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Flashcards in 4 Eating Disorders Deck (95):
1

Anorexia Nervosa

restriction of energy intake to requirements, resulting in significantly low body weight.

2

Anorexia Nervosa is characterized by...

intense fear of gaining weight, becoming fat

3

People with anorexia have a gross ___ of ____ ____

gross distortion of body image

4

Anorexia Nervosa's prevalence rate in US

1%

5

People with Anorexia is predominantly...(gender and age group)

females, 12 to 30 years old

6

How many percentage of male suffered from anorexia?

fewer than 10%

7

People involved in what (occupation/hobbies) have an increased risk of having anorexia?

modeling, ballet, wrestling elite athletes

8

What 3 factors played in the etiology of anorexia?

biologic, social, and psychological

9

We have an increased risk if our ___ degree biologic relatives have this disorder.

1st

10

Anorexia is often associated with what?

a stressful life event

11

Children are at increased risk if they have what 2 types of disorder?

obsessional and anxiety disorders

12

What class of medication contribute to denial of hunger?

endongenous opioids

13

name one biologic factor influencing anorexia nervosa.

starvation

14

When patients with anorexia get a CT, what will the result reveal?

an enlarged CSF space.

15

Studies have shown that people with anorexia have an dysfunction in what 3 hormones?

serotonin, dopamine, norepinephrine

16

Name the 4 social factors that can contribute to anorexia

1. sociocultural influences
2. family issues
3. vocational influences: ballet, wrestling, gymnastics, athletes, models
4. internet influences

17

Name the 7 psychological and psychodynamic factors.

1. Reaction to independence
2. weight concerns
3. increased social and sexual functioning
4. lack of autonomy and self hood
5. unable to separate psychologically from mother
6. negative emotionality/affect
7. perfectionism

18

what are some behaviors associated with anorexia patients?

intense fear of gaining weight
secretive
refuse to eat with families or in public
often preoccupied with food
diet with restricted fat and carbs
laxative and diuretic abuse
over exercising/physical hyperactivity
rigid and perfectionistic
compulsive stealing
poor sexual adjustment.

19

what are some signs and symptoms of anorexia patients?

BMI 17 or below
Hypothermia
Hypotension
Lanugo
ECG changes: T wave flattening or inversion, ST segment depression, lengthening of QT interval
Dependent edema
Bradycardia
Amenorrhea

20

What are the 4 comorbidities associated with pts with anorexia?

Depression (65% of cases)
OCD (26%)
Social anxiety disorder (34%)
Bipolar Disorder

21

Between the restricting type and the binge- purge type of anorexia, which has the calorie restriction behavior?

restricting type, intermittent in binge-purge type.

22

what are the 2 subtypes of anorexia nervosa?

restricting type and the binge-purge type

23

Between the restricting type and the binge- purge type of anorexia, which has the binge/purge behavior?

binge-purge type

24

Between the restricting type and the binge- purge type of anorexia, which has the social isolation behavior?

both

25

Between the restricting type and the binge- purge type of anorexia, which has the over-exercising behavior?

both

26

Between the restricting type and the binge- purge type of anorexia, which has the perfectionistic behavior?

both

27

Between the restricting type and the binge- purge type of anorexia, which has the diminished sexual interest behavior?

both

28

Between the restricting type and the binge- purge type of anorexia, which has the substance abuse behavior?

less common in restricting type, more common in binge-purge type

29

Between the restricting type and the binge- purge type of anorexia, which has the impulse control disorders behavior?

very common in binge-purge type

30

Between the restricting type and the binge- purge type of anorexia, which has the suicide behavior?

less common in restricting type, high risk in binge-purge type.

31

what are the consequences of starvation on the vital signs?

bradycardia, hypotension with marked orthostatic changes, hypothermia, poikilithermia

32

what are the consequences of starvation in general?

muscle atrophy, loss of body fat

33

what are the consequences of starvation on the CNS?

generalized brain atrophy with enlarged ventricles, decreased cortical mass, seizures, abnormal EEG.

