Bariatrics and Eating Disorders Flashcards
Common Emotions Associated with Eating Disorders
- Anger
- Sense of powerlessness (loss of self-control)
- Poor self-worth/low self-esteem
- Decreased ability to trust others
- Unable to meet expectations of others
Characteristics of Anorexia Nervosa
- Deliberate starvation
- Intense fear of gaining weight or “becoming fat”
- Distorted body image
- Lack of recognition of low body weight
- Precipitated by stress
- Poor peer relationships
- Oversensitive
- Manipulative
Onset of Anorexia Nervosa
Early - Late Adolescence
Types of Anorexia Nervosa
- Restricting
2. Binge eating / purging
Behavioral S/Sx of Anorexia Nervosa
- Morbid fear of obesity
- Preoccupation with food / refusal to eat
- May experience anxiety / depression
- May involve self-induced vomiting, laxative abuse, or excessive exercise
Physical S/Sx of Anorexia Nervosa
- Underweight
- Bradycardia
- Edema
- Amenorrhea
- Immature sexual development
- Hypothermia / cold intolerance
- Hypotension
- Electrolyte imbalances
- Abnormal thyroid function
- Elevated cholesterol levels
- Sudden cardiac arrest R/T electrolyte imbalances
- Lanugo
Diagnostic Criteria for Anorexia Nervosa
- Restriction of food that leads to low BMI
- Lack of recognition of seriousness of low weight
- Abnormal labs (Na, K)
Normal BMI
19 - 25
Goals for the Anorexic Client
- Establish trust / rapport
- Focus on their strengths
- Non-judgemental environment
- Encourage sharing of feelings
Interventions for the Anorexic Client
- Participate in goal setting
- Set realistic goals
- Weight training NOT cardio
- Supervision at mealtimes for 1 hour
- Normalize eating habits (eating publicly)
- Do NOT comment on their appearance
- Weigh them with their back turned
Characteristics of Bulimia Nervosa
- Binging and purging
- Precipitated by stress
- High / unrealistic expectations of self
- Ingests food to cope then feels extreme guilt afterwards
- Manipulative: shows few outward signs
- Distorted body image
- Usually normal weight
- Difficulty with boundaries
- Impulsive in others aspects of life
Bulimia outcomes vs Anorexia outcomes
- Bulimia is more prevalent than anorexia
- Bulimia is not as life threatening
- Bulimia has better outcomes and therefore lower mortality
Behavioral S/Sx of Bulimia
- Repeated binging and purging
- Fasting or excessive exercise afterwards
- Purging
- Non-purging
- Depression
- Episodes occur at least 2 X weekly for at least 3 months
Physical S/Sx of Bulimia Nervosa
- Most near normal weight (some over / some under)
- Dehydration
- Electrolyte imbalances
- Tooth enamel erosion
- Acne
Diagnostic Criteria of Bulimia Nervosa
- Eating large amounts of food with in a discrete period of time
- Or engaging in recurrent episodes of binging and purging
Goals for Bulimia Patients
- Teach s/sx of electrolyte imbalance
- Eat in common area
- Monitor for 1 hour after meal
- Realistic goals
- Identify binging trigger
Criteria for Hospitalization for all Eating Disorders
- Bradycardia < 40
- Hypothermia < 36 C
- Systolic BP < 80/50
- Hypokalemia
- Loss of > 30 % of body weight in 6 months
- Less than 85% below normal body weight
- Risk for suicide
- Failure to comply with treatment
Medications for Anorexia and Bulimia
- Fluoxetine
- Sertraline
- Olanzapine
Fluoextine
SSRI
- Anorexia: reduces occurrence of relapse, once client reaches maintenance weight
- Bulimia: reduces binge / purging episodes
Sertraline
Helps reduce frequency of binges
Olanzapine
Helps improve mood and decrease obsessional behaviors
- Side effect is increased appetitie
Physical S/Sx of Binge Eating Disorder
- Recurrent episodes of uncontrolled over eating
- Physical discomfort after eating (rapidly)
- Purging does not result after binging
Diagnostic Criteria for Binge Eating Disorder
Binge at least once a week for 6 months
Etiology of Obesity
- Genetics
- Lesions on hypothalamus
- Hypothyroidism
- DM
- Cushing’s Syndrome
- Lifestyle
- Unmet psychosocial needs
Risk Factors for Childhood Obesity
- Children with low self-esteem
- Children with parents that are overweight or obese
- Children that have a sedentary lifestyle
- No sports or physical activity
- Play video games, watch TV, or social media
High Risk Groups for Obesity
- African Americans
- Live in the southern states
- Females
- Teens
- Hispanics
How are bariatric surgeries classified?
