Eating Disorders Flashcards
Predisposing Factors of Eating Disorders
- Biological influences
- Psychodynamic influences
- Family influences
? - Characteristics
- morbid fear of obesity
- gross distortion of body image
- preoccupation w/food
- refusal to eat (even if suffers hunger pangs)
Anorexia nervosa (AN)
> BMI of 17 or lower or <15 in extreme cases
AN
- Excessive weight loss, may be less than 85% of expected weight
- Reduction in food intake (horde or conceal)
- Possible laxative use, diuretics, purging, use of diet pills
- Preoccupation or obsession w/food
- Possible excessive exercise
- Compulsive behaviors (i.e., excessive handwashing)
AN - Assessment Findings
- Hypothermia, bradycardia (more pronounced at rest), hypotension
- Edema, lanugo, metabolic changes
- Amenorrhea (happens w/severe wt loss)
AN - Diagnostic Criteria
A. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
? type
The individual, over the last 3 months, has engaged in recurrent episodes of binge-eating or purging behaviors
> i.e., laxatives, enemas, & diuretics
Binge-eating/purging (type)
? type
Means that the individual, over the last 3 months, has engaged in restricting of calorie intake which does not include any sort of purging or binging activity
> They accomplish their wt loss through dieting, fasting, and/or the use of excessive exercise
Restricting (type)
Hospitalization
- Malnutrition
- Dehydration
> Assess for thirst, orthostatic hypotension, tachycardia, & elevated sodium lvls - Severe electrolyte imbalance
> Low K, PO4, Mg - Cardiac arrhythmia or severe bradycardia (<50 bpm)
- Hypothermia (<96.8°)
- Hypotension
- Suicidal ideation
?
- Binging, purging, overconcerned w/appearance & other’s perception
- More common than anorexia; eating high-cal foods in secret
- Most are within normal wt range
Bulimia Nervosa (BN)
BN
- Normal wt range
- Dehydration & electrolyte imbalance
- Erosion of tooth enamel (d/t gastric acid in vomit)
- Tears in gastric mucosa or esophageal mucosa
- Russell’s sign (calluses on dorsal surface of hands, typically knuckles, that’s 2nd to long-term purging)
- Parotid enlargement (from vomiting)
- Dental caries
- Mouth ulcers
BN - Diagnostic Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most individuals would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over-eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting or the misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Severity of Bulimia
- Mild (1-3) [episodes]
- Moderate (4-7)
- Severe (8-13)
- Extreme (on average, 14 or more episodes/week)
Binge Eating Disorder - Diagnostic Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
! Etiology isn’t fully understood but brain imaging studies have shown an orbitofrontal cortex displaying increased activity (that center is responsible for the reward & pleasure responses & usually r/t substances [food])
! This disorder is absent of the compensatory purging; there’s no misuse of laxatives or self-induced vomiting
B. The binge eating episodes are associated with 3 (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty after overeating.
! Individual is at risk for weight gain & obesity
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of BN or AN.
Nursing Diagnoses
- Imbalanced nutrition: less than body requirements
- Deficient fluid volume
- Denial
- Disturbed body image/low self-esteem
- Anxiety (moderate to severe)
- Obesity
Nursing Interventions (AN/BN)
- Restore nutritional status
- Diet according to dietician, remain w/pt, limit meal time
- NG feeding if PO refusal
- Support & positive reinforce improvements in eating behaviors
- I&O
- Daily weight
- Assess hydration status
- Enforce restrictions
! Refeeding syndrome
> Develop trust
Convey unconditional positive regard
Acknowledge anger
> Avoid arguing
Help identify maladaptive behavior
Explore feelings/fears
Nursing Interventions - All
> Help the client develop a realistic perception of body image & relationship w/food
> Promote feelings of control
! Perfection is unrealistic & explore the need for this
Nursing Interventions - BE/Obesity (For BE disorder w/obesity)
> Encourage client to keep a diary of food intake
Plan a progressive exercise program
Support or therapy group
> Identify realistic wt loss goals
Determine the client’s motivation for developing healthier patterns of eating
Rx education
Outcomes/Evaluation
✓ Accepted self as less than perfect
✓ Developed adaptive coping strategies
✓ Acknowledged that past self-expectations may have been unrealistic
✓ Developed a more realistic perception of body image
Treatment Modalities (AN/BN)
- Behavior modification
- Cognitive behavior therapy (CBT)
?
Confronts irrational thinking patterns & associated feelings w/eating disorders
Cognitive Behavior Therapy (CBT)
?
Its’ goal is to change the maladaptive eating behaviors
> Pt must perceive being in control; success has been seen in those w/anorexia who are able to contract for privileges based on wt gain
Behavior modification
?
Is used for adolescents; is an intensive outpatient program w/3 phases
It actively involves the family in each step
The Maudsley Approach
The Maudsley Approach
- Weight restoration
- Returning control over eating to the adolescent
- Establishing healthy adolescent identity
Psychopharmacology
- No specific med identified for AN
- SSRI’s for comorbid depression
- Fluoxetine (Prozac) for BN (60 mg/day) [dec cravings for carbs]
- Other antidepressants
Treatment Modalities in BE
- High-dose SSRIs
- Topiramate (Topamax)
- Lisdexamfetamine (Vyvanse)
- In combination w/CBT