34

what are the consequences of starvation on the cardiovascular system?

peripheral edema, decreased cardiac diameter, narrowed left ventricle wall, decreased response to exercise demand, superior mesenteric artery syndrome

35

what are the consequences of starvation on the renal system?

pre-renal azotemia (abnormally high levels of nitrogen-containing compounds in the blood. ex: urea, creatinine)

36

what are the consequences of starvation on the hematologic system?

anemia of starvation, leukopenia, hypocellular bone marrow

37

what are the consequences of starvation on the GI system?

delayed gastric emptying, gastic dilatation, decreased intestinal lipase and lactase

38

what are the consequences of starvation on the metabolic system?

hypercholesterolemia, non-symptomatic hypoglycemia, elevated liver enzymes, decreased bone mineral density

39

what are the consequences of starvation on the endocrine system?

Low luteinizing hormone, low FSH, low estrogen or testosterone, low/nl thyroxine, low tri-iodothyronine, increased reverse tri-iodothyronine, elevated cortisol, elevated growth hormone, partial diabetes insipidus, increased prolactin

40

What should the nurse assess on a pt with anorexia?

BMI
VS
Labs: CBC, lipids, LFT’s
ECG
Bone density
Delayed or absent menses
Hypertrophy of salivary glands
Dental enamel erosion/caries
Scars or calluses on dorsal surface of fingers
Suicide assessment

41

When checking for the lab work for a pt with anorexia, which ones should the nurse pay attention to in the hematology lab test? (3)

Leukopenia
Anemia
Thrombocytopenia

42

When checking for the lab work for a pt with anorexia, which ones should the nurse pay attention to in the serum chemistry test? (5)

Hypercholesterolemia
Elevated hepatic enzymes
Hypomagnesia, hypozincemia, hypokalemic acidosis

43

When checking for the lab work for a pt with anorexia, what can the nurse expect on the endocrine lab test? (4)

low T4 and T3
Low estrogen or testosterone

44

What diagnostic tests can the nurse use for patients with anorexia to check their health status? (3)

electrocardiogram (ekg)
bone mass
electroencephalography (eeg)

45

what could be expected on an ekg for a patient with anorexia? (2)

sinus bradycardia and QT prolongation

46

what could be expected on an bone mass test for a patient with anorexia? (2)

osteopenia and osteoporosis

47

What could be expected on an eeg for a patient with anorexia?(1)

diffuse abnormalities

48

what are the nursing cares of a patient with anorexia?

Monitor intake and output
Daily weights
Stay with patient during meal times
Do not focus on food and eating, focus on the meaning of the behavior
Enforce behavioral program
Avoid arguing and bargaining
Psychoeducation about the effects of starvation

49

what is bulimia nervosa?

Recurrent episodes of binge eating

50

what is one behavior of bulimia nervosa?

Recurrent inappropriate compensatory behaviors to prevent weight gain

51

what is one thing pt with bulimia nervosa most concerned about?

Self-evaluation is unduly influenced by body shape and image (self image and perception)

52

how many percentage of women have bulimia nervosa?

2-4% of young women

53

when is the usual onset of bulimia nervosa?

adolescence or young adulthood

54

how many percent of college women experience transient bulimia symptoms?

20%

55

what is the rate of men compared to females diagnosed of bulimia nervosa?

1 man in every 10 females

56

what medical history is common in people with bulimia nervosa?

history of obesity

57

what are the 4 comorbidities of bulimia nervosa?

Depression
Anxiety disorders
Substance abuse
Personality disorders

58

when does bulimia nervosa usually begin in a pt?

during or after an episode of dieting

59

what can induced bulimia nervosa in a pt?

multiple stressful life events.

60

what are two complications associated with bulimia nervosa?

elevated risk for mortality and elevated suicide risk

61

what is one difference between bulimia nervosa and anorexia nervosa?