- Restrictive
- Malabsorptive
- Restrictive and Malabsorptive
Restrictive
Creating a smaller pouch or space to decrease food intake
Malabsorptive
Bypassing the portions of the small intestines which can decrease the absorption of vitamins and nutrients
** Must take supplements after surgery
Criteria for Bariatric Surgery
- BMI of 40 or greater
- 100 pounds overweight
- Can be considered for surgery with a BMI of 35 or greater with comorbidities related to obesity
Screening for Surgery
- Obese for 5 or more years
- Understand its a major lifestyle change
- Me committed
- Meet with dietitian
- Psych evaluation
Exclusions for Bariatric Surgery
- Current drug or alcohol abuse
- Reversible endocrine disorder that causes obesity
- Uncontrolled, severe psychiatric illness
- Lack of comprehension of risks, benefits, expected outcomes, alternatives, and lifestyle changes required with surgery
Bariatric Surgery Options
- Lap Band or gastric banding
- Roux-en-Y gastric bypass
- Sleeve gastrectomy
Roux-en-Y Gastric Bypass
- 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
Risks of Roux-en-Y
- Staple dehiscence
- Dumping Syndrome
- Abdominal compartment syndrome
- Bleeding
- Sepsis
- DVT / PE
- Delayed wound healing
- Wound dehiscence
Lap Band
- 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
Risks for Lap Band
- Bleeding
- Infection
- Leakage
- Slipping
- Erosion-foreign body
- Necrosis
Sleeve Gastrectomy
- 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
Dumping Syndrome Treatment
- 6 small meals a day
- Avoid simple sugars
- Decrease carbohydrate intake
- Increase dietary fiber
- Avoid dairy products
- Limit fluid intake with meals
General Patient Education for Bariatric Surgery
- Outpatient or overnight stay
- Prepare patient for IV, urinary catheter
- TCDB / Incentive spirometry
- Risk for DVT/PE
- Wound drain (possible)
- Quit smoking prior to surgery
- Pain management
- No tablets-all meds in liquid form
- Will only be able to intake 15-30 mL at a time
- Nausea common
- Upper GI with contrast to rule out leakage following surgery
- Vitamin and protein supplements
- Early ambulation
- Physical Activity: walking 20-30 minutes a day - Permanent diet modifications
- Liquid diet for about 2 weeks with no sugar, then progress to puree, soft, and then solid
Why should a patient quit smoking before bariatric surgery?
- Decreases wound healing time
- Smoking increases risk for DVT / PE
- Smoking increases the risk of infection
Pain Management for Bariatric Surgery
- May have a PCA
- Splint abdomen
- Liquid oral medications
Leakage Symptoms
- Abdomen pain radiating to shoulders
- Restlessness
- Tachycardia
- Fever
- Hypotension
* * Call MD!!!
Short Term Complications of Bariatric Surgery
- Bleeding
- DVT / PE
- Leakage
- GERD
- Dehydration
- Fluid imbalances
Long Term Complications of Bariatric Surgery
- Vitamin deficiencies
- Nutritional deficiencies
- May require life time supplements of vitamins and protein
Post-Op Skin Care
- Must bathe
- Abdominal binder to decrease wound dehiscence
- Risk for tissue ischemia and pressure ulcers
- Shear injuries
- Make sure not lying on drains or catheters which can burrow in the skin
- Redness, rash under skin folds
- Can use antifungal powder (wound heals slower if in skin folds)
Follow-Ups after Bariatric Surgery
- Diet progression
- Adequate hydration
- Medications: anti-hypertensive, insulin, oral anti-diabetic, analgesics
- Exercise plan
- Continue psychological support
