Eating Disorders

Question 1

COMMONALITY: Based on irrational misperception of body image
People with eating disorders (EDs) have cognitive distortions that are the result of processing errors in the brain
FATAL
COMMON DIAGNOSTIC CATEGORIES/criterias

Answer 1

Types of eating disorders

Question 2

Anorexia nervosa
Bulimia nervosa
Binge-eating disorders
Obesity

Answer 2

COMMON DIAGNOSTIC CATEGORIES/criterias

Question 3

EDs are connected to the underlying emotions of:
Anxiety
Dysphoria (state of dissatisfaction with life)
Low self-esteem
Feelings of lack of control -often seen; control: what eat - feelings of control when feel out of control

Answer 3

Cognitive distortion

Question 4

Eating disorders are deadly
Treatment involves whole family
Significant co-morbidity with:
The Academy for Eating Disorders (AED) advises to always assess for psychiatric risk, including suicidal and self-harm thoughts, plans, and/or intent

Answer 4

Co-morbidity

Question 5

Mood and anxiety disorders
Substance abuse
Body dysmorphic disorders
Impulse control disorders
Personality disorders, especially borderline and obsessive-compulsive personality disorders
Some going on with eating disorders

Answer 5

Significant co-morbidity with:

Question 6

Lose so much weight; see lot males
Loss of Appetite/refusal to eat
Loss of menstrual period
Dieting with relish - pride not eating and control over what eating
Denial of hunger
Excessive exercising/frequent weighing - obsessed with scale
Use of laxatives and/or vomiting
Layered clothing - masters at hiding weight
Bizarre eating habits
Intolerance to cold
Leaving for the bathroom after meals - also with Bulimia
May also vomit
Tend not to eat
Red or raw knuckles - also with Bulimia
FATAL because electrolytes can get out

Answer 6

RED FLAGS—ANOREXIA

Question 7

1.Which is characteristic of the diagnosis of anorexia nervosa?
A.Obsession with weight gain
B.Body image disturbance
C.Disregard for the feelings of others
D.Healthy family relationships

Answer 7

Correct answer: B
The distortion in body image by a client diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated.

Question 8

Perfectionist (expect be perfect)/low self-esteem - lot shoulds
Female: 12-25; increase in 8-11 y.o.
Seeks to rule life by controlling body
Often uninformed & fear sex - uninformed about sex - afraid getting breasts/menstrual cycles; stop eating menstrual cycle goes away
Shy, timid, neat
High energy level/high achiever
Often dependent esp upon parents

Answer 8

Common characteristics often identified with anorexia

Question 9

Treatment as quickly as possible - give areas where can be involved or have a say or control
Be consistent/Behavior Modification
Individual therapy/self-esteem, identify
Give them ways to be in control
Watch labs/electrolytes - deadly because electrolytes out of balance
Expect gain ¼ to ½ lb/week (anorexia) - really low
Family Therapy - impacts entire fam becomes issue what eating/not eating; involve fam in therapy
Medications/antidepressants - not uncommon to give; dependent on what going on with them; may be on antianxiety

Answer 9

General treatment

Question 10

Way cope - lifelong thing to help them cope with them
Outcomes need to be measurable within specific, realistic time frames, as determined for each individual patient (e.g., within 3 weeks, by discharge). - slow down weight gain
Patient will:

Answer 10

Outcomes identification anorexia nervosa

Question 11

Refrain from self-harm - cutting can be big issue; SI; SAFETY
Normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks
Achieve 85% to 90% of ideal body weight
Be free of physical complications
Demonstrate two new, healthy eating habits. Participate in the treatment of associated psychiatric symptoms (e.g., defects in mood, self-esteem)
Participate in long-term treatment to prevent relapses - common to have relapses with nay eating disorders

Answer 11

Patient will:

Question 12

Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (binging)
Eat huge amount food in short period of time then binge to self-inducing to get rid of it; knuckles very raw; get rid of whatever consumed; often sweets
Feel guilty then get rid of it
Watch electrolytes and labs because will potentially kill them
The episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Answer 12

