o Discharge from the genital area, which activity
may be pus-like, especially if there is an ➢ Use condoms
ulcer present. ➢ Avoid sexual activity if your partner has signs
o Fever and chills, especially during the and symptoms
secondary stage of the infection when
the lymph nodes become involved. THE LIMITS OF CONDOMS
o Abdominal pain or discomfort, ▪ Condoms are better at protecting against
particularly if the infection spreads to gonorrhea, chlamydia, HIV and trichomoniasis
the pelvic area. ▪ It has less protection against herpes, syphilis,
o Rectal symptoms (if affected): This and genital warts
includes pain during bowel movements, ▪ No protection against crabs and scabies
rectal discharge, or bleeding.
o Fatigue and general malaise as the
body reacts to the infection. STDS AND PREGNANCY
o Chronic swelling or scarring in the ▪ Can cause women to go into labor too early
genital or anal area, which may occur in ▪ Can be passed from mother to baby
more severe or untreated cases. ▪ Effects include stillbirth, low birth weight,
▪ LGV is treated with antibiotics. The most neurologic problems, blindness, liver disease,
commonly used antibiotics for LGV are: and serious infections
o Doxycycline (typically for 21 days).
o Azithromycin (can be used as an CAN STDS COMEBACK?
alternative, typically a one-time dose). ▪ Most STD treatments do not protect one from
o Erythromycin (may be used in certain getting the same infection again
cases). ▪ A new exposure can start a new infection

PELVIC INFLAMMATORY DISEASE

▪ Not an STD
▪ A serious complication of untreated STD,
especially chlamydia and gonorrhea
▪ It affects the uterus

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AMENORRHEA HOW COMMON IS AMENORRHEA?

▪ The absence of menstruation during the
reproductive years of women’s life 1. Primary Amenorrhea (Rare: <1% of females)
▪ Missing one or more periods ▪ Affects 0.1–2.5% of adolescent girls worldwide.
▪ Less common than secondary amenorrhea.
FACTORS THAT CAN AFFECT LATE PERIOD OR MENSES ▪ Often due to genetic, hormonal, or structural
issues that prevent menstruation.
HYPOTHALAMUS
▪ The hypothalamus releases Gonadotropin- 2. Secondary Amenorrhea (More Common: 3–5% of
Releasing Hormone (GnRH), which signals the women)
pituitary gland to release Follicle-Stimulating ▪ Occurs in 3–5% of women of reproductive age
Hormone (FSH) and Luteinizing Hormone (LH). (excluding pregnancy, lactation, or
If you're stressed, overexercising, or experiencing menopause).
weight changes, the hypothalamus may ▪ More frequent in athletes, women with PCOS,
decrease GnRH secretion, leading to delayed those under chronic stress, or with eating
ovulation or an absent period (amenorrhea). disorders.

OVARIES RISK FACTORS OF AMENORRHEA

▪ The ovaries respond to FSH and LH by releasing ▪ Athletes: Up to 69% of female athletes in intense
estrogen and progesterone, which regulate sports (e.g., ballet, long-distance running)
ovulation and the menstrual cycle. Conditions experience hypothalamic amenorrhea due to
like Polycystic Ovary Syndrome (PCOS), low energy availability.
hormonal imbalances, or delayed ovulation can ▪ Polycystic Ovary Syndrome (PCOS): Affects 6–
result in a late or irregular period. 12% of women of reproductive age and is a
common cause of secondary amenorrhea.
UTERUS ▪ Eating Disorders: Amenorrhea occurs in 50–84%
▪ If the uterine lining doesn’t develop properly or of women with anorexia nervosa.
there’s an imbalance in hormone signaling, the
period might be delayed or absent. SYMPTOMS
▪ Lack of periods
▪ Hot flashes
COMMON REASONS FOR LATE PERIODS ▪ Vaginal dryness
✓ Stress (affects hypothalamus) ▪ Headache
✓ Hormonal imbalances (affects ovaries) ▪ Acne
✓ Extreme weight loss/gain ▪ Hirsutism
✓ PCOS or thyroid issues
✓ Pregnancy NATURAL OR NORMAL REASON
✓ Uterine conditions (fibroids, scarring, etc.) ✓ Pregnancy
✓ Breastfeeding
TYPES OF AMENORRHEA ✓ Menopause
▪ PRIMARY ✓ Surgery
o one that has not gotten their first period
by age 15 or within the years of the first COMMON CAUSES OF PRIMARY AMENORRHEA
sign of puberty ▪ Chromosomal or genetic problem (eg. Turner
o Due to genetic conditions or acquired Syndrome)
abnormalities ▪ Hormonal Issues
▪ SECONDARY ▪ Structural issues
o One has been getting regular periods
but stopped getting the period for at
least 3 months

