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Clinical Nutrition 3 > Eating Disorder Part 2 > Flashcards

Eating Disorder Part 2 Flashcards

1
Q

Describe the steps that result an eating disorder to turn into a loss of functional capacity

A

Restrictive and bulimic behaviours –> Nutritional consequences –> Physical and psychosocial deterioration –> loss of functional capacity

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2
Q

How are many of the psychosocial and cognitive rigidities solved in ED patients

A

Usually improves after refeeding, if in adolescents more likely

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3
Q

Skin clinical signs in restrictive eating

A
  • Acrocyanosis
  • Hair loss, dry skin
  • Lanugo-like body hair
  • Stomatitis
  • Increased acne
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4
Q

Skin clinical signs in bulimia/purging

A
  • Russell’s sign
  • Nose bleeding (epistaxis)
  • Subconjonctival haemorrhages
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5
Q

CVD clinical signs in restrictive eating

A
  • Hypotension
  • Bradycardia
  • Heart palpitations, chest pain
  • Arrhythmia of cardia muscle mass (Mitral valve prolapse)
  • Relongation of QTc interval
  • Pericardial effusions
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6
Q

CVD clinical signs in binge/purging

A
  • Dizzyness
  • Heart palpitations
  • Chest pain
  • Arryhmia
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7
Q

Endocrine changes in restrictive eating

A
  • Frequent bladder emptying
  • Amenorrhea in women, impotency in men
  • Hypoglycemia
  • Hyperactivity
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8
Q

Endocrine changes during binge/purging

A
  • Irregular mense
  • Sleep disturbance
  • Feeling cold and fatigue
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9
Q

Muscles/bone mass/dental system changes during restrictive eating

A
  • Muscle loss, cramps and weakness
  • Rhabdomyolysis
  • Osteopenia and osteoporosis
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10
Q

Muscles/bone mass/dental system changes during binge/purge

A
  • Muscle cramps/weakness
  • Perimolysis (dental erosion)
  • Enlargement of parotid glands
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11
Q

Digestive system changes in restrictive eating

A
  • Early satiety
  • Epigastric discomfort
  • Delayed gastric emptying
  • Constipation/diarhea
  • Bloating, abdominal pain
  • SMA syndrome
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12
Q

What is SMA syndrome?

A

Superior mesenteric artery syndrome (SMAS) is a digestive condition that occurs when the duodenum is compressed between two arteries (the aorta and the superior mesenteric artery). This compression causes partial or complete blockage of the duodenum.

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13
Q

Digestive system changes in binging/purging?

A
  • Swollen salivary glands
  • Epigastric discomfort
  • Eosophagitis
  • GERD
  • Mallory-Weiss syndrome
  • Constipation, diarrhea
  • Hemorrhoids, rectal bleeding, prolapsus
  • Loss of normal colon function
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14
Q

What is Mallory Weiss syndrome (bulimia)?

A

Tear of the inside of the esophagus

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15
Q

What can haemorrhoids be caused by in the bulimic patient?

A

Laxatives

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16
Q

Kidney function changes in restrictive eating and in bulimia?

A

Water retention and reduced kidney function

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17
Q

Brain changes are usually seen in _____ patients

A

AN

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18
Q

Brain function changes in restrictive eating?

A

-Brain atrophy, leading to neurocognitive functioning impairment.

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19
Q

Cognitive changes are usually seen in ____ patients

A

Both An and Bn

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20
Q

Cognitive changes in restrictive and bulimia patients?

A
  • Loss of concentration
  • Loss of memory
  • Difficult to make decision
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21
Q

(T/F) BN patients are more likely associated with O.C behaviours

A

F, AN patient

BN more associated with mood changes

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22
Q

Psychological changes in both restrictive and bulimia/purging?

A
  • Intense food preoccupation
  • Irritability
  • Loss of interest
  • Social isolation
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23
Q

What are the two highest causes of mortality for An patients?

A
  • Heart failure

- Suicide

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24
Q

Albumin?

A

Usually low in severe malnutrition

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25
Q

What are two common blood value issues with those with EDs?

A
  • Anemia

- Leucopenia/Thrombocytopenia

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26
Q

Glucose?

A
  • Often decreases (hypoglycemia) but asymptomatic

- Symptomatic once regain occurs

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27
Q

Sodium?

A
  • Decreases

- May be attributed to water-loading or diuretic use

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28
Q

Potassium?

A
  • Decreases
  • Vomiting, laxatives, diuretics
  • Caution with re-feeding
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29
Q

Magnesium?

A
  • Decreases

- Poor nutrition or refeeding

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30
Q

Phosphorous?

A

-If low, indicative of re-feeding

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31
Q

Chloride?

A
  • Decreases in the context of vomiting

- -Increases in the context of laxatives

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32
Q

Bicarbonate?

