19 Eating Disorders

Question 1

ED has a _____ rate and ____ risk

Answer 1

high mortality; suicide

Question 2

ED treatment modalities is focused on…

Answer 2

normalizing eating patterns + beginning to address issues raised by illness

Question 3

comorbidities w ED

Answer 3

• depression
• personality disorder
• substance abuse disorder
• anxiety

Question 4

anorexia nervosa

Answer 4

persistent energy intake restrictions leading to significantly low body wt

• fear of gaining wt/becoming fat
• disturbance in perceived wt or shape

Question 5

anorexia characteristics

Answer 5

-preoccupied w food, rituals of eating, or refusal to eat

Question 6

anorexia onset

Answer 6

• assoc w stressful life event

- usually adolescence to young adult

Question 7

compared to clients w restrictive type, those who have binge/purge type have a higher rate of…

Answer 7

impulsivity

-more likely to abuse drugs + alcohol

Question 8

types of anorexia

Answer 8

1 restricting> drastically restricts intake; no binge/purge

2 binge/purge

Question 9

bulimia nervosa

Answer 9

recurrently eat large quantities of food over a short period of time [BINGE]
-then followed by inapprop compensatory behavr [VOMIT/PURGE] to rid of excess calories

**sense of lack of control over earting

Question 10

bulimia frequency

Answer 10

binge/purge occur once a week for 3 months

Question 11

binge eating is a ___ period of time

Answer 11

discrete period of time

-usually less than 2 hr

Question 12

amount of food during a binge

Answer 12

larger than what most individuals eat in similar period of time

Question 13

bulimia characteristics

Answer 13

• wt within norm range or slightly higher

- bw binges, client typically restricts caloric intake + selects “diet” foods

Question 14

bulimia types

Answer 14

1 purging

2 nonpurging

Question 15

purging bulimic clients use…

Answer 15

SELF INDUCED VOMITING, laxatives, diuretics, enemas to lose/maintain weight

Question 16

nonpurging bulimics…

Answer 16

compensate for eating thru other means

-excessive exercise, laxatives, diuretics, enemas

Question 17

Binge Eating Disorder

Answer 17

recurrently eat large quantities of food over a short period of time w/o use of compensatory behaviors
-severity is based on how often client binges per week

Question 18

after binge-eating episode, client feels…

Answer 18

distress

Question 19

unlike anorexia + bulimia,

Binge Eating Disorder affects…

Answer 19

men + women

• all ages
• more commonly 46-55

Question 20

eating disorder risk factors

Answer 20

• occupational choices that encourage thinness
• hx of being a “picky” eater in childhood
• athletics esp in elite level or sport that required lean body (cycling) or specific wt is necessary (wrestling)
• hx of obesity
• fam hx

Question 21

biological factors on eating disorder

Answer 21

-hypothalamic, neurotransmitter, hormonal, or biochem imbalance, serotonin pathway issues

Question 22

interpersonal relationships on eating disorders

Answer 22

influenced by parental pressure + need to succeed

Question 23

psychological influence on eating disorder

Answer 23

-rigidity, ritualism
-separation + individuation conflicts
feelings of ineffectiveness, helplessness, + depression
-distorted body image
-internal or external locus of control or self identity
potential hx of phys abuse

Question 24

environmental factors on eating disorder

Answer 24

media influence + pressure fr society to have the “perfect body”

Question 25

temperament on eating disorder

Answer 25

anxiety or obsessive traits in childhood

Question 26

nursing hx should include...

Answer 26

- client's perception of issue - eating habits - hx of dieting - methods of wt control - value attached to specific wt/shape - interpersonal/social functioning - difficulty w impulsivity - fam + interpersonal relations

Question 27

fam + interpersonal relationships are typically...

Answer 27

troublesome, chaotic, + reflecting a lack of nurture

Question 28

cognitive distortions include

Answer 28

- overgeneralization - "all or nothing" thinking - catastrophizing - personalization - emotional reasoning

Question 29

example of overgeneralization

Answer 29

other ppl dont like me bc im fat

Question 30

example of "all or nothing" thinking

Answer 30

if i eat any desert ill gain 50 lbs

Question 31

example of catastrophizing

Answer 31

my life is over if i gain weight

Question 32

example of personalization

Answer 32

when i walk thru the hallway, i know everyone is looking at me

Question 33

example of emotional reasoning

Answer 33

i know i look bad bc i feel bloated

Question 34

ED mental status

Answer 34

- demonstrated high interest in prepping food but not eating - fear of gaining wt - perceived they are severely overweight + sees image reflected in mirror - exhibit low self esteem, impulsivity, + difficulty, w interpersonal relationships - need for intense phys regimen - guilt/shame due to binging - obsessive-compulsive can be related/unrelated to food

Question 35

expected VS

Answer 35

- low BP w possible orthostatic hypotns - decr pulse - decr temp - HTN w binge eating disorder

Question 36

ED weight

Answer 36

ANRX: less than 85% of expected norm wt BLM: wt w/in norm range or slightly higher BED: typically overweight/obese

Question 37

Anorexia physical apearance

Answer 37

- lanugo (fine hair) - pale or yellowed skin - cool temp - poor skin turgor - amenorrhea

Question 38

Bulimia physical appearance

Answer 38

- Russell's signs (callus/scars on knuckles) - enlarged parotid glands - dental erosion/caries

Question 39

GI sysem

Answer 39

- constipation (dehydratn) - diarrhea (laxative) - ab pain - self induced vomiting - esophageal tears, gastric rupture

Question 40

criteria for acute care tx

Answer 40

- wt loss of 20% of ideal body wt or less than 10% body fat - unsuccessful wt gain in outpatient - HR<50, BP SYS<90, temp< 96.8 - ECG changes - electrolyte disturbances - psych criteria (dprssn, suicdl, dam crisis, psychosis)

Question 41

cognitive-behavioral therapies

Answer 41

- cognitive reframing - relaxation techniques - journal writing - desensitization exercise

Question 42

nursing care

Answer 42

- monitor VS, I+O, wt - behavior contracts - monitor client before + after meals - monitor exercise - teach + encourage self-care - incorp family when appropriate - work w dietician

Question 43

medically acceptable wt gain

Answer 43

2-3lb per week

Question 44

diet during care

Answer 44

- consider client's preference - structured/inflexible eating schedule in beginning of therapy> discourages binging - small frequent meals is more easily tolerated - liquid supplements as prescribed - high fiber> prevent constripation - low Na> prevent fluid retention - limit high fat + gassy food at start - admin vitamins + minerals - avoid caffeine

Question 45

why should pt avoid caffeine?

Answer 45

can incr energy > resulting in difficulty controlling eating disorder behaviors

Question 46

refeeding syndrome

Answer 46

potentially fatal complicatn | -can occur when fluids, electrolytes, carbs are introduced to severely malnourished client

Question 47

how to avoid refeeding syndrome

Answer 47

- develop controlled rate of nutritional support in initial tx - monitor blood electrolytes - admin fluid replacements as prescribed

Question 48

medications

Answer 48

fluoxetine: SSRI onset: 1-3wks (initial), 2 mos (max response) - avoid hazardous activities - notify provider if sex dysfunction occurs

Question 49

orlistat med

Answer 49

for binge eating to help lose weight