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Sophomore 2 Test 5 > Bariatrics and Eating Disorders > Flashcards

Bariatrics and Eating Disorders Flashcards

1
Q

Common Emotions Associated with Eating Disorders

A
  1. Anger
  2. Sense of powerlessness (loss of self-control)
  3. Poor self-worth/low self-esteem
  4. Decreased ability to trust others
  5. Unable to meet expectations of others
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2
Q

Characteristics of Anorexia Nervosa

A
  1. Deliberate starvation
  2. Intense fear of gaining weight or “becoming fat”
  3. Distorted body image
  4. Lack of recognition of low body weight
  5. Precipitated by stress
  6. Poor peer relationships
  7. Oversensitive
  8. Manipulative
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3
Q

Onset of Anorexia Nervosa

A

Early - Late Adolescence

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4
Q

Types of Anorexia Nervosa

A
  1. Restricting

2. Binge eating / purging

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5
Q

Behavioral S/Sx of Anorexia Nervosa

A
  1. Morbid fear of obesity
  2. Preoccupation with food / refusal to eat
  3. May experience anxiety / depression
  4. May involve self-induced vomiting, laxative abuse, or excessive exercise
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6
Q

Physical S/Sx of Anorexia Nervosa

A
  1. Underweight
  2. Bradycardia
  3. Edema
  4. Amenorrhea
  5. Immature sexual development
  6. Hypothermia / cold intolerance
  7. Hypotension
  8. Electrolyte imbalances
  9. Abnormal thyroid function
  10. Elevated cholesterol levels
  11. Sudden cardiac arrest R/T electrolyte imbalances
  12. Lanugo
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7
Q

Diagnostic Criteria for Anorexia Nervosa

A
  1. Restriction of food that leads to low BMI
  2. Lack of recognition of seriousness of low weight
  3. Abnormal labs (Na, K)
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8
Q

Normal BMI

A

19 - 25

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9
Q

Goals for the Anorexic Client

A
  1. Establish trust / rapport
  2. Focus on their strengths
  3. Non-judgemental environment
  4. Encourage sharing of feelings
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10
Q

Interventions for the Anorexic Client

A
  1. Participate in goal setting
  2. Set realistic goals
  3. Weight training NOT cardio
  4. Supervision at mealtimes for 1 hour
  5. Normalize eating habits (eating publicly)
  6. Do NOT comment on their appearance
  7. Weigh them with their back turned
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11
Q

Characteristics of Bulimia Nervosa

A
  1. Binging and purging
  2. Precipitated by stress
  3. High / unrealistic expectations of self
  4. Ingests food to cope then feels extreme guilt afterwards
  5. Manipulative: shows few outward signs
  6. Distorted body image
  7. Usually normal weight
  8. Difficulty with boundaries
  9. Impulsive in others aspects of life
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12
Q

Bulimia outcomes vs Anorexia outcomes

A
  1. Bulimia is more prevalent than anorexia
  2. Bulimia is not as life threatening
  3. Bulimia has better outcomes and therefore lower mortality
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13
Q

Behavioral S/Sx of Bulimia

A
  1. Repeated binging and purging
    • Fasting or excessive exercise afterwards
  2. Purging
  3. Non-purging
  4. Depression
  5. Episodes occur at least 2 X weekly for at least 3 months
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14
Q

Physical S/Sx of Bulimia Nervosa

A
  1. Most near normal weight (some over / some under)
  2. Dehydration
  3. Electrolyte imbalances
  4. Tooth enamel erosion
  5. Acne
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15
Q

Diagnostic Criteria of Bulimia Nervosa

A
  1. Eating large amounts of food with in a discrete period of time
  2. Or engaging in recurrent episodes of binging and purging
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16
Q

Goals for Bulimia Patients

A
  1. Teach s/sx of electrolyte imbalance
  2. Eat in common area
  3. Monitor for 1 hour after meal
  4. Realistic goals
  5. Identify binging trigger
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17
Q

Criteria for Hospitalization for all Eating Disorders

A
  1. Bradycardia < 40
  2. Hypothermia < 36 C
  3. Systolic BP < 80/50
  4. Hypokalemia
  5. Loss of > 30 % of body weight in 6 months
  6. Less than 85% below normal body weight
  7. Risk for suicide
  8. Failure to comply with treatment
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18
Q

Medications for Anorexia and Bulimia

A
  1. Fluoxetine
  2. Sertraline
  3. Olanzapine
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19
Q

Fluoextine

A

SSRI

  • Anorexia: reduces occurrence of relapse, once client reaches maintenance weight
  • Bulimia: reduces binge / purging episodes
20
Q

Sertraline

A

Helps reduce frequency of binges

21
Q

Olanzapine

A

Helps improve mood and decrease obsessional behaviors

- Side effect is increased appetitie

22
Q

Physical S/Sx of Binge Eating Disorder

A
  1. Recurrent episodes of uncontrolled over eating
  2. Physical discomfort after eating (rapidly)
  3. Purging does not result after binging
23
Q

Diagnostic Criteria for Binge Eating Disorder

A

Binge at least once a week for 6 months

24
Q

Etiology of Obesity

A
  1. Genetics
  2. Lesions on hypothalamus
  3. Hypothyroidism
  4. DM
  5. Cushing’s Syndrome
  6. Lifestyle
  7. Unmet psychosocial needs
25
Q

Risk Factors for Childhood Obesity

A
  1. Children with low self-esteem
  2. Children with parents that are overweight or obese
  3. Children that have a sedentary lifestyle
    - No sports or physical activity
    - Play video games, watch TV, or social media
26
Q

High Risk Groups for Obesity

A
  1. African Americans
  2. Live in the southern states
  3. Females
  4. Teens
  5. Hispanics
27
Q

How are bariatric surgeries classified?

