Flashcards in Test 1 - Eating Disorders Deck (39):
Do anorexic patients feel hunger pains?
Yes. It is only with food intake of less than 200 calories per day that hunger sensations cease.
(I interpret this as saying if a person eats
What is lanugo?
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn. Caused by anorexia - believed to be a way for body to keep warm.
What is a plan to success for anorexia?
Client must feel that they are in control. Successes have been observed when the client with AN is allowed to contract for privileges based on weight gain. Client should have input into the care plan and can clearly see what treatment choices are. Gives patient a sense of autonomy.
A person who eats an amount far larger than normal and does not not purge has an ED called
Binge Eating Disorder
A person who does not eat, eats extremely little....
A morbid fear of obesity, what are the symptoms of this eating disorder
refusal to eat
Self induced vomiting
Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder?
A. The home environment maintains loose personal boundaries.
B. The home environment places an overemphasis on food.
C. The home environment is overprotective and demands perfection.
D. The home environment condones corporal punishment.
The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.
A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding?
A. The emesis produced during purging is acidic and corrodes the tooth enamel.
B. Purging causes the depletion of dietary calcium.
C. Food is rapidly ingested without proper mastication.
D. Poor dental and oral hygiene leads to dental caries. ANS:
The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.
A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client?
A. The client will use stress-reducing techniques to avoid purging.
B. The client will discuss chaos in personal life and be able to verbalize a link to purging.
C. The client will gain 2 pounds prior to the next weekly appointment.
D. The client will remain free of signs and symptoms of malnutrition and dehydration.
The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.
What is the DSM guidelines for bulimia in regard to binge episodes?
Minimum of 2 binge eating episodes per week for three months.
What type of meal plan should we implement for an anorexic person?
6 small meals a day
What type of meal plan should we implement for a bulimic person?
3 regular meals (per lecture)
T or F: A person with bulimia may have a weight fluctuation of 10 lbs in one day.
T or F: Anorexic patients embrace traditional femininity
False. Bulimic patients embrace it. Anorexic patients are extremely thin and bony.
What are common issues found in adolescents with eating disorders?
high risk for anxiety, depression and suicide
T or F: Men are not anorexic
False. Some men are, more common in gay men
What are ways that bulimics purge?
vomiting, laxatives, diuretics, enemas
T or F: there is often a history of sexual abuse in bulimic patients
A patient has a sore throat, esophagitis and enamel erosion. Their parotid glands are enlarged and they have calluses on their knuckles. Skin turgor is poor and they have not had a period in a few months. What is this person's Dx?
What is the best type of therapy for EDO patients?
Patient should think before acting (think before purging or skipping food or exercising, etc)
What are appropriate diagnoses for EDO patients?
Disturbance in self oncept (anorexic individuals see themselves as fat even when emaciated)
Alteration in family process (parents expect perfection and are controlling, child uses controlling food as a way to have a say).
What are appropriate interventions for Bulimic pts?
-Ensure adequate nutritional intake
-monitor for 2 hours after meals for BN to prevent binge
-Set target weights
-Eat with pt. (role model), talk while they eat.
-avoid discussions about food
-weigh patient where only nurse can see the number
-Provide structure around meals
-Use positive reinforcement to increase self esteem
If giving an edo patient an antidepressant, what is preferred and what is a "no no"?
DO NOT use buproprion (Wellbutrin) because it decreases seizure threshold
SSRI- fluoxetine (prozac) or
TCA- clomipramine (Anafranil)
SSRI - fluoxetine (prozac)
anticonvulsant - topiramate (Topamax)
SSRI - fluoxetine (prozac)
A patient has an intense fear of gaining weight. She has not had a menstrual period in four months. She has lost at least 25% of her body weight, has dry skin and hair loss along with lanugo. What is her Dx?
A patient has extremely low blood sugar and cholesterol with abnormally low levels of growth hormone and irregular heart beat, decreased pulse and hypotension. What is this patient's Dx?
