Exam 3: eating disorders Flashcards
(12 cards)
progression of symptoms leading to an eating disorder
-normal eating
-development of risk factors: low self-esteem, dieting, parental attitudes, body dissatisfaction, media body ideals
-partial syndrome ED: binge eating, serious dieting
-full syndrome ED: increase in frequency and severity of binge-eating, purging, or starvation, along with treatment
always good to get a baseline for how someone eats!!!
PHYSICAL STABILITY FIRST, FOLLOWED BY PSYCH EVALUATION!
-CBT is consistent for both anorexia and bulimia nervosa!
anorexia nervosa
low body weight
-intense fear of gaining weight or becoming fat
-disturbance in experiencing body weight or shape
-two types: restricting, or binge eating and purging
clinical course: body image distortion, drive for thinness, emotional dysregulation, perfectionism, guilt and anger
diagnostic criteria: refusal to maintain body weight, intense fear of gaining weight
lifespan, epidemiology, and etiology of anorexia nervosa
lifespan: diagnosed as young as 8 years old, most common eating disorder diagnosed in individuals over 50 years of age, late onset is mostly diagnosed in women, in older adults it is associated with significant psychotic comorbidities and overall morbidity.
epidemiology: gender, ethnicity and culture, risk factors, increased BMR, overexercising, elite athlete, low self-esteem, body dissatisfaction, feelings of ineffectiveness, family overprotectiveness, enmeshed, rigid boundaries, inability to solve conflicts
etiology: family response to disorder, rigidity, lots of rules, overprotectiveness
nursing care for anorexia nervosa
RECOVERY-ORIENTED CARE: safety issues with high mortality: suicide, monitor for lethal plan, cardiopulmonary arrest.
assessment: body system evaluation, weight and BMI, menstrual history, mental status and appearance, behavioral responses such as body distortion, fear of weight gain, unrealistic expectations or thinking, ritualistic behaviors (how they eat, what they eat, where they eat), difficulty expressing negative feelings, inability to experience visceral cues and emotions.
medical complications: BRADYCARDIA, HYPOTENSION, ELECTROLYTE IMBALANCES, suicidal ideation
-therapeutic communication may be difficult initially- tend to be suspicious and mistrustful especially of authority figures and health personnel (state of paranoia), impatient, irritable: a firm, accepting, and patient approach is important!!! provide rationale for all interventions, consistent, nonreactive approach, avoid power struggles- always think about personal feelings of frustration and need for control. often eating disorders are related to needed control.
interventions for anorexia nervosa
-establish mental health and wellness goals: positive wellness habits of nutrition, physical activity, sleep, coping with stress, and developing a support system. prioritize long and short-term goals. set realistic goals
-physical care: nutritional rehabilitation- refeeding syndrome, promotion of sleep, medication interventions, management of complications.
-promoting safety
-develop recovery-oriented rehabilitation strategies: maintain normal weight and nutrition, resist urges to diet and over exercise
-evaluation and treatment outcomes: long-term outcomes are more positive than short-term outcomes, remission rates vary from 20-70%, recovery often takes years and can be characterized by residual symptoms.
-hospitalization: close monitoring, privilege-earning program common
-family interventions: can help family express feelings, increase effective communication, reduce protectiveness, resolve guilt.
-prevention: national eating disorder awareness and advocacy groups
-emergency care: if emergency treatment is needed, admission usually follows
-psychoeducation: for parents and school
-veteran resources
bulimia nervosa
-usually older onset than those with anorexia nervosa
-generally not as life threatening as anorexia nervosa, with better outcomes and. lower mortality rates
-usual treatment is outpatient therapy
diagnostic criteria: recurrent episodes of binge eating and compensatory behaviors
-purging= vomiting or use of laxatives, diuretics, or emetics
-non-purging= fasting or overexercising
episodes occurring at least once a week for the last 3 months
no severe weight loss or amenorrhea as with anorexia nervosa
-not as severe weight loss compared to anorexia nervosa- medically more stable
risk factors, epidemiology, and etiology of bulimia nervosa
risk factors: like those of anorexia nervosa, high BMI, female, obstetric complication, perinatal factors, possible link to sexual abuse
epidemiology: onset between 15-24, females>males, related to culture in same way as anorexia nervosa, higher rates in hispanic and white women, ethnic differences to do with the degree to which individuals from specific cultural backgrounds internalize the thin ideal
-common comorbid conditions include substance abuse, depression, and OCD
etiology: genetic and familial predispositions, reduced brain serotonin transmission, depletion of plasma trytophan, psychological, environmental, or sociocultural factors, distorted thinking may be basis of binge-eating and purging-likely explains maintenance rather than cause of it, family factors such as chaotic families with few rules, unclear boundaries, potentially enmeshed mother-daughter relationship.
-family dynamic may be opposite of anorexia-more relaxed, no rules, they may take on a parental role
assessment for bulimia nervosa
physical assessment:
-electrolytes: hypokalemia is common and may lead to muscle weakness, fatiguability, cardiac arrhythmia, palpitations, cardiac conduction defects
-current eating patterns
-dentition-tooth enamel erosion
-number of times per day of binge-eating and purging
-dietary restraint practices
-sleep patterns
-exercise habits
psychosocial: body dissatisfaction, mood, ability to set boundaries, control impulsivity, and maintain quality relationships, poor quality of life, alcohol binging, feels shame and guilt, strong need to please.
-assess strengths, periods of time when able to resist binging and purging, usually motivated to reduce or eliminate the binging and purging
interventions for bulimia nervosa
-establish mental health and wellness goals
-positive wellness habits of nutrition, physical activity, sleeping, coping with stress, and developing a support system
-strict monitoring and food intake
-supervision of bathroom visits
-sleep management
-pharmacologic interventions: SSRIs, fluoxetine: prozac has long half life with less risk for withdrawal
-monitor and administer medications
-therapeutic interactions
-use behavioral intervention
-journaling, self-monitoring, group therapy
-nutrition and health eating, clarification of misconceptions about food
-priority is to address emerging medical problems
-suicide or self-harm behaviors should also be addressed
-staff must set boundaries! nonjudgmental, accepting, stress importance or relationship and outline purpose, explain nature of relationship and goal of therapy to help clarify the boundaries
-hospitalization: for extreme dehydration, electrolyte imbalance, depression, suicidality, or symptoms unresponsive to outpatient treatment
-community: educate school nurses and teachers
-outpatient is most typical level of care!!!!!
-recovery groups and support groups
-trusting relationships may be difficult to form
-avoid triggering words
-no nutrition facts for patient
-may need 1-1 or sitter at mealtimes and afterwards
binge-eating disorder
characterized by binge eating, but without purging or use of compensatory behaviors
estimated between 10-30% of obese people have binge-eating disorder
-etiology similar to bulimia nervosa
-current treatment is similar to bulimia nervosa
purging disorder
frequent purging without binges
-purge at least once a week and have intense fear of gaining weight or becoming fat
-report guilt associated with behavior
night eating syndrome
eating after awakening from sleep or consuming an excessive amount of food after the evening meal
-conceptualized as a disorder of circadian modulation of food intake and sleep