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COMMON CAUSES OF SECONDARY AMENORRHEA SURGERY IS NEEDED WHEN THERE IS:

▪ Birth control methods (Depo provera, IUDs) ✓ Vaginal septum or imperforated hymen
▪ Pregnancy ✓ Pituitary tumor
▪ Stress ✓ Uterine scar tissue
▪ Poor nutrition
▪ Weight changes PREVENTION
▪ Certain needs ▪ Follow diet and exercise
▪ Extreme physical activities ▪ Be aware of the menstrual cycle
▪ Anemia ▪ Get regular gynecological appointments,
including a pelvic exam and pap smear test
OTHERS: ▪ Get regular and adequate sleep
▪ Primary ovarian insufficiency
▪ Hypothalamic amenorrhea DYSMENORRHEA
▪ Pituitary disorders ▪ The medical term for a painful menstrual period
▪ Hormonal imbalances
▪ Ovarian tumors TYPES OF DYSMENORRHEA
▪ Obesity
PRIMARY DYSMENORRHEA
RISK FACTORS ▪ Caused by increased prostaglandins, which
▪ Family history trigger uterine contractions and reduce blood
▪ Genetic chromosomal conditions flow.
▪ Obesity ▪ Menstrual cramps that come back every time
▪ Eating disorder one has a period
▪ Poor diet ▪ Usually begins 1 or 2 days you get your period
▪ Stress ▪ The most common type
▪ Improves with age or after childbirth.
▪ No underlying disease.
COMPLICATIONS
▪ Osteoporosis or cardiovascular disease (due to
lack of estrogen) SECONDARY DYSMENORRHEA
▪ Difficulties getting pregnant ▪ Painful condition because of an underlying
▪ Pelvic pain health condition or an infection in the
reproductive organs
DIAGNOSTIC TESTS ▪ Less common type
▪ Pregnancy test ▪ Pain worsens over time and may last beyond
▪ Complete blood count menstruation.
▪ Genetic testing
▪ MRI IS HAVING DYSMENORRHEA NORMAL?
▪ Ultrasound ▪ Having dysmenorrhea is common, especially
primary dysmenorrhea, which affects 50–90% of
menstruating women
MANAGEMENT AND TREATMENT ▪ About 60% of people with a uterus have mild
▪ Following a diet and exercise cramps during their periods
▪ Stress management technique ▪ Mild to moderate cramps that last for 1–3 days
▪ Changing exercise level during your period are considered normal as
▪ Hormonal treatment long as they are manageable with pain relief
▪ Surgery methods like NSAIDs (e.g., ibuprofen), heat
▪ Estrogen therapy therapy, or rest.
▪ Calcium and vitamin D supplements
▪ Strength training

