1229 Exam 6: Eating Disorders

Question 1

Anorexia Nervosa

Answer 1

an eating disorder marked by weight loss, emaciation, a disturbance in body image, and fear of gaining weight

Question 2

Bulimia Nervosa

Answer 2

a disorder marked by recurrent episodes of binge eating, self induced vomiting and diarrhea, excessive exercise, strict dieting or fasting, and an exaggerated concern about body shape and weight

Question 3

Binge Eating

Answer 3

a form of compulsive overeating w/ episodes of binge eating occur. Some authorities do not consider it a separate form of compulsive eating disorder

Question 4

Not otherwise specified (NOS)

Answer 4

an eating disorder that contains some but not all of the criteria to meet a specific disorder
Read pg 306 for criteria of NOS

Question 5

4 Theory Types of Eating disorders

Answer 5

Neurobiological
Psychological
Sociocultural
Genetic
Theses are the 4 types of theories and significance of each has evolved over time and remain in a state of flux

Question 6

Neurobiological Theory

Answer 6

more evidence is in favor for biological cause for some eating disorder, especially Bulimia and Anorexia
Serotonin is becoming more likely suspect in the cause of most eating disorders

Question 7

REMEMBER

Answer 7

Eating disorders are not considered specific diseases but are syndromes

Question 8

Psychological Theory

Answer 8

This is the weakest theory based on studies

The currently accepted psychopathology in eating disorders is low self esteem and doubts about self worth.

Question 9

Sociocultural Theory

Answer 9

The world has an idea that the thinner a woman is the more desirable she is. Culture has a very strong influence on females in the US. Culture plays a large role in the increase in eating disorders

Question 10

Genetic Theory

Answer 10

There is a strong link in genetics in all eating disorders, studies on families with anorexia and bulimia have revealed strong genetic links to eating disorders, the stronger the evidence becomes that genetics play a major role

Question 11

Characteristics of Anorexia and Bulimia

Answer 11

fear of weight gain
have body image distortions
low self esteem issues
have high incidence of depression
more prevalent in metro areas than rural areas
affect about the same percentage of females vs males: about 9-1 females

Question 12

S/S of Anorexia

Answer 12

extreme weight loss
thin appearance (emaciated in extreme cases)
abnormal blood counts (anemia & leukopenia)
Fatigue (usually a later symptom)
Insomnia
Dizziness or fainting
A bluish discoloration of the fingers
Brittle nails
Hair that thins, breaks or falls out
Soft, downy hair covering the body (lanugo)

Question 13

S/S Anorexia cont..

Answer 13

Absence of menstruation
Constipation
Dry Skin
Intolerance of cold
Irregular heart rhythms (electrolytes)
Low BP
Dehydration
Osteoporosis
Swelling of arms or legs (decreased albumin)

Question 14

S/S of Bulimia

Answer 14

Feeling that cant control eating behavior
Eating until the point of discomfort or pain
Eating much more in a binge episode than in a normal meal
Self induced vomiting after eating
Exercising excessively
Misuse of laxatives, diuretics or enemas
Being preoccupied with body shape and weight
Going to bathroom after or during meals
Abnormal bowel function
Damaged teeth and gums
Sores in throat and mouth (anorexics too)
Dehydration

Question 15

S/S Bulimia cont..

Answer 15

Irregular heartbeat
Sores, scars or calluses on the knuckles or hands
Menstrual irregularities or loss of menstruation (amenorrhea)
Depression
Anxiety

Question 16

Bulimia may be categorized in two ways:

Answer 16

Purging Bulimia-regularly engage in self induced vomiting or the misuse of laxatives, diuretics or enemas too compensate for binges
Non Purging Bulimia- use other methods to rid yourself of calories and prevent weight gain, such as fasting or over exercising

Question 17

Treatment

Answer 17

Milieu Therapy-controlled or inpatient environment with a team of health care professionals that usually include psychiatrist, psychologist, or therapist
It is best if treated in a specialized clinic for eating disorders
Psychiatrist or Psychiatric Nurse Pract. will manage overall care, including meds and therapies.