A patient has an obsession with food, but controls their own intake. This patient loves to cook for other but would prefer not to eat. THis patient is ?
T or F: Anorexic patients may purge
True. There are two types of anorexic patients:
1. Restrictive type: diets, fasts, exercises; progressive type
2. Binge-Eating/Purge type: may use vomting and abuse of laxatives or diuretics to achieve quicker weight loss.
What is the difference between anorexia and bulimia?
The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.
What are interventions for anorexic patients?
1. rule out medical - disease (TB, HIV, etc), hyperthyroid, pyloric obstruction and drug abuse.
2. Assess reasons WHY the patient may be anorexic
3. Monitor VS, I&O, electrolytes
4. Set time limit for eating (30 minutes)
5. Monitor food disposal, vomiting, exercise
6. Avoid food conversations or weight focuses conversations
7. assess for loading prior to weights (weigh in the AM after urination and before any food/drinks..)
8. Use contracts
9. use suicide precautions
10. Allow food choices and encourage snacks between meals (6 small meals is best)
12. Family/group therapy
13. Use NG if patient is in life threatening thinness
T or F: Obesity is considered a psychiatric disorder under the DSM-5
BINGE eating leads to obesity. But obesity could be caused by non psychiatric reasoning (disease, etc).
It MAY be considered under psychological factors affecting medical condition. A person who has BED has recurrent episodes of binge eating. They eat an amount of food that's def larger than what most people would eat in a similar period. They have a sense of lack of control over eating.
What is the difference between a bulimic person and a person with BED?
Bulimics take action to rid themselves of calories/weight. BED do not.
What are characteristics of BED patients?
1. repeated episodes of uncontrolled eating
2. Not associated with hunger, food is used to calm and nurture as a coping mechanism for anxiety
3. experience anxiety, depression, low self esteem, poor body image, guilt and self disgust.
4. secretive eating, eating alone
5. usually soft foods easily digested
6. OCCURS 1 time/WEEK for 3 months
What is the nursing process for BED patients?
1. assess for anxiety, loss of control, disgust, guilt, shame, anger, depression, low self esteem and feelings of isolation.
2. Family Hx - marital conflict? depression?
3. Attempts to lose weight?
4. Using food as love, etc?
5. Medical issues causing?
What are intervetnions for BED pt?
1. KEEP FOOD JOURNAL - include what you ate and your emotions at the time
2. develop an eating plan
3. weight goals
4. exercise program
5. discuss plateaus
6. Meds - SSRIs and appetite supressants (sibutramine)
7. Team approach - nutritionist, psychiatrist for med mgmt, social worker for family education
8. Refer to support groups
What theory says these are reasons for EDO?
"unconscious conflicts, regression, fear of sexual maturity"
"Anorexia rejection of feminine form and attempt to regain body of a child"
"Compulsive over eating is unmet oral needs during infanct, feels empty, defense against intimacy with opposite sex."
FREUD - Psychoanalytic
Which theory states the following reason for EDO?
"Intrapersonal/interpersonal conflicts in FAMILY (likely unconscious), avoidance of parental conflict if the focus is on the patient"
Anorexic FAMILY - rigid expectation of overly compliant child. There's a conflict between enslavement vs autonomy for the patient within the family structure. Control over their own body is a way of asserting onself.
For overeaters, there is ambivalance toward them, conflict between parents, and the patient/child is the scapegoat for family issues.
Family Systems Theory
Which theory states:
"Learned behaviors are based on irrational thoughts and beliefs such as clean your plate!"
"focus on gaining insight into maladaptive behavior integrated with new and healthier responses to emotional stimuli (think before you act)
Which theory says the following are causes of EDOs?
" There are disturbances of the GI tract."
"Leptin-hormone secreted by fat cells may play a role."
"Genetics are a key factor."
"Neuroendocrine abnormalties may be a factor."
"Neurochemical influences - low NE, 5HT in bulimics, DA regulation is impaired in anorexia."