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CAUSE OF DYSMENORRHEA SECONDARY DYSMENORRHEA

▪ Pain that lasts longer than 3 days or occurs
CAUSES OF PRIMARY DYSMENORRHEA (NO outside of menstruation
UNDERLYING DISEASE)
▪ Severe cramps that don’t improve with pain
▪ Increased Prostaglandins → Stronger uterine relievers
contractions → Reduced blood flow → Pain ▪ Heavy menstrual bleeding or irregular periods
▪ Risk Factors: ▪ Pain during or after sex
o Being under 30 years old ▪ Pelvic pain between periods
o Family history of dysmenorrhea ▪ Painful bowel movements or urination (may
o Heavy or irregular periods indicate endometriosis)
o Smoking, alcohol, caffeine intake
o Stress or lack of exercise
WHO IS MORE LIKELY TO HAVE DYSMENORRHEA?
CAUSES OF SECONDARY DYSMENORRHEA (DUE TO
▪ Early menarche before age 12
UNDERLYING CONDITIONS)
▪ Younger than 20
▪ Endometriosis
▪ Age <30 years old (especially teens and young
o Tissue similar to the uterine lining grows
adults)
outside the uterus, causing severe pain
▪ Family history of dysmenorrhea (genetic
and infertility.
predisposition)
▪ Adenomyosis
▪ Heavy or long menstrual periods
o The uterine lining grows into the muscle
▪ Smoking and alcohol consumption
wall, making periods heavier and more
▪ High levels of stress or anxiety
painful.
▪ Lack of physical activity
▪ Uterine Fibroids
▪ Being underweight or overweight
o Noncancerous growths in the uterus
that cause intense cramping and heavy
DIAGNOSIS AND TEST
bleeding.
▪ Assessment
▪ Pelvic Inflammatory Disease (PID)
▪ Pelvic exam
o Infection of the reproductive organs,
▪ The goal is to determine if there is a medical
causes inflammation and period pain.
condition
▪ Ovarian Cysts or PCOS
▪ Ultrasound
o Hormonal imbalances that can cause
▪ Laparoscopy - a surgical procedure used to
irregular cycles and cramping.
examine the organs in the belly (abdomen)
▪ Cervical Stenosis
▪ Hysteroscopy - the exam of the inside of the
o Narrowing of the cervix, making
cervix and uterus
menstrual flow difficult and painful.

MANAGEMENT AND TREATMENT

▪ Over-the-Counter (OTC) Medications
SYMPTOMS
✔ NSAIDs (e.g., ibuprofen, naproxen) –
Reduce pain and inflammation by
PRIMARY DYSMENORRHEA
lowering prostaglandins.
▪ Aching and throbbing pain in the abdomen
✔ Acetaminophen (Paracetamol) – Mild
▪ Feeling of pressure in the abdomen
pain relief for those who can't take
▪ Pain that radiates to the lower back, hips, or
NSAIDs.
thighs
▪ Hormonal Birth Control (For Frequent or
▪ Nausea or vomiting
Severe Cramps)
▪ Diarrhea or constipation
✔ Birth control pills, patches, injections,
▪ Fatigue and weakness
or IUDs can regulate hormones and
▪ Headaches or dizziness
reduce cramps.
✔ Consult a doctor before starting
hormonal therapy.

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WAYS TO REDUCE MENSTRUAL CRAMPS ▪ Cancer Risks

▪ Apply Heat Therapy ▪ Mental Health & Psychological Effects
✔ Use a heating pad or warm compress
on your lower abdomen. THERAPEUTIC MANAGEMENT
✔ Take a warm bath to relax the ▪ Early recognition and control measures
muscles. ▪ Educate family about complications of obesity
▪ Exercise & Stretching ▪ Diet, exercise, and behavior modifications
✔ Light exercises like walking, yoga, and ▪ Nutritional counseling
stretching can help reduce cramps. ▪ Group Involvement
✔ Aerobic activities (e.g., jogging, ▪ Engage in regular physical activity (150–300
dancing, swimming) improve blood minutes per week)
circulation.
▪ Massage & Relaxation ANOREXIA NERVOSA
✔ Gently massage the lower abdomen ▪ A serious and potentially life-threatening but
with essential oils (lavender, treatable eating disorder
peppermint, or clary sage). ▪ Characterized by extreme food restrictions and
✔ Try deep breathing, meditation, or an intense fear of gaining weight
stress-relief techniques. ▪ People with anorexia limit the number of calories
▪ Eat a Healthy Diet and the type of foods they eat
✔ Increase omega-3 fatty acids ▪ They may exercise compulsively and purge the
(salmon, walnuts, flaxseeds). food they eat through intentional vomiting
✔ Eat more fruits, vegetables, whole ▪ They have distorted self-image of their body
grains, and iron-rich foods (to prevent ▪ Have an intense fear of gaining weight
fatigue from blood loss).
✔ Avoid processed foods, caffeine,
alcohol, and salty foods (which can BEHAVIORAL SIGNS OF ANOREXIA
worsen bloating and cramps). ✓ Intentional vomiting
▪ Herbal Teas ✓ Misuse of laxatives
✔ Ginger tea – Reduces inflammation ✓ Extreme Food Restriction
and pain. ✓ Obsessive Calorie Counting
✔ Chamomile tea – Helps relax muscles ✓ Excessive Exercise
and improve sleep. ✓ Avoiding Social Gatherings with Food
✔ Peppermint tea – Soothes digestive ✓ Wearing Loose or Baggy Clothes
issues and reduces bloating. ✓ Dizziness, Fatigue, & Always Feeling Cold

