Eating Disorder Flashcards
View of Continuum of Eating Disorders
Anorexia (eating too little)
Bulimia (eating chaotically)
Obesity (eating too much)
Categories of Eating Disorders
Anorexia nervosa
Restricting subtype
Binge eating and purging subtype
Bulimia nervosa
Etiology of Eating Disorders
Developmental factors
Family influences (family dysfunction, childhood adversity)
Sociocultural factors (media, pressure from others)
Development factors leading to Eating Disorders
Struggle for autonomy, identity
Overprotective or enmeshed families
Body image disturbance
Self-perceptions of the body
When does Anorexia Nervosa onset occur?
Onset usually between the ages of 14 and 18
What is behavior anorexia nervosa early behavior?
Denial early on; depression and lability with progression; isolation
Treatment of Anorexia Nervosa- how is it/how do the pt react to it?
Treatment: often difficult; client is resistant, uninterested, denies problem
Features of Anorexia Nervosa
Significant low body weight
Fear of gaining weight even though under weight
Disturbance of body image
What ‘type’ of behavior does pt have with food?
Restricting Type
-No binging or purging
Binge eating/purging type
-Recurrent binging & purging
Diagnostic Markers for Anorexia
Leukopenia (Normal WBC 4,000-11,000)
Dehydration (Increase in Blood Urea Nitrogen (BUN) Normal 7-20)
Hypokalemia (Normal 3.6 -5.2)
Sinus Bradycardia
Prolonged QTc interval
Osteoporosis
More diagnostic markers of anorexia
Amenorrhea
Emaciation
Hypotension,
Hypothermia,
Lanugo
Peripheral edema
Enlarged parotid glands
Dental erosion
Russell’s sign (callus on the knuckles from purging)
Anorexia Nervosa: Medical management
Weight restoration/nutritional rehabilitation/refeeding*
Rehydration/correction of electrolyte imbalances
Anorexia Nervosa Psychopharmacology:
Psychopharmacology: amitriptyline (tricyclic antidepressant), cyproheptadine, olanzapine, fluoxetine
Anorexia nervosa Psychotherapy
Family therapy
Individual therapy
CBT
Milieu Management of Anorexia
Precise meal times
Adherence to the selected menu
Observation during & after meals
Regularly scheduled weighing
Monitor all trips to the bathroom
Searches for laxatives
Daily weigh ins in a gown after voiding
Bulimia Nervosa onset
Onset: late adolescence or early adulthood (average age of 18–19 years)
Clients go to great lengths to hide
Bulimia Nervosa
Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (binging).
Self induced vomiting, misuse of laxatives, diuretics, enemas, fasting or excessive exercise
Recurrent binge eating occurs at least once a week for 3 months
Negative body image
Weight of bulimics
- Most patients with bulimia are within a normal weight range, some slightly underweight, some slightly overweight
Treatment of Bulimia Nervosa
CBT
Psychopharmacology: antidepressants specifically Fluoxetine (Prozac)
Binge Eating Disorder
Eating large amounts of food over a 2 hour period
Sense of lack of control
The binge episode are associated with 3 or more of the following:
Eating much more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not hungry
Eating alone
Feeling disgusted with oneself
Marked distress
Occurs at least once a week for 3 months
- Binge eating is not associated with inappropriate compensatory behaviors as in bulimia nervosa
Treatment of Binge Eating Disorder
Cognitive Behavioral Therapy, Dialectical Behavioral Therapy & Interpersonal Therapy.
Topiramate (Topamax)/ an anticonvulsant
Antidepressants
Lisdexamfetamine dimesylate
(Vyvanse)/attention-deficit hyperactivity disorder. FDA approved for moderate to severe binge eating disorder
Nursing Process for Eating Disorders
History
Anorexia: perfectionists, eager to please
Bulimia: history of impulsive behavior
General appearance and motor behavior
Anorexia: slow, lethargic, emaciated
Bulimia: generally close to expected weight for size
Mood and affect: labile moods; sad, anxious, worried
Eating Disorders Assessment Part 2
Assessment—(cont.)
Thought process and content: preoccupation with food or dieting
Sensorium and intellectual processes: signs of starvation in malnourished clients with anorexia
Judgment and insight
Anorexia: limited insight, poor judgment about health status
Bulimia: ashamed of behaviors
Self-concept: low self-esteem
Roles and relationships: unable to fulfill roles
Physiological and self-care considerations
Eating Disorders Nursing Process Outcome identification
Establish adequate nutritional eating patterns
Eliminate compensatory behaviors (excessive exercise, laxatives, diuretics, purging)
Demonstrate coping mechanisms not related to food
Verbalize feelings of guilt, anger, anxiety, excessive need for control
Verbalize acceptance of body image with stable body weight
Interventions for Eating Disorders
Establishing nutritional eating patterns (inpatient treatment if severe)
Identifying emotions, developing coping strategies (self-monitoring for bulimia)
Dealing with body image issues
Providing client and family education
RN Self-Awareness Issues
Feelings of frustration when client rejects help.
Being seen as “the enemy” if you must ensure that the client eats.
Dealing with own issues about body image and dieting.
Be empathetic and nonjudgmental.
