Approach to Eating DOs Flashcards
What is the difference between anorexia nervosa and bulimia nervosa?
Anorexic patients are underweight where as bulimic patients are not necessarily underweight and can range from slightly underweight to normal and obese.
What do you have to worry about mentally with bulimic & anorexic patients
Suicide risk.
Bulimia incr. risk 7x than gen pop
Anorexia incr. risk by 5x
Anorexia Nervosa subtypes
Restricting type & Binge/purge type
What characterizes the restrictive type of AN?
3 mo of no binging/purging or use of laxatives. Excessive exercising, fasting & dieting
What characterizes the binge-eating/purging type?
3 mo of binging & purging behaviors including self-induced vomiting, misuse of laxatives, diuretics, & enemas.
Medical complications of AN with refeeding
Refeeding Syndrome - Complications that result from fluid and electrolyte shifts during aggressive nutritional rehab of malnourished pts.
Your anorexic pt who is being treated at your facility begins to experience seizures, peripheral edema, chest & muscle pains. You order labs and see they have low phosphate & potassium levels, elevated CK corresponding with rhabdomyolysis & elevated LDH corresponding with hemolysis. Tests are also suspecting beginning heart failure. What syndrome is the pt presenting with?
Refeeding syndrome.
- hypophosphatemia
- hypokalemia
- heart failure
- peripheral edema
- rhabdomyolysis
- seizures
- hemolysis
How do you avoid refeeding syn?
Limit calories and fluid in early stages of refeeding, closely monitor labs, avoid rapid increases in calories ingested.
Mood DOs associated with AN
Obsessive compulsive DO!
personality traits of perfectionism, compulsive and narcissistic.
Treatment for AN
Team of mental health clinician, a registered dietitian, and general medical clinician
What meds should you avoid in AN?
Bupropion - incr. seizure risk with binging and purging
Tricyclic antidepressants - cardiotoxicity
Olanzapine - can cause rapid weight gain
Criteria for bulimia nervosa dx
Binge eating and inappropriate compensatory behaviors that occur at least 2x a week for 3 mo’s
What is a major complication of bulimia nervosa
Mallory-weiss tear
What is the treatment of choice for bulmia n?
Cognitive behavior therapy (CBT)
What drug should you avoid in BN pts?
Buproprion!!
Seizure risk for binge-purge pts