EMOTIONAL MENTAL SIGNS

OBESITY ✓ Intense Fear of Gaining Weight even when
▪ Common nutritional disturbance of children and underweight
one of the most challenging ✓ Mood Swings & Irritability due to extreme hunger
▪ Obesity results from a caloric intake that and malnutrition
consistently exceeds caloric requirements and ✓ Perfectionism
expenditure ✓ Guilt & Shame Around Eating
✓ Obsessive Thoughts About Food & Weight
COMPLICATIONS ✓ Social Withdrawal
▪ nsulin resistance
▪ Fatty liver disease
▪ Cardiovascular Complications
▪ Hormonal Imbalances
▪ Joint & Musculoskeletal Problems
▪ Gastroesophageal Reflux Disease (GERD)
▪ Gallbladder Disease & Gallstones

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PHYSICAL SIGNS AND SYMPTOMS OF ANOREXIA TYPES OF ANOREXIA NERVOSA (DSM-5 SUBTYPES)
▪ Low body weight 1. Restricting Type
▪ Significant weight loss ➢ Weight loss through severe dieting, fasting,
▪ A BMI below 17.5 or excessive exercise (no bingeing or
▪ Fatigue & Weakness purging).
▪ Dizziness & Fainting
▪ Slow Heart Rate (Bradycardia) & Low Blood 2. Binge-Eating/Purging Type
Pressure ➢ Episodes of binge eating or purging (self-
▪ Dry, Pale, or Yellowish Skin induced vomiting, laxatives, diuretics,
▪ Brittle Nails enemas).
▪ Hair Thinning or Falling Out
▪ Severe Constipation & Bloating MANAGEMENT FOR ANOREXIA NERVOSA
▪ Loss of Menstrual Periods (Amenorrhea) ▪ Stabilizing weight loss
▪ Muscle Weakness & Loss ▪ Beginning nutrition rehabilitation
▪ Eliminating binge eating and purging behaviors
▪ Treating psychological issues
FACTORS THAT MAY BE INVOLVED ▪ Developing long-term behavioral changes
✓ Genetics
✓ Trauma TREATMENT FOR ANOREXIA
✓ Environment and culture ▪ Psychotherapy
✓ Peer pressure ▪ Medication
✓ Emotional health ▪ Nutrition counseling
▪ Hospitalization
DIAGNOSTIC AND TESTS ▪ Group and/or family therapy

3 DIAGNOSTIC CRITERIA FOR ANOREXIA NERVOSA MEDICATIONS

(DSM-5)

1. Restriction of Energy Intake (Severe Weight Loss) ANTIDEPRESSANTS (FOR MOOD & ANXIETY)
➢ Significant restriction of food intake leading to low ▪ Fluoxetine (Prozac) – SSRI used to reduce
body weight relative to age, sex, and development. obsessive thoughts and improve mood.
➢ Weight is significantly below normal or expected ▪ Sertraline (Zoloft) – Helps with anxiety and
levels. depression.
▪ Escitalopram (Lexapro) – Reduces anxiety and
2. Intense Fear of Gaining Weight obsessive behaviors.
➢ Extreme fear of gaining weight or becoming fat, ▪ Used when anorexia coexists with depression
even when underweight. or anxiety disorders.
➢ Persistent behaviors to avoid weight gain, such as
excessive exercise, strict dieting, or purging. ANTIPSYCHOTICS (FOR DISTORTED THINKING & WEIGHT
GAIN)
3. Distorted Body Image & Denial of the Problem ▪ Olanzapine (Zyprexa) – May help with weight
➢ Distorted perception of body weight or shape gain and reduce obsessive thoughts about food.
believing they are overweight despite being ▪ Quetiapine (Seroquel) – Sometimes used for
underweight. severe anxiety and mood stabilization.
➢ Low self-worth tied to body weight and shape. ▪ Used when a person has severe body image
➢ Denial of the seriousness of low body weight not distortion or obsessive thoughts.
recognizing the health risks.