A
  • Increases in the context of vomiting

- Decreases in the context of laxatives

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33
Q

BUN?

A

-Increases, indicative of dehydration

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34
Q

Creatinine?

A

-Increases, indicative of dehydration or renal dysfunction

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35
Q

CPK ?

A
  • Increases in the context of muscle breakdown

- Decreases in the context of reduced muscle mass

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36
Q

Amylase?

A

-Increases, often indicative of salivary origin from vomiting

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37
Q

ALT, AST and total bilirubin?

A

-Increases in the context of liver dysfunction

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38
Q

What are risk factors for BED? (MOTH-CAP-PDD)

A
  • Menstrual abnormalities
  • Obesity
  • T2DM
  • Hypertension
  • Chronic pain
  • Asthma
  • PCOS
  • Psyche
  • Digestive problems
  • Dyslipidemia
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39
Q

What does the non-linear process of remission aim to accomplish?

A
  • To normalize eating behaviours
  • Weight gain if underweight
  • Abstinence of compensatory behaviours
  • Healthy attitude towards food, weight and body image
40
Q

What may cause underfeeding?

A

The start low go slow method

41
Q

What can we do instead of “start low go slow” to avoid both underfeeding and re-feeding syndrome

A

Start feeding upwards of 1500-2500 kcal/day with prophylactic supplements while monitoring patient electrolytes, heart and fluid status.

42
Q

Discuss ambivalence and eating disorders

A

Although ED patients want to get better, they often are fearful of losing their “identity” of an eating disorder

43
Q

What may help resolve or improve ambivalence?

A

Motivational interviewing

44
Q

What is a principle of motivational interviewing?

A

Transference and countertransference, where the interviewer should not internalize or feel responsibility for the interviewer

45
Q

What are 4 key principles of motivational interviewing?

A
  • Resolve ambivalence
  • Listen, evoke and summarize
  • Explore pros and cons
  • Inform, then guide patient agreement
46
Q

What psychosocial intervention is used for an adolescent?

A

Family based treatment (FBT)

47
Q

Describe FBT

A

Parents are in charge and are responsible for the feeding protocols. They will feed the child. Used in AN patients

48
Q

Phase 1 of FBT?

A

Parents in control to feed and restore

49
Q

Phase 2 of FBT?

A

When weight i restored, feeding responsibility is transferred back to the child, however if weight loss occurs control is back to the adults

50
Q

Phase 3 of FBT?

A

Promote and advance the independence of the child, where therapy transitions to have healthy behaviours and relationships with food

51
Q

Success rate of FBT?

A

40%

52
Q

(T/F) FBT is also used for adults with AN and in the Paediatric population

A

False, only evidence based for adolescents with AN

53
Q

Evidence-based therapy for adults with BN and BED?

A
  • Cognitive Behavioural Therapy
  • Dialectical Behavioural Therapy
  • InterPersonal Therapy
54
Q

Discuss CBT

A
  • Questioning of belief, where the distorted beliefs are challenged and corrected to restore proper behaviours
  • An aspect is food-journalling
  • Short-term
55
Q

Discuss DBT

A
  • An effective alternative therapy to CBT

- Short-term, mindful eating

56
Q

Why do some patients not respond to CBT and prefer DBT?

A

Patients with impulsivity issues often do not respond to CBT, may prefer DBT

57
Q

Discuss InterPersonal Therapy

A
  • Long-term effectiveness

- Focus is on attachment, interpersonal skills

58
Q

What are factors included in a nutritional assessment of someone with an ED?

A
  • Behavioural symptoms
  • History of the eating disorder
  • Comorbidity
  • Clinical signs and symptoms of malnutrition
59
Q

Example of assessing behavioural symptoms?

A

Ask:

  • Do you lose control over eating?
  • Do you binge eat?
60
Q

What is important to consider when doing an Nutritional Assessment?

A

have confidence is asking uncomfortable questions, patient often can perceive hesitation

61
Q

How can we assess history of an ED?

A
  • What is the motivation for your ED?
  • Have you seeked help for your ED?
  • Do you have family members with an ED?
62
Q

Give 5 examples of what to include in nutrition education and re-feeding guidance

A
  • Addressing irrational beliefs about eating, weight and shape
  • Eating disorder manifestations
  • Consequences of restrictive eating
  • Medical complications
  • What is normal eating, normal portion sizes?
63
Q

(T/F) We start at the highest intensity for ED intervention

A

F, we start at lower intensity, and then may work up

64
Q

What is the lowest level of care?

A
  • Pschoed groups
  • CBT individual sessions
  • Nutrition groups
  • Food exposure groups
  • Nutritional counseling
  • Family therapy
  • Pharcaotherapy
65
Q

What is the second level of care?