Bulimia Nervosa: Nursing process: assessment

Question 13

1. Excessive concern about wt.
2. Frequent overeating
3. Binging often on sweets
4. Expresses guilt or shame overeating
5. Disappears after meal - going to purge
6. Depressive mood
7. Weight may be appropriate for height or may be slightly overweight - outwardly hard to identify

Answer 13

RED FLAGS–BULIMIA

Question 14

Outcomes need to be measurable and with realistic, but specific, time goals as determined for the individual patient
Include in goal setting in what they want to be the outcome
Patient will…..

Answer 14

Outcomes identification bulimia nervosa

Question 15

Refrain from binge-purge behaviors - not binge; what do besides it
Demonstrate 2 new skills for managing anxiety
Obtain & maintain normal electrolyte balance
Be free of self-directed harm
Express feelings in a nonfood-related manner
Name two personal strengths - improve self-esteem

Answer 15

Patient will…..

Question 16

Terror of gaining weight
Preoccupation with food
Views self as fat even when emaciated
Judges self-worth by weight
Prominent parotid glands, if purging
Peculiar handling of food:
Cutting food into small bits
Pushing food around the plate
Maintaining a rigorous exercise regimen - not purge but will exercise to get rid of it
Controls what they eat to feel powerful to overcome feelings of helplessness

Answer 16

Anorexia Nervosa

Question 17

Binge eating
Self-induced vomiting
Laxative and diuretic abuse
History of anorexia nervosa in one quarter to one third of individuals
Depressive signs and symptoms
Problems with interpersonal relationships
Prominent parotid glands, if purging

Answer 17

Bulimia Nervosa

Question 18

A body mass index of 30 is considered obese.
Obesity can contribute to increases in morbidity and mortality. - can be fatal
Can be overweight and healthy; watch biases
Eating disorder in DSM-5
Obese people are at higher risk for: lot things

Answer 18

Obesity

Question 19

Hyperlipidemia
Diabetes mellitus
Osteoarthritis
Angina
Cardiac issues
Respiratory insufficiency

Answer 19

Obese people are at higher risk for: lot things

Question 20

The DSM-5 identifies binge eating disorder (BED) as an eating disorder that can lead to obesity - can lead to being overweight; not look emaciated
Is a variant of compulsive overeating
Often symp of severe depression
Is an eating pattern that resembles that of obesity
Recurrent episodes of thinking about and eating large amount of food occur in a short period
Not restrict or purge food
Feelings of disgust, depression, and guilt are expressed after bingeing
Binge-eating disorder (BED) is now recognized as a specific disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).
Is noted as a symptom of depression

Answer 20

Binge eating disorder (BED)

Question 21

The individual binges on large amounts of food, as in bulimia nervosa
BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories - not try get rid of food; feel bad about binging but not get rid of it

Answer 21

The DSM-5 identifies binge eating disorder (BED) as an eating disorder that can lead to obesity - can lead to being overweight; not look emaciated

Question 22

In approximately 50% of obese binge eaters, no attempt to restrict dietary intake occurs before bingeing - just binge; not purge it
Effective treatment for obese binge eaters integrates behavior modification, improvement of depressive symptoms (identify that and then improve BED), and achievement of the appropriate weight
Effective program for BED integrates modification with noted associated mood changes, working toward an appropriate weight
Relationship with food

Answer 22

Binge-eating disorder and obese binge eaters

Question 23

NOT IN DSM-5
Aware what eating and want eat healthy; so focused on quality, not quantity
Orthorexia is an eating disorder that involves an unhealthy obsession with healthy eating. Revolves around food quality, not quantity. Not focused on losing weight.
Avoidant food intake
Go to the extreme
There may be extreme limitation on diff food groups that result in only consuming less than a total of 10 ingredients if actually eating: missing nutrients, vitamins and other things need to stay health; Allowing food to revolve around one’s daily schedule.
Obsession with meal planning and food label and what eat
Not in DSM-5, but under Avoidant/Restrictive Food Intake (ARFID) as a broad diagnostic category. - seeing more and more of it
Not have well-rounded eating plan; missing other things; hurts body