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HORMONAL THERAPY (FOR BONE & HORMONE ISSUES) o Physiological Effects:

▪ Estrogen Therapy (Birth Control Pills) – May ✓ Increased heart rate and blood pressure
help restore menstrual cycles, but not always ✓ Dilated pupils
recommended. ✓ Nausea (especially with Peyote and
▪ Calcium & Vitamin D Supplements – Prevents Psilocybin)
osteoporosis due to low bone density. ✓ Sweating or chills
▪ Medroxyprogesterone (provera, depo provera)
▪ Used for bone health and hormonal Long-term Effects
imbalances caused by anorexia. o Persistent Psychosis: Hallucinations, paranoia,
disorganized thinking
o Hallucinogen Persisting Perception Disorder
SUBSTANCE ABUSE (HPPD): Flashbacks of hallucinations even after
▪ refers to the harmful or excessive use of drugs, stopping drug use
alcohol, or other substances that negatively o Memory and Cognitive Impairment: Difficulty
impact a person's health, relationships, and with learning and focus
daily life. It often leads to addiction, dependence, o Psychological Dependence: Craving the altered
and serious health risks. state

SUBSTANCE DEPENDENCE CANNABIS (MARIJUANA, POT, HASHISH)

▪ Pattern of repeated use of a substance which ▪ Cause altered state of awareness, relaxation,
usually results in tolerance, withdrawal and and mild euphoria
compulsive drug-taking behavior ▪ Decrease inhibitions
▪ Client takes substance in larger amount and ▪ Decrease motivation from prolonged use
over longer periods of time ▪ Can cause psychosis
▪ Client has desire to cut down but unsuccessful ▪ Causes drying of mucous membrane and
reddening of the eyes
SUBSTANCE TOLERANCE ▪ In pregnancy, it reduces milk production
▪ A need to increase the amount of a substance
to achieve the desired effect
OPIOIDS (CODEINE (COUGH SYRUP), HEROIN, CHINA
WHITE)
PRECIPITATING FACTORS ▪ Meperidine hydrochloride for treatment of pain
✓ Rebellion ▪ Decrease response to pian, respiratory
✓ Pleasure seeking experiences depression, constriction of pupils, euphoria,
✓ Group influences apathy, and impaired judgment
✓ Depression ▪ In pregnancy it may induce PIH
✓ Grieving

DRUGS THAT ARE COMMONLY ABUSED

CNS STIMULANTS (AMPHETAMINE (METHAMPETAMINE
HCL SHABU), BENSERAZIDE, INHALERS, CAFFEINE,
HALLUCINOGENS (LYSERGIC ACID DIETHYLAMIDE, DIET PILLS, ECSTASY)
MESCALINE, PEYOTE, PHENCYCLIDINE, PSILOCYBIN)
▪ Increased Alertness & Energy – Feeling awake
Short-term Effects
and hyperactive
o Perceptual Distortions: Visual and auditory
▪ Euphoria ("High") – Intense pleasure and
hallucinations, altered sense of time and space
confidence
o Mood Changes: Euphoria, intense emotions, or
▪ Increased Heart Rate & Blood Pressure – Risk of
anxiety
hypertension and heart attack
o Cognitive Effects: Confusion, impaired judgment,
▪ Dilated Pupils – Common stimulant effect
difficulty focusing
▪ Loss of Appetite – Leads to weight loss
o Increased Sensory Awareness: Colors appear
▪ Restlessness & Anxiety – Nervousness,
brighter, sounds become more intense
jitteriness

