4 Eating Disorders Flashcards
1
Q
Anorexia Nervosa
A
restriction of energy intake to requirements, resulting in significantly low body weight.
2
Q
Anorexia Nervosa is characterized by…
A
intense fear of gaining weight, becoming fat
3
Q
People with anorexia have a gross ___ of ____ ____
A
gross distortion of body image
4
Q
Anorexia Nervosa’s prevalence rate in US
A
1%
5
Q
People with Anorexia is predominantly…(gender and age group)
A
females, 12 to 30 years old
6
Q
How many percentage of male suffered from anorexia?
A
fewer than 10%
7
Q
People involved in what (occupation/hobbies) have an increased risk of having anorexia?
A
modeling, ballet, wrestling elite athletes
8
Q
What 3 factors played in the etiology of anorexia?
A
biologic, social, and psychological
9
Q
We have an increased risk if our ___ degree biologic relatives have this disorder.
A
1st
10
Q
Anorexia is often associated with what?
A
a stressful life event
11
Q
Children are at increased risk if they have what 2 types of disorder?
A
obsessional and anxiety disorders
12
Q
What class of medication contribute to denial of hunger?
A
endongenous opioids
13
Q
name one biologic factor influencing anorexia nervosa.
A
starvation
14
Q
When patients with anorexia get a CT, what will the result reveal?
A
an enlarged CSF space.
15
Q
Studies have shown that people with anorexia have an dysfunction in what 3 hormones?
A
serotonin, dopamine, norepinephrine
16
Q
Name the 4 social factors that can contribute to anorexia
A
- sociocultural influences
- family issues
- vocational influences: ballet, wrestling, gymnastics, athletes, models
- internet influences
17
Q
Name the 7 psychological and psychodynamic factors.
A
- Reaction to independence
- weight concerns
- increased social and sexual functioning
- lack of autonomy and self hood
- unable to separate psychologically from mother
- negative emotionality/affect
- perfectionism
18
Q
what are some behaviors associated with anorexia patients?
A
intense fear of gaining weight secretive refuse to eat with families or in public often preoccupied with food diet with restricted fat and carbs laxative and diuretic abuse over exercising/physical hyperactivity rigid and perfectionistic compulsive stealing poor sexual adjustment.
19
Q
what are some signs and symptoms of anorexia patients?
A
BMI 17 or below Hypothermia Hypotension Lanugo ECG changes: T wave flattening or inversion, ST segment depression, lengthening of QT interval Dependent edema Bradycardia Amenorrhea
20
Q
What are the 4 comorbidities associated with pts with anorexia?
A
Depression (65% of cases)
OCD (26%)
Social anxiety disorder (34%)
Bipolar Disorder
21
Q
Between the restricting type and the binge- purge type of anorexia, which has the calorie restriction behavior?
A
restricting type, intermittent in binge-purge type.
22
Q
what are the 2 subtypes of anorexia nervosa?
A
restricting type and the binge-purge type
23
Q
Between the restricting type and the binge- purge type of anorexia, which has the binge/purge behavior?
A
binge-purge type
24
Q
Between the restricting type and the binge- purge type of anorexia, which has the social isolation behavior?
A
both
25
Between the restricting type and the binge- purge type of anorexia, which has the over-exercising behavior?
both
26
Between the restricting type and the binge- purge type of anorexia, which has the perfectionistic behavior?
both
27
Between the restricting type and the binge- purge type of anorexia, which has the diminished sexual interest behavior?
both
28
Between the restricting type and the binge- purge type of anorexia, which has the substance abuse behavior?
less common in restricting type, more common in binge-purge type
29
Between the restricting type and the binge- purge type of anorexia, which has the impulse control disorders behavior?
very common in binge-purge type
30
Between the restricting type and the binge- purge type of anorexia, which has the suicide behavior?
less common in restricting type, high risk in binge-purge type.
31
what are the consequences of starvation on the vital signs?
bradycardia, hypotension with marked orthostatic changes, hypothermia, poikilithermia
32
what are the consequences of starvation in general?
muscle atrophy, loss of body fat
33
what are the consequences of starvation on the CNS?
generalized brain atrophy with enlarged ventricles, decreased cortical mass, seizures, abnormal EEG.
