Anorexia vs. Bulumia

Question 1

Anorexia

Answer 1

a relentless pursuit of thinness
Sx. -rigid rules and over control (hallmark)
-rules suppress conscious anxiety
-obsessive rituals
-eating (cutting into small pieces, chewing 20 times a bite
-exercise (multiple hours)
-self-worth dependent on others approval

often overachievers, distortion of body image, laxative abuse, hoard food/talk about it a lot, fear obesity

Question 2

Anorexia S/S

Answer 2

Signs: think their overweight (usually underweight)
fearful of slightest weight gain
preoccupied with food & exercise
resist treatment
report feeling fine/loss of interest in sex
cognitive distortions (if I eat 1 popsicle = blow up like a balloon)

Sx:

• 25-50% body weight loss d/t caloric restriction/excessive exercising
• adolescence
• amenorrhea d/t low weight
• decreased bone density d/t low estrogen & low Ca+ intake
• sunken eyes & skeletal appearance
• lanugo d/t starvation
• yellow skin d/t hypercarotenemia
• impaired renal d/t dehydration
• peripheral edema d/t hypoalbuminemia and refeeding
• cardiovascular abnormalities d/t starvation, dehydration, e/e imbalance

Question 3

Anorexia Labs & VS

Answer 3

Bradycardia, hypotension, arrhythmias, delayed gastric motility, hypothyroid-like sx. (thin hair, dry skin), hypokalemia, elevated BUN, elevated cortisol d/t high stress, leukopenia, anemia, hypokalemia

Question 4

Refeeding Syndrome

Answer 4

• recovering from a period of starvation
• assoc. low levels of Ph, K+, Mg
• body adapts to starvation and starts using liver/muscles for energy (after 1st 24hr of no food)
• if after 3 days of no food body adapts again
• if person starts to eat again, body switches back to food for energy = f/e imbalance and vitamin deficiencies

Question 5

Anorexia RX:

Answer 5

Patients:

• express feelings about body size
• ask them to make 3 positive statement about their bodies
• can draw/journal
• might have a 1hr lockout of bathroom/bedroom after meals
• encouraged to meet goals

Question 6

Bulimia

Answer 6

• may be healthy body weight/overweight
• lack of control
• have inappropriate compensatory behavior
  
  • excessive exercise (not compulsive)
    - vomiting
• purging may/may not be present
• bingeing triggered by something else

Question 7

Bulimia sx.

Answer 7

• dental caries, tooth erosion d/t vomiting
• parotid swelling d/t increased amylase
• gastric dilation/rupture d/t binge eating
• calluses, scars on hand d/t self-induced vomiting
• peripheral edema d/t rebound fluid (esp. with diuretics)
• muscle weakening d/t electrolyte imbalance
• abnormal labs (low K+/Na+, e/e imbalance) d/t purging, vomiting, laxative/diuretic use
• cardiovascular abnormalities, (cardiomyopathy, ECG changes d/t e/e imbalance

Question 8

Bulimia Rx:

Answer 8

Reduce anxiety

• try to recognize that create anxiety (trigger bingeing)
• calm, reassuring attitude
• quiet environment
• manage stress
• contract with the patient
• allow for feeling expression when at binge/purge risk
• use “I” statements

Manage f/e

• I&Os (rehydration with 2,000-3,000mL liquid)
• weight (same time/place/scale/amount of clothing)
• observe for at least 1hr a/meals
• frequent mouth care

Question 9

Eating Disorder Meds

Answer 9

Treat the assoc. sx. of anxiety/depression. No specific meds for individual disorders.

• SSRIs (Prozac -1st choice)
• Atypical Antipsychotics (olanzapine, chlorpromazine)