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▪ Insomnia – Difficulty sleeping WARNING SIGNS OF SUICIDE

▪ Increased Body Temperature & Sweating
VERBAL WARNING SIGNS
Talking about suicide – Saying things like “I wish I
ALCOHOL were dead” or “Everyone would be better off without me.”
▪ A CNS depressant affecting all body tissues
▪ Euphoria & Relaxation – Initial feelings of Expressing hopelessness – “There’s no way out” or
happiness and reduced stress “Nothing will ever get better.”
▪ Lowered Inhibitions – Increased sociability, risk-
taking behavior Saying goodbye – Giving unexpected goodbyes,
▪ Slowed Reflexes & Poor Coordination – saying “Take care of yourself” as if they won’t be around.
Impaired motor skills, risk of accidents
▪ Blurred Vision & Slurred Speech – Common Feeling like a burden – “I just make life harder for
with moderate to high doses everyone.”
▪ Nausea & Vomiting – Common at high doses
(alcohol poisoning risk)
▪ Dehydration & Hangover – Headache, fatigue, EMOTIONAL & BEHAVIORAL CHANGES
and thirst after excessive drinking ⚠ Sudden Mood Swings – Going from deep sadness to
▪ Memory Impairment ("Blackouts") – Gaps in calmness (may indicate they’ve made a decision).
memo
⚠ Social Withdrawal – Avoiding friends, family, and
usual activities.
SUICIDE
▪ The deliberate act of self-injury with the intent ⚠ Loss of Interest – No longer caring about work,
that the injury result in death hobbies, or personal hygiene.

SUICIDE IDEATION ⚠ Increased Risk-Taking – Reckless driving, unsafe sex,

▪ involves a preoccupation with thought about excessive substance use.
committing suicide
⚠ Self-Harm – Cutting, burning, or other forms of self-
SUICIDE ATTEMPT injury.
▪ intended to cause injury or death

BEHAVIORAL RED FLAGS

Giving Away Belongings – Giving away valuables or
FACTORS ASSOCIATED making a will.
1. History
2. Individual factors Searching for Suicide Methods – Looking up ways to
o Impulsiveness die online or collecting pills/weapons.
o Difficulty tolerating frustration
o Thinking disorders Sudden Improvement in Mood – Sometimes, people
o Physical or body image problems become unusually calm before attempting suicide
3. Family factors because they’ve made a decision.
o Difficult home situations
o Hostile parents Increased Substance Use – Drinking or drug use as a
o Overt rejections coping mechanism.
4. Social and environmental factors

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PHYSICAL SYMPTOMS
Extreme fatigue or insomnia
Changes in appetite or weight
Frequent headaches, stomach aches, or other
unexplained pain

NURSING MANAGEMENT
1. Assessment & Early Identification

Conduct a Suicide Risk Assessment (SRA) using

standardized tools (e.g., SAD PERSONS scale, Columbia-
Suicide Severity Rating Scale).
Ask Directly About Suicidal Thoughts – “Are you
thinking about hurting yourself?”
Assess the Plan & Lethality – Do they have a plan?
How accessible is the method?
Evaluate Protective & Risk Factors – Support system,
previous attempts, substance use, psychiatric history.

2. Immediate Interventions
Ensure Safety First – Remove harmful objects (sharp
items, belts, medications).
One-on-One Observation – Never leave the patient
alone if they are high-risk.
Implement Suicide Precautions:
o Assign a room near the nurse’s station.
o Keep the bed in the lowest position with minimal
furniture.
o Monitor medication intake (watch for hoarding
or overdose).
Encourage Expression of Feelings – Use therapeutic
communication: “I am here for you.”

3. Psychosocial Support & Coping Strategies

Provide Emotional Support – Build trust through
active listening and empathy.
Encourage Family Involvement – Educate them on
warning signs and support strategies.
Teach Coping Skills – Stress management,
journaling, and relaxation techniques.
Promote a Structured Routine – Helps with stability
and reducing feelings of chaos.

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ANNOTATIONS

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