Higher rates of partial and full recovery than Anorexia

62

What are some biologic factors that can cause bulimia?

Serotonin and norepinephrine,
Increased frequency in families,
Increased endorphin levels after vomiting

63

What are some social factors that can cause bulimia?

High achievers
Increased familial depression
Family conflict

64

What are some psychological factors of bulimia?

Difficulties with adolescent demands,
Impulse problems,
ETOH and substance abuse,
Shoplifting,
Emotional lability,
Self injurious behaviors,
Suicide attempts,
Self destructive sexual relationships,
Promiscuity,
Personality disorders

65

what are the metabolic consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

hypokalemic alkalosis or acidosis, dyhydration

66

what are the renal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

pre-renal azotemia, acute and chronic liver failure

67

what are the cardiovascular consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

arrhythmias, myocardial toxicity from emetine

68

what are the dental consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

lingual surface enamel loss, multiple caries

69

what are the gastrointestinal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

swollen parotid glands, elevated serum amylase levels, gastric distention, IBS, melanosis coli from laxative abuse

70

what are the musculoskeletal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?

cramps, tetany

71

what should the nurse assess on a patient with bulimia nervosa?

labs, weight, Russell's sign, dental erosion, bilateral parotid enlargement.

72

what is binge eating disorder?

recurrent episodes of binge eating

73

Marked ___ regarding binge eating.

distress

74

Is there inappropriate compensatory behaviors present with binge eating disorder?

No

75

Binge eating disorder is most common in which hospital unit?

ED

76

how many percentage of patients seek medical care for obesity?

25%

77

how many people are diagnosed with severe obesity?

50 to 75%

78

what BMI is considered severe obesity?

BMI > 40

79

what percentage of females have binge eating disorder?

4%

80

what percentage of males have binge eating disorder?

2%

81

what are the 5 etiologies of binge eating disorder?

1. Impulsive and extroverted personality styles
2. Low calorie diets
3. Stress
4. Alleviate anxiety
5. Cope with depressive symptoms

82

What are the treatments of eating disorders? (6)

1. Restoration of patient’s nutritional state
2. Medical stabilization
3. Hospitalization recommended at 30% below expected weight
4. Psychotherapy: CBT, family tx, family education
5. Pharmacotherapy: SSRI’s
6. Interdisciplinary team, multi-modal, nutrition, medicine, psychiatry

83

What are the goals of nursing care of the client with an eating disorder? (3)

1. Restoration of nutritional balance.
2. Helping client gain control over life situations in ways other than inappropriate eating behaviors.
3. Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance.

84

What should the nurse educate the patient and the family? (7)

1. Symptoms of anorexia and bulimia
2. Effects of the illness
3. Principles of nutrition
4. Importance of expressing feelings/emotions
5. Alternative coping mechanisms
6. Medication teaching
7. Relaxation/stress management

85

What are some nursing diagnoses of eating disorders? (5)

1. Imbalanced nutrition: less/more than body requirements
2. Disturbed body image
3. Deficient fluid volume
4. Ineffective denial
5. Anxiety

86

What eating disorders is SSRI (Fluoxetine) good for?(3)

Anorexia, bulimia and binge eating

87

what eating disorder is Topiramate (Topamax) good for? (1)

binge eating

88

What eating disorders is desimprimine (norpramine) good for?(2)

bulimia and binge eating

89

What eating disorders is Amitriptylene (elavil) good for? (1)

anorexia

90

What eating disorders is Clomiprimine (Anafranil) good for? (1)

anorexia

91

What eating disorders is Olanzapine (Zyprexa) good for? (1)

anorexia

92

What eating disorders is Cyprohyptadine (Periactin) good for? (1)

anorexia

93

What eating disorders is Imiprimine (Tofranil) good for? (1)

bulimia

94

What eating disorders is Lisdexamfetamine (Vyvanse) good for? (1)

binge eating.

95

what is the most commonly used medication for eating disorders?

SSRI (Fluoxetine)