A

-Day program of 24 hours/week for 12-16 weeks

66
Q

What is the third level of care?

A

Day hospital, for 40 hours/week, often at hospital all day but will return at night

67
Q

What is the fourth, and highest level of care?

A

Hospitalization on a 6 bed unit fo 3 months

68
Q

Why are patients more reluctant at a higher level of care?

A

Due to ambivalence, not ready to let go of their ED yet

69
Q

What are the 7 hospitalization admission criteria?

A
  • Severe or rapid weight-loss
  • Severe binge-eating and purging
  • Medical complications
  • Lack of response to outpatient tx
  • Severe psychiatric co-morbidity
  • Laxative withdrawal
  • To clarify a diagnosis
70
Q

Approaches to refeeding in patient with AN, mildly/mod malnourished?

A

-High calorie re-feeding as long as fluid balance, electrolytes is OK with medical monitoring

71
Q

How can we administer higher kcal?

A

through meals, or through meals + NGT

72
Q

Advantage of NGT?

A

Allows to to speed up feeding, must monitor for refeeding

73
Q

What is the gold standard approach in starting the feeding?

A
  • there isn’t one

- patient specific

74
Q

When is starting feeding critical and directive? When is it less conservative and conversational?

A
  • Adolescents

- Adults

75
Q

(T/F) those with ED undergoing refeeding will require different nutrient compositions that those within the recommended ranges

A

F

76
Q

How is a re-feeding plan usually communicated?

A

From a directive, to a more compassionate approach

77
Q

What is the weight gain goal at the Douglas?

A

1 kg/week

78
Q

Is bathroom access allowed after meals?

A

No

79
Q

How can we support those with ED with oral feeds in hospital setting?

A
  • Meal support
  • Post meal discussions
  • Exposure to variety of foods
  • Involvement in food preparation
  • Differentiate true dislikes from feared foods
  • Food environment which attains sense of control, and consistency
80
Q

How is food components altered for ED patients with oral feeds in a hospital setting?

A
  • Limit dietary exclusions, such as veganism
  • Prescribe water intake for patients who avoid it or abuse it
  • Limit coffee, tea or tisane consumption
  • Introduce food gradually with small, frequent feedings to prevent bloating
  • Avoid excessive sodium to limit risk of fluid and electrolyte overexpansion
  • Reduce raw F&V
  • Provide sufficient fibre
81
Q

What is the weight gain goal of a patient in the Day program

A

500 g/week if BMI <20

82
Q

How are patients in day program supported with their ED?

A
  • Food shopping, prep of meals
  • Group meal support
  • Post-meal discussion
  • Nutrition, psycho-education, body image and weekend planning group sessions
  • Yoga, post-meal relaxation
83
Q

How many meals are dat program patients provided with?

A

1 meal and 2 snacks or 2 meals and 2 snacks

84
Q

How can we develop a rapport and therapeutic alliance?

A
  • Define patient needs, expectations
  • Invole the patient in decision maing
  • Remain non-judgemental
  • Explore the patient emotional relationship with food and their food fears
  • Be alert for those who whose nutrition counseling to focus on the psychological issues
85
Q

How should we advise meal planning for those with EDs?

A

-Eat 5-6 times/day
-Introduce foods which have been removed from the diet
Gradually increase energy intake
-Use portion-controlled foods
-Establish and organized approach to eating which gives patients confidence

86
Q

Behavioural strategies for those with EDs?

A
  • Use monitoring to recognize eating symptoms and triggers
  • Limit access to triggering foods, slowly introduce it
  • After binging, return to normal food intake
  • Food intakes are non-negotiables
  • Eat in a sitting position at table, avoid eating food from containers
87
Q

_____ is a treatment goal for AN

A

Weight gain

88
Q

What is expected with normalization of eating amongst BN patients?

A

Weight gain

89
Q

What is a preventative of relapse of AN patients?

A

Reaching a normal weight

90
Q

What may be indicative of a normal weight?

A

Resuming menstruation

91
Q

How can we promote body image?

A
  • Avoid weighing between sessions
  • Get comfortable, fitting clothes
  • Discuss body weight history
  • Define a normal or healthy weight
92
Q

What happens in food exposure groups?

A
  • Opportunity to challenge fear with foods with a small group, followed by a post meal discussion
  • Usually 6-12 week
93
Q

Is the CGF used in ED nutritional intervention?

A

No

94
Q

What plate-by-plate approach is often used in ED nutritional intervention for weight restoration?

A
  • 1/2 grains/starches
  • 1/4 vegetables
  • 1/4 protein
95
Q

What plate-by-plate approach is often used in ED nutritional intervention if weight restoration is not the goal?

A

-1/3 grains, vegetables and protein

Clinical Nutrition 3 (30 decks)

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