A
  1. Restrictive
  2. Malabsorptive
  3. Restrictive and Malabsorptive
28
Q

Restrictive

A

Creating a smaller pouch or space to decrease food intake

29
Q

Malabsorptive

A

Bypassing the portions of the small intestines which can decrease the absorption of vitamins and nutrients
** Must take supplements after surgery

30
Q

Criteria for Bariatric Surgery

A
  1. BMI of 40 or greater
  2. 100 pounds overweight
  3. Can be considered for surgery with a BMI of 35 or greater with comorbidities related to obesity
31
Q

Screening for Surgery

A
  1. Obese for 5 or more years
  2. Understand its a major lifestyle change
  3. Me committed
  4. Meet with dietitian
  5. Psych evaluation
32
Q

Exclusions for Bariatric Surgery

A
  1. Current drug or alcohol abuse
  2. Reversible endocrine disorder that causes obesity
  3. Uncontrolled, severe psychiatric illness
  4. Lack of comprehension of risks, benefits, expected outcomes, alternatives, and lifestyle changes required with surgery
33
Q

Bariatric Surgery Options

A
  1. Lap Band or gastric banding
  2. Roux-en-Y gastric bypass
  3. Sleeve gastrectomy
34
Q

Roux-en-Y Gastric Bypass

A
  • Restrictive and Malabsorptive
  • Creates a small stomach pouch (about 30 mL or less) by stapling off part of the stomach and making a small stoma that is reattached at the jejunum bypassing parts of the small intestines
35
Q

Risks of Roux-en-Y

A
  1. Staple dehiscence
  2. Dumping Syndrome
  3. Abdominal compartment syndrome
  4. Bleeding
  5. Sepsis
  6. DVT / PE
  7. Delayed wound healing
  8. Wound dehiscence
36
Q

Lap Band

A
  • Restrictive
  • Inflatable silicone band is placed around the upper portion of the stomach creating a narrowing between the upper and lower stomach
  • Band is connected to a port placed under the subcutaneous tissue. The band contains a balloon that can be inflated or deflated by using the port to inject saline or remove saline
37
Q

Risks for Lap Band

A
  1. Bleeding
  2. Infection
  3. Leakage
  4. Slipping
  5. Erosion-foreign body
  6. Necrosis
38
Q

Sleeve Gastrectomy

A
  • Restrictive
  • Reduces the size of the stomach by removing a large portion of the stomach by stapling
  • No problem with dumping syndrome or absorption because intestines are not bypassed
  • Can have leakage
39
Q

Dumping Syndrome Treatment

A
  1. 6 small meals a day
  2. Avoid simple sugars
  3. Decrease carbohydrate intake
  4. Increase dietary fiber
  5. Avoid dairy products
  6. Limit fluid intake with meals
40
Q

General Patient Education for Bariatric Surgery

A
  1. Outpatient or overnight stay
  2. Prepare patient for IV, urinary catheter
  3. TCDB / Incentive spirometry
  4. Risk for DVT/PE
  5. Wound drain (possible)
  6. Quit smoking prior to surgery
  7. Pain management
  8. No tablets-all meds in liquid form
  9. Will only be able to intake 15-30 mL at a time
  10. Nausea common
  11. Upper GI with contrast to rule out leakage following surgery
  12. Vitamin and protein supplements
  13. Early ambulation
    - Physical Activity: walking 20-30 minutes a day
  14. Permanent diet modifications
    - Liquid diet for about 2 weeks with no sugar, then progress to puree, soft, and then solid
41
Q

Why should a patient quit smoking before bariatric surgery?

A
  • Decreases wound healing time
    • Smoking increases risk for DVT / PE
    • Smoking increases the risk of infection
42
Q

Pain Management for Bariatric Surgery

A
  1. May have a PCA
  2. Splint abdomen
  3. Liquid oral medications
43
Q

Leakage Symptoms

A
  1. Abdomen pain radiating to shoulders
  2. Restlessness
  3. Tachycardia
  4. Fever
  5. Hypotension
    * * Call MD!!!
44
Q

Short Term Complications of Bariatric Surgery

A
  1. Bleeding
  2. DVT / PE
  3. Leakage
  4. GERD
  5. Dehydration
  6. Fluid imbalances
45
Q

Long Term Complications of Bariatric Surgery

A
  1. Vitamin deficiencies
  2. Nutritional deficiencies
  3. May require life time supplements of vitamins and protein
46
Q

Post-Op Skin Care

A
  1. Must bathe
  2. Abdominal binder to decrease wound dehiscence
  3. Risk for tissue ischemia and pressure ulcers
  4. Shear injuries
  5. Make sure not lying on drains or catheters which can burrow in the skin
  6. Redness, rash under skin folds
    - Can use antifungal powder (wound heals slower if in skin folds)
47
Q

Follow-Ups after Bariatric Surgery

A
  1. Diet progression
  2. Adequate hydration
  3. Medications: anti-hypertensive, insulin, oral anti-diabetic, analgesics
  4. Exercise plan
  5. Continue psychological support

Sophomore 2 Test 5 (4 decks)

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