34
what are the consequences of starvation on the cardiovascular system?
peripheral edema, decreased cardiac diameter, narrowed left ventricle wall, decreased response to exercise demand, superior mesenteric artery syndrome
35
what are the consequences of starvation on the renal system?
pre-renal azotemia (abnormally high levels of nitrogen-containing compounds in the blood. ex: urea, creatinine)
36
what are the consequences of starvation on the hematologic system?
anemia of starvation, leukopenia, hypocellular bone marrow
37
what are the consequences of starvation on the GI system?
delayed gastric emptying, gastic dilatation, decreased intestinal lipase and lactase
38
what are the consequences of starvation on the metabolic system?
hypercholesterolemia, non-symptomatic hypoglycemia, elevated liver enzymes, decreased bone mineral density
39
what are the consequences of starvation on the endocrine system?
Low luteinizing hormone, low FSH, low estrogen or testosterone, low/nl thyroxine, low tri-iodothyronine, increased reverse tri-iodothyronine, elevated cortisol, elevated growth hormone, partial diabetes insipidus, increased prolactin
40
What should the nurse assess on a pt with anorexia?
```
BMI
VS
Labs: CBC, lipids, LFT’s
ECG
Bone density
Delayed or absent menses
Hypertrophy of salivary glands
Dental enamel erosion/caries
Scars or calluses on dorsal surface of fingers
Suicide assessment
```
41
When checking for the lab work for a pt with anorexia, which ones should the nurse pay attention to in the hematology lab test? (3)
Leukopenia
Anemia
Thrombocytopenia
42
When checking for the lab work for a pt with anorexia, which ones should the nurse pay attention to in the serum chemistry test? (5)
Hypercholesterolemia
Elevated hepatic enzymes
Hypomagnesia, hypozincemia, hypokalemic acidosis
43
When checking for the lab work for a pt with anorexia, what can the nurse expect on the endocrine lab test? (4)
low T4 and T3
| Low estrogen or testosterone
44
What diagnostic tests can the nurse use for patients with anorexia to check their health status? (3)
electrocardiogram (ekg)
bone mass
electroencephalography (eeg)
45
what could be expected on an ekg for a patient with anorexia? (2)
sinus bradycardia and QT prolongation
46
what could be expected on an bone mass test for a patient with anorexia? (2)
osteopenia and osteoporosis
47
What could be expected on an eeg for a patient with anorexia?(1)
diffuse abnormalities
48
what are the nursing cares of a patient with anorexia?
Monitor intake and output
Daily weights
Stay with patient during meal times
Do not focus on food and eating, focus on the meaning of the behavior
Enforce behavioral program
Avoid arguing and bargaining
Psychoeducation about the effects of starvation
49
what is bulimia nervosa?
Recurrent episodes of binge eating
50
what is one behavior of bulimia nervosa?
Recurrent inappropriate compensatory behaviors to prevent weight gain
51
what is one thing pt with bulimia nervosa most concerned about?
Self-evaluation is unduly influenced by body shape and image (self image and perception)
52
how many percentage of women have bulimia nervosa?
2-4% of young women
53
when is the usual onset of bulimia nervosa?
adolescence or young adulthood
54
how many percent of college women experience transient bulimia symptoms?
20%
55
what is the rate of men compared to females diagnosed of bulimia nervosa?
1 man in every 10 females
56
what medical history is common in people with bulimia nervosa?
history of obesity
57
what are the 4 comorbidities of bulimia nervosa?
Depression
Anxiety disorders
Substance abuse
Personality disorders
58
when does bulimia nervosa usually begin in a pt?
during or after an episode of dieting
59
what can induced bulimia nervosa in a pt?
multiple stressful life events.
60
what are two complications associated with bulimia nervosa?
elevated risk for mortality and elevated suicide risk
61
what is one difference between bulimia nervosa and anorexia nervosa?