Answer 23

Orthorexia

Question 24

Nursing care of the client with an eating disorder is aimed at restoring nutritional balance diet - eating nutritionally; getting healthy balance in life; gain control in what eat - less anxiety - self esteem increases
Emphasis is also placed on helping the client gain control over life situations often (often root cause) in ways other than inappropriate eating behaviors - where in life have control in healthy way; control issue often
Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance - focus on these

Answer 24

Planning and implementation

Question 25

Has achieved and maintained at least 80 percent of expected body weight - not fight too much on body weight; think about relationship with food and view self; think about labs - electrolytes - serious disorder for people
Has vital signs, blood pressure, and laboratory serum studies within normal limits - keep all stable
Verbalizes importance of adequate nutrition

Answer 25

Gen overall outcomes: The Client

Question 26

Avoid reassurance. Being told they are not fat is little benefit—may confirm you don’t understand what is going on; cannot believe/trust you
Instead of “I’m really proud of you”; Say, “You must really be proud of yourself.” They need help to build own approval system - help improve their self-esteem - put it back on them to have them recognize it in them
Remember the eating disorder is a sign/symp of something else going on
Avoid moralizing

Answer 26

Working with someone with an eating disorder

Question 27

Behavior Modification
Successes have been observed when the client:
Individual Therapy
Family Therapy

Answer 27

Treatment modalities

Question 28

Used frequently if working on eating disorder
Issues of control are central to the etiology of these disorders
For the program to be successful, the client must perceive that he or she is in control of the treatment and control in life - front and center of treatment - part treatment plan; some say; got say in it

Answer 28

Behavior Modification

Question 29

Have them develop contract and help develop care plan - control and say in it
Is allowed to contract for privileges based on weight gain
Has input into the care plan
Clearly sees what the treatment choices are
Plan realistic; see they have choices; deal with emotional stuff and see that they have choices

Answer 29

Successes have been observed when the client:

Question 30

Helpful when underlying psychological problems are contributing to the maladaptive behaviors
Hospitalized for eating disorder - d/c cont this therapy since lifelong

Answer 30

Individual Therapy

Question 31

Involves educating the family about the disorder
Assesses the family’s impact on maintaining the disorder - learn ways to work with loved one to help them with their self-esteem - identify how feeling self and things + about themself
Takes over fam and fairly common
Fam needs be engaged
Symp of eating disorder and how impacts body
Assists in methods to promote adaptive functioning by the client

Answer 31

Family Therapy

Question 32

Nature of the Illness
Support Services

Answer 32

client/fam edu

Question 33

Symptoms of anorexia nervosa and bulimia nervosa/whatever eating disorder
What constitutes obesity?
Symp of eating disorder in gen; seeing emotionaltly and how impacts the body
Causes of eating disorders
Effects of the illness or condition on the body - s/s and importance of lab values

Answer 33

Nature of the Illness

Question 34

Weight Watchers International - good support sys
Overeaters Anonymous - good support and educational things for fam/indiv
National Association of Anorexia Nervosa and Associated Disorders
National Eating Disorders Association - support for indiv and fam

Answer 34

Support Services

Question 35

Depends what going on with them; often antidepressants
Look at cause - depends on the symp and what needing
Numerous studies of pharmacologic intervention have failed to demonstrate efficacy for any one agent
See lot anxiety and depression but not given
Improvement in weight gain and appetite is facilitated through the treatment of the underlying anxiety

Answer 35

Pharmacologic interventions

Question 36

Lot anxiety/depression so see those but not given
Various medications have been prescribed for associated symptoms such as:
Anxiety
Depression

Answer 36

Psychopharmacology