Question 18

Comparison between Anorexia and Bulimia

Answer 18

Anorexia’s fear eating, Bulimics don’t fear eating but panic if they can’t purge
Co morbidity with clinical depression is common in both around 50%
Both on the increase among teen girls, increase in males in the past 2-3 decades
Clinical care for clients whose weight is below 75% of ideal body weight takes priority

Question 19

Medical Care

Answer 19

First focus is the clients physical well being
Suicide precautions are routine on admission
Restoring weight to a more normal level is first priority
Central coordinator of care for an eating disorder client is almost always the RN

Question 20

Complications

Answer 20

Observe for s/s of electrolyte imbalance, heart arrhythmias, low BP, check if cold, Re-feeding syndrome

Question 21

Re-feeding Syndrome

Answer 21

a rare but serious complication seen in victims of starvation when they start to feed
Rare in clinical settings
Occurs in clients who are starved or severely malnourished
usually occurs in 4 days or less from start of feeding

Question 22

Symptoms of Re-feeding syndrome

Answer 22

confusion, lethargy, convulsions, severe bradycardia

Question 23

Binge Eating Treatment

Answer 23

Cognitive Behavioral Therapy-focuses on dysfunctional thoughts and behaviors involved in binge eating
Interpersonal Psychotherapy- focuses on the relationship problems and interpersonal issues that contribute to compulsive eating
Dialectical Behavior Therapy-combines cognitive behavior techniques with meditation, teaching how to accept themselves, tolerate stress, and regulate emotions

Question 24

Drugs used in Binge Treatment

Answer 24

Drugs most be in conjunction with therapy
Useful in treating the depression associated with binge eating
Best effective treatment is a combined medical and psychological regimen
Effective meds are Paxil, Prozac & Zoloft
With proper therapy a high percentage recover

Question 25

Signs of Emotional Eating

Answer 25

Using food to fill a void in life, feel better or cheer up , calm down or soothe nerves, escape from problems, cope w/ stress and worries, rewarding

Question 26

Differences in Binge and Bulimia

Answer 26

Binge is similar to Bulimia in both disorders involve consuming massive amounts of food in a short time. Binge eaters do not regularly try to purge or work off the extra calories consumed. Bulimics try to rid calories as soon as consumed

Question 27

Causes of Binge eating

Answer 27

Genetic mutation causes food addiction, low levels of serotonin, some parents set the stage for binge eating by using food as comfort, sexual abuse has led to some cases, depression, low self esteem, loneliness, and body dissatisfaction

Question 28

Physical effects of Long term Binge

Answer 28

Type 2 diabetes, gallbladder disease, high cholesterol, high BP, heart disease, certain types of cancer, osteoarthritis, joint and muscle pain, GI problems, sleep apnea

Question 29

Obesity

Answer 29

Overweight refers to body weight that is at least 10% over the recommended weight for a certain individual. BMI more than 25
Obesity is generally defined as a BMI >30
It is not always caused by simple behavioral issues.

Question 30

Cause of Obesity

Answer 30

comes from consuming more calories than the body needs, usually a sedentary life style or eating a diet high in fats and calories

Question 31

Treatments for Obesity

Answer 31

Med- currently 2 broad classifications of med for obesity. Long and short term
Long Term-Lipase inhibitors, prevent fat breakdown
OTC-Many contain ephedrine but ephedrine is not proven safe for the treatment of obesity. Ephedrine has been associated with weight loss but it is important to note that there are serious side effects associated with this weight loss treatment

Question 32

Surgery for Obesity

Answer 32

is recommended as an option in the treatment only for pts with either a BMI of more than 40 or a BMI of 35 to 39.9 when other serious obesity related conditions are present. Death rate from obesity surgery is 1:200
Pts with severe obesity need a medical work up from an endocrinologist

Question 33

KEY POINTS

Answer 33

Eating disorders are not a specific disease but a syndrome
Anorexia and Bulimia are effectively treated by Cognitive behavior therapy w/ drugs as a back up
Drugs alone will not treat disorders
Surgery is a last resort in treating obesity
In a starving anorexic or bulimic crisis, medical take priority before behavioral therapy

Question 34

BOXES TO READ

Answer 34

Med Complications: BOX 17-1 p304
Box 17-2 Criteria for admission of pt w/ eating disorders
17-1 p 301-303