NRNP – 6665: Eating, Sleeping, and Elimination Disorders

Eating, sleeping, and elimination disorders may come to the attention of providers in a variety of settings. These disorders can be profoundly disturbing to patients’ lives and may have significant comorbidities with other disorders. Eating disorders, such as anorexia and bulimia, are widely known. But it is important to understand and be able to recognize less common disorders, such as pica and rumination disorder. Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep, and they frequently accompany other disorders, especially depression, anxiety, and PTSD. The elimination disorders of enuresis and encopresis are troubling to children and parents and cause significant difficulty in daily functioning.

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Obtaining a thorough history is essential to diagnosing eating, sleeping, and elimination disorders; formulating a treatment plan; and monitoring the plan’s effectiveness. This week, you will explore these categories of disorders and complete your midterm exam.

Learning Objectives

Students will:

Apply concepts related to psychopathology, diagnostic reasoning, and treatment planning in advanced practice psychiatric-mental health nursing care

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 15, “Feeding and Eating Disorders”
Chapter 16, “Normal Sleep and Sleep-Wake Disorders”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Chapter 70, “Sleeping Interventions: A Developmental Perspective”
Chapter 71, “Feeding and Eating Disorders”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

Chapter 10, “Sleep Disorders”

Medication Review

Review the FDA-approved use of the following medicines related to treating eating, sleeping, and elimination disorders.

Bulimia nervosa/binge eating		Enuresis
Fluoxetine – bulimia Lisdexamfetamine – binge eating		Desmopressin Tofranil
Excessive sleepiness in narcolepsy, obstructive sleep apnea/hypopnea syndrome, shift work sleep disorder	Insomnia		Restless leg syndrome
armodafinil modafinil pitolisant sodium oxybate Solriamfetol	Doxepin Eszopiclone Estazolam Flurazepam Lemborexant Quazepam Ramelteon Suvorexant Temazepam Triazolam Zaleplon Zolpidem		Ropinirole Pramipexole Rotigotine patch Gabapentin enacarbil

Mood Disorders in Adults

I am finally doing everything right. I stayed up all night studying for my final exams and even managed to clean out my closet and order a whole new bedroom from the internet. I know I will ace all my exams. Nothing can go wrong like they did a few months ago. I was so low and was sleeping all the time. I did not think I would ever be happy again, but now I know I can do anything.

—Jessica, age 22

Patients presenting with mood disorders may find that their moods impact their ability to function or that their moods are not consistent with their circumstances. Bipolar and related disorders are one category of mood disorders. They affect nearly 3% of the U.S. population each year (Depression and Bipolar Support Alliance, n.d.). Although being relatively rare in terms of lifetime prevalence, bipolar disorder is burdensome to the individual and health care system because of its early onset, severity, and chronic nature. The average age of onset is around 25 and it affects men and women equally.

The importance of evidence-based intervention for treatment in persons with mood disorders cannot be underestimated. Unstable moods can result in repeat chronic hospitalizations and profound life disruption. Mood disorders are a leading cause of disability worldwide and can contribute to suicide (World Health Organization, 2020). Practitioners should understand that developing a good rapport and relationship with the patient can make a significant difference in the course, symptom management, and stability of the patient.

This week, you will assess, diagnose, and develop appropriate treatment plans for adults presenting with mood disorders.

_Reference:

_{Depression and Bipolar Support Alliance. (n.d.). Bipolar disorder statistics. https://www.dbsalliance.org/education/bipolar-disorder/bipolar-disorder-statistics/#}

_{World Health Organization. (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression}

Learning Objectives

Students will:

Assess adults presenting with mood disorders
Develop differential diagnoses for adult patients with mood disorders
Develop appropriate treatment plans for adult patients with mood disorders
Advocate health promotion and patient education strategies for adult patients with mood disorders