19 Eating Disorders Flashcards
ED has a _____ rate and ____ risk
high mortality; suicide
ED treatment modalities is focused on…
normalizing eating patterns + beginning to address issues raised by illness
comorbidities w ED
- depression
- personality disorder
- substance abuse disorder
- anxiety
anorexia nervosa
persistent energy intake restrictions leading to significantly low body wt
- fear of gaining wt/becoming fat
- disturbance in perceived wt or shape
anorexia characteristics
-preoccupied w food, rituals of eating, or refusal to eat
anorexia onset
- assoc w stressful life event
- usually adolescence to young adult
compared to clients w restrictive type, those who have binge/purge type have a higher rate of…
impulsivity
-more likely to abuse drugs + alcohol
types of anorexia
1 restricting> drastically restricts intake; no binge/purge
2 binge/purge
bulimia nervosa
recurrently eat large quantities of food over a short period of time [BINGE]
-then followed by inapprop compensatory behavr [VOMIT/PURGE] to rid of excess calories
**sense of lack of control over earting
bulimia frequency
binge/purge occur once a week for 3 months
binge eating is a ___ period of time
discrete period of time
-usually less than 2 hr
amount of food during a binge
larger than what most individuals eat in similar period of time
bulimia characteristics
- wt within norm range or slightly higher
- bw binges, client typically restricts caloric intake + selects “diet” foods
bulimia types
1 purging
2 nonpurging
purging bulimic clients use…
SELF INDUCED VOMITING, laxatives, diuretics, enemas to lose/maintain weight
nonpurging bulimics…
compensate for eating thru other means
-excessive exercise, laxatives, diuretics, enemas
Binge Eating Disorder
recurrently eat large quantities of food over a short period of time w/o use of compensatory behaviors
-severity is based on how often client binges per week
after binge-eating episode, client feels…
distress
unlike anorexia + bulimia,
Binge Eating Disorder affects…
men + women
- all ages
- more commonly 46-55
eating disorder risk factors
- occupational choices that encourage thinness
- hx of being a “picky” eater in childhood
- athletics esp in elite level or sport that required lean body (cycling) or specific wt is necessary (wrestling)
- hx of obesity
- fam hx
biological factors on eating disorder
-hypothalamic, neurotransmitter, hormonal, or biochem imbalance, serotonin pathway issues
interpersonal relationships on eating disorders
influenced by parental pressure + need to succeed
psychological influence on eating disorder
-rigidity, ritualism
-separation + individuation conflicts
feelings of ineffectiveness, helplessness, + depression
-distorted body image
-internal or external locus of control or self identity
potential hx of phys abuse
environmental factors on eating disorder
media influence + pressure fr society to have the “perfect body”
temperament on eating disorder
anxiety or obsessive traits in childhood
nursing hx should include…
- client’s perception of issue
- eating habits
- hx of dieting
- methods of wt control
- value attached to specific wt/shape
- interpersonal/social functioning
- difficulty w impulsivity
- fam + interpersonal relations
fam + interpersonal relationships are typically…
troublesome, chaotic, + reflecting a lack of nurture
cognitive distortions include
- overgeneralization
- “all or nothing” thinking
- catastrophizing
- personalization
- emotional reasoning
example of overgeneralization
other ppl dont like me bc im fat
example of “all or nothing” thinking
if i eat any desert ill gain 50 lbs
example of catastrophizing
my life is over if i gain weight
example of personalization
when i walk thru the hallway, i know everyone is looking at me
example of emotional reasoning
i know i look bad bc i feel bloated
ED mental status
- demonstrated high interest in prepping food but not eating
- fear of gaining wt
- perceived they are severely overweight + sees image reflected in mirror
- exhibit low self esteem, impulsivity, + difficulty, w interpersonal relationships
- need for intense phys regimen
- guilt/shame due to binging
- obsessive-compulsive can be related/unrelated to food
expected VS
- low BP w possible orthostatic hypotns
- decr pulse
- decr temp
- HTN w binge eating disorder
ED weight
ANRX: less than 85% of expected norm wt
BLM: wt w/in norm range or slightly higher
BED: typically overweight/obese
Anorexia physical apearance
- lanugo (fine hair)
- pale or yellowed skin
- cool temp
- poor skin turgor
- amenorrhea
Bulimia physical appearance
- Russell’s signs (callus/scars on knuckles)
- enlarged parotid glands
- dental erosion/caries
GI sysem
- constipation (dehydratn)
- diarrhea (laxative)
- ab pain
- self induced vomiting
- esophageal tears, gastric rupture
criteria for acute care tx
- wt loss of 20% of ideal body wt or less than 10% body fat
- unsuccessful wt gain in outpatient
- HR<50, BP SYS<90, temp< 96.8
- ECG changes
- electrolyte disturbances
- psych criteria (dprssn, suicdl, dam crisis, psychosis)
cognitive-behavioral therapies
- cognitive reframing
- relaxation techniques
- journal writing
- desensitization exercise
nursing care
- monitor VS, I+O, wt
- behavior contracts
- monitor client before + after meals
- monitor exercise
- teach + encourage self-care
- incorp family when appropriate
- work w dietician
medically acceptable wt gain
2-3lb per week
diet during care
- consider client’s preference
- structured/inflexible eating schedule in beginning of therapy> discourages binging
- small frequent meals is more easily tolerated
- liquid supplements as prescribed
- high fiber> prevent constripation
- low Na> prevent fluid retention
- limit high fat + gassy food at start
- admin vitamins + minerals
- avoid caffeine
why should pt avoid caffeine?
can incr energy > resulting in difficulty controlling eating disorder behaviors
refeeding syndrome
potentially fatal complicatn
-can occur when fluids, electrolytes, carbs are introduced to severely malnourished client
how to avoid refeeding syndrome
- develop controlled rate of nutritional support in initial tx
- monitor blood electrolytes
- admin fluid replacements as prescribed
medications
fluoxetine: SSRI
onset: 1-3wks (initial), 2 mos (max response)
- avoid hazardous activities
- notify provider if sex dysfunction occurs
orlistat med
for binge eating to help lose weight
