Eating Disorders Flashcards
Anorexia Nervosa + Behaviors
Is a clinical syndrome in which the person has a fear of obesity. It is characterized by the individual’s gross distortion of body image, preoccupation with food, and refusal to eat.
- Amenorrhea
- Depressive symptoms
- Preoccupation with thoughts of food
- Feelings of ineffectiveness
- Inflexible thinking
- Strong need to control environment
- Limited spontaneity and overly restrained emotional expression
- C/o constipation and abdominal pain
- Cold intolerance
- Emaciation
- Peripheral edema
- Elevated BUN
- Electrolyte imbalance
- Anemia
- Cardiovascular: Hypotension, bradycardia, heart failure!!!!!!!!!!!!!!!!!!!!!!!!!
Anorexia Characteristics
Physiological and psychological components:
- Limit calorie intake to 200 – 700 per day,
- May obsess over eating habits, types of foods
- Excessive exercising
- Food rituals
- Denies eating problems, actual vs desired wt.
- Other associated Behaviors
- Ineffective method of gaining attention
- See others’ comments as negative even if positive “ you look healthy” = “ I am fat”
- Get attention, feel caring and love
- Feelings of powerlessness in other areas, compensates with control of food
- Views wt gain as weak, a failure, hates self for failure, so looses wt.
- Very poor self-image, displeased with their look, think of themselves as unattractive
Other Anorexic characteristics
- Younger population, early teens, elderly
- More introverted
- Change in eating habits, skipping meals, may eat separately and different foods than other members of family, eat slower,
- *weight loss*, slow and progressive, may deny hunger
- Tend to wear more concealing clothes
Bullemia Nervosa
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Unique feature of “binge and purge”:
a) recurrent episodes (at least twice a week for 3 months) of binge eating (a sense of loss of control) followed by
b) self-induced vomiting or abuse of laxative or diuretics or enemas, extreme exercise - Poor or distorted body image, fear of weight gain, feelings of shame, guilt, low self-esteem
Other Characteristics
- More common than anorexia
- Older teens and early 20’s
- More extrovert
- Binge secretly,
- Cycles of weight gain and loss as weight control methods not effective
- Strong emotions followed by guilt, remorse, shame, self-contempt.
- Feelings of failure related to loss of self-control
- Menses irregular or absent
- Other abnormal behaviors: substance abuse, drugs, alcohol, cigarettes
- Feelings of failure, out of control
Binge Eating Disorder
Recurrent episodes of rapid consumption of large quantities of food in a limited period of time (morbid obese)
- Cause distress and intense guilt
- Feeling of loss of control
- No attempt to prevent weight gain
Causes of Eating Disorder Syndrome
- Genetic
- Biological: imbalance, eg: serotonin, norepinephrine, other psychological conditions
- Family dynamics and Developmental problems
- Sociocultural
Stimuli
Person is sensitive to variety of stressors
- Loss (significant other, family)
- Presence of interpersonal rejection, (fat = rejection), perception of failure
- Family conflicts, dysfunctional, sexual abuse
- Investigate issues of control, perception of control
- Body-image distortion
Stimuli: Predisposing factors
Sociocultural: Eating disorder rare in societies where “plumpness” accepted or valued
- Western society role expectations, ideal: lean, strong, competent, feminine, graceful, successful, smart
- Success = slim, attractive, poor role model
- athleticism, disapproving obesity increases risk of eating disorder in children(esp. girls)
- In adults: “Desperate Housewife syndrome”
Physiological Changes: Metabolic, endocrine abnormalities
- Bradycardia, HF, hypotension
- Fluid/E imbalance,
- Osteoporosis (long term)
- Amenorrhea
- Constipation
- Cold intolerance
- pedal edema
Electrolyte imbalances: hypokalemia, hyponatremia
- Muscle weakness,
- cardiac arrhythmias, hypotension
- death
- Erosion of esophagus, buccal mucous membrane from frequent vomiting
- Darkened teeth from acidity (vomiting)
Assessment: Physiological
- Head to toe physical assessment, skin, hair, BMI, blood work: lytes, CBC
- Diet profile of last 24 hrs, 48 hrs, favorite foods, eating habits
- Other health practices, specific
- History from family members
- Physiological Assessment
- Inspect teeth, inside of mouth, tongue, neck
- Assess grips, skin temperature, turgor
- BMI
Assessment: Psychosocial
Eating disorder is maladaptive coping
- Investigate insight/perception of problem/complications
- Value attached to shape/weight
- What is upsetting, stressful
- What precedes episodes eg. Bulimic, or fasting (keeping a diary)
- Assess pt’s other methods of dealing with stressors/coping
Coping
Anorexic: feel in control when losing weight: achieving their goal
- Use denial as coping strategy, denial of any problem, of malnutrition
- Perception of control over fears and life
Bulimic:
Defense Mechanisms: avoidance, denial, intellectualization
Nursing Diagnosis
Anorexia:
- Altered nutrition less than body requirements related to severe restricted food intake,
- Body image disturbance related to eating disorder (fear of getting fat)
- Ineffective denial related to eating disorder
Bulimia:
- Altered nutrition rt fear of gaining weight,
- Body image disturbance related to anxiety about body size
Ineffective coping rt impulsive and uncontrolled responses to …
- Constipation, dehydration, esophageal erosion, decreased cardiac output…
Goals
Ultimate goal: patient will resume healthy eating patterns and normal physiological parameters in relation to weight and nutrition
Short-term goals: the pt will accurately describe body dimensions
- The pt. will exercise in moderate amounts only when nutritionally stable
- The pt will choose a week’s worth of balanced diet from the hosp. menu
- Patient will express satisfaction with body appearance
- Patient will demonstrate adaptive coping skills, will use strategies to enhance function
- Patient will set realistic goals for exercise and nutritional intake
*Long term as condition is usually chronic with setbacks*
Nursing Interventions
If in crisis: address physical life threatening condition:
- ICU, IV, rehydrate, nourish,
- Correct electrolyte imbalances
- Close supervision
- Assess suicidal tendencies
Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), have been effective for reducing binge eating and purging in people with BN.
Nursing Interventions: Depending on severity:
- Dangerous physical manifestation: restrictive, e.g. staff will control when and what pt. eats, may restrict visitors / family
- Constant supervised meals
- Restrict activity and access to diversions
- Restrict access to own clothes
- Strict regular weighing (without) telling pt. when, in hosp. gown only or just underwear
- Nursing Interventions
Once weight loss stabilized, reward system: increase privileges and activity levels
- Meds poor results: SSRI (Prozac, Paxil)
- Assess own values: non-judgmental, trust, to be sensitive,
- Contracts
- Multidisciplinary, group therapy
- Teaching
- Counseling
Long term/chronic condition, support
- Involve family members
- Develop adaptive coping skills, modify self-image, self-esteem
- exercise routine
- Self-help groups, support groups, group therapy
