Eating Disorder

Question 1

View of Continuum of Eating Disorders

Answer 1

Anorexia (eating too little)

Bulimia (eating chaotically)

Obesity (eating too much)

Question 2

Categories of Eating Disorders

Answer 2

Anorexia nervosa
Restricting subtype
Binge eating and purging subtype

Bulimia nervosa

Question 3

Etiology of Eating Disorders

Answer 3

Developmental factors

Family influences (family dysfunction, childhood adversity)

Sociocultural factors (media, pressure from others)

Question 4

Development factors leading to Eating Disorders

Answer 4

Struggle for autonomy, identity

Overprotective or enmeshed families

Body image disturbance

Self-perceptions of the body

Question 5

When does Anorexia Nervosa onset occur?

Answer 5

Onset usually between the ages of 14 and 18

Question 6

What is behavior anorexia nervosa early behavior?

Answer 6

Denial early on; depression and lability with progression; isolation

Question 7

Treatment of Anorexia Nervosa- how is it/how do the pt react to it?

Answer 7

Treatment: often difficult; client is resistant, uninterested, denies problem

Question 8

Features of Anorexia Nervosa

Answer 8

Significant low body weight

Fear of gaining weight even though under weight

Disturbance of body image

Question 9

What ‘type’ of behavior does pt have with food?

Answer 9

Restricting Type
-No binging or purging

Binge eating/purging type
-Recurrent binging & purging

Question 10

Diagnostic Markers for Anorexia

Answer 10

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

Question 11

More diagnostic markers of anorexia

Answer 11

Amenorrhea

Emaciation

Hypotension,

Hypothermia,

Lanugo

Peripheral edema

Enlarged parotid glands

Dental erosion

Russell’s sign (callus on the knuckles from purging)

Question 12

Anorexia Nervosa: Medical management

Answer 12

Weight restoration/nutritional rehabilitation/refeeding*

Rehydration/correction of electrolyte imbalances

Question 13

Anorexia Nervosa Psychopharmacology:

Answer 13

Psychopharmacology: amitriptyline (tricyclic antidepressant), cyproheptadine, olanzapine, fluoxetine

Question 14

Anorexia nervosa Psychotherapy

Answer 14

Family therapy

Individual therapy

CBT

Question 15

Milieu Management of Anorexia

Answer 15

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

Question 16

Bulimia Nervosa onset

Answer 16

Onset: late adolescence or early adulthood (average age of 18–19 years)

Clients go to great lengths to hide

Question 17

Bulimia Nervosa

Answer 17

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

Question 18

Weight of bulimics

Answer 18

• Most patients with bulimia are within a normal weight range, some slightly underweight, some slightly overweight

Question 19

Treatment of Bulimia Nervosa

Answer 19

CBT

Psychopharmacology: antidepressants specifically Fluoxetine (Prozac)

Question 20

Binge Eating Disorder

Answer 20

Eating large amounts of food over a 2 hour period

Sense of lack of control

Question 21

The binge episode are associated with 3 or more of the following:

Answer 21

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

Question 22

Treatment of Binge Eating Disorder

Answer 22

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

Question 23

Nursing Process for Eating Disorders

Answer 23

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

Question 24

Eating Disorders Assessment Part 2

Answer 24

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

Question 25

Eating Disorders Nursing Process Outcome identification

Answer 25

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

Question 26

Interventions for Eating Disorders

Answer 26

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

Question 27

RN Self-Awareness Issues

Answer 27

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.