Higher rates of partial and full recovery than Anorexia
62
What are some biologic factors that can cause bulimia?
Serotonin and norepinephrine,
Increased frequency in families,
Increased endorphin levels after vomiting
63
What are some social factors that can cause bulimia?
High achievers
Increased familial depression
Family conflict
64
What are some psychological factors of bulimia?
```
Difficulties with adolescent demands,
Impulse problems,
ETOH and substance abuse,
Shoplifting,
Emotional lability,
Self injurious behaviors,
Suicide attempts,
Self destructive sexual relationships,
Promiscuity,
Personality disorders
```
65
what are the metabolic consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
hypokalemic alkalosis or acidosis, dyhydration
66
what are the renal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
pre-renal azotemia, acute and chronic liver failure
67
what are the cardiovascular consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
arrhythmias, myocardial toxicity from emetine
68
what are the dental consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
lingual surface enamel loss, multiple caries
69
what are the gastrointestinal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
swollen parotid glands, elevated serum amylase levels, gastric distention, IBS, melanosis coli from laxative abuse
70
what are the musculoskeletal consequences of Bulimia Nervosa and Binge-Eating and Purging Type Anorexia Nervosa?
cramps, tetany
71
what should the nurse assess on a patient with bulimia nervosa?
labs, weight, Russell's sign, dental erosion, bilateral parotid enlargement.
72
what is binge eating disorder?
recurrent episodes of binge eating
73
Marked ___ regarding binge eating.
distress
74
Is there inappropriate compensatory behaviors present with binge eating disorder?
No
75
Binge eating disorder is most common in which hospital unit?
ED
76
how many percentage of patients seek medical care for obesity?
25%
77
how many people are diagnosed with severe obesity?
50 to 75%
78
what BMI is considered severe obesity?
BMI > 40
79
what percentage of females have binge eating disorder?
4%
80
what percentage of males have binge eating disorder?
2%
81
what are the 5 etiologies of binge eating disorder?
1. Impulsive and extroverted personality styles
2. Low calorie diets
3. Stress
4. Alleviate anxiety
5. Cope with depressive symptoms
82
What are the treatments of eating disorders? (6)
1. Restoration of patient’s nutritional state
2. Medical stabilization
3. Hospitalization recommended at 30% below expected weight
4. Psychotherapy: CBT, family tx, family education
5. Pharmacotherapy: SSRI’s
6. Interdisciplinary team, multi-modal, nutrition, medicine, psychiatry
83
What are the goals of nursing care of the client with an eating disorder? (3)
1. Restoration of nutritional balance.
2. Helping client gain control over life situations in ways other than inappropriate eating behaviors.
3. Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance.
84
What should the nurse educate the patient and the family? (7)
1. Symptoms of anorexia and bulimia
2. Effects of the illness
3. Principles of nutrition
4. Importance of expressing feelings/emotions
5. Alternative coping mechanisms
6. Medication teaching
7. Relaxation/stress management
85
What are some nursing diagnoses of eating disorders? (5)
1. Imbalanced nutrition: less/more than body requirements
2. Disturbed body image
3. Deficient fluid volume
4. Ineffective denial
5. Anxiety
86
What eating disorders is SSRI (Fluoxetine) good for?(3)
Anorexia, bulimia and binge eating
87
what eating disorder is Topiramate (Topamax) good for? (1)
binge eating
88
What eating disorders is desimprimine (norpramine) good for?(2)
bulimia and binge eating
89
What eating disorders is Amitriptylene (elavil) good for? (1)
anorexia
90
What eating disorders is Clomiprimine (Anafranil) good for? (1)
anorexia
91
What eating disorders is Olanzapine (Zyprexa) good for? (1)
anorexia
92
What eating disorders is Cyprohyptadine (Periactin) good for? (1)
anorexia
93
What eating disorders is Imiprimine (Tofranil) good for? (1)
bulimia
94
What eating disorders is Lisdexamfetamine (Vyvanse) good for? (1)
binge eating.
95
what is the most commonly used medication for eating disorders?
SSRI (Fluoxetine)
