Eating Disorders

Question 0

Medical complications of eating disorders

Answer 0

CNS change
Renal
Hematology all
GI
Metabolic
Endocrine
Cardiovascular 
Amenorrhea
Bradycardia and cold intolerance
Constipation
Hypotension
Acid base, fluid and electrolyte imbalance 
Pedal edema (protein disturbances)

Question 1

Questions to ask

Answer 1

When do you ask?
What might you ask?
How might you ask?
Are you satisfied with your eating patterns?
Do you ever eat in secret?

Question 2

Crisis management

Answer 2

Remaining in view for periods of times following meals
Allowing choice regarding meals
Restricting choices
Bed rest
Restrictive activities
Lab values
Behavioral contracting

Question 3

Comorbid mental illnes

Answer 3

Substance use
OCD
Depression

Question 4

Predisposing factors

Answer 4

• psychological
• sexual abuse: PTSD
• environment: dancers, drug abuse, sexual abuse, media
• family: increased if female relative had it
• biological: serotonin and dopamine levels
• sociocultural : confusing role expectations

Question 5

Anorexia as a coping mechanism

Answer 5

• happiest when they’re losing weight and achieving their weight goal and fasting
• maladaptive use of denial and angry with others who try to help
• not really about weight but instead it is trying to gain some control like and fears of maturity, independence, sexuality or parental demands

Question 6

Referring syndrome ***

Answer 6

Oral refeeding of chronically semistarved cause of cardiac insufficiency and neuro complications 
Ie
-fluid overload
- glucose intolerance (diabetes)
- GI dysfunction 
- cardiac Dysrythmias

Question 7

Fluid overload

Answer 7

1. Decrease in cardiac mass= change in stroke volume and end diastolic volume, bradycardia, fragmentation, or cardiac myofibrils
2. carbohydrate refeeding increases insulin = enhancing Na absorption and H2O absorption
   - overload of water can lead to cardiac failure, CHF

Question 8

Glucose intolerance

Answer 8

• starving causes use of fatty acids and ketones while glucose conserved
• insulin use impaired
• refeeding causes marked elevations in glucose
• if thiamine (B12) depleted can = Wernickes encephalopathy

Question 9

Mineral depletion

Answer 9

• hypophosphotemia: complex interchange of insulin and related sorts of nitrogen and PO4
• Starving changes balance and refeeding triggers further shifts
• Decrease PO4 = neuro problems & cardiac decompensation and death

Question 10

Cardiac Dysrythmias

Answer 10

• ventricular tachyarrythmias and prolonged QT

- terminal Dysrythmia may occur

Question 11

GI dysfunction

Answer 11

• Starving or semi starving causes structural & functional changes to intestinal mucosa & pancreas
• Refeeding may cause diarrhea, e- disturbance  death

Question 12

Binge eating disorder

Answer 12

engage in repeated episodes of binge eating, followed by significant distress. do not regularly use compensatory behaviours like bulimics

Question 13

signs of anorexia

Answer 13

1. low weight
2. amenorrhea
3. yellow skin
4. lanugo
5. cold extremities
6. peripheral edema
7. muscle weakening
8. constipation
9. abnormal lab levels (low thyroxine, and triiodothyronine)
10. abnormal CT and EEG
11. brachycardia, hypotension, heart failure
12. impaired renal function
13. hypokalemia
14. anemic pancytopenia
15. decreased bone density

Question 14

Comprehensive assessment for anorexia

Answer 14

• perception of the problem
• eating habits
• history of dieting
• methods used to achieve weight control
• value attached to a specific shape and weight
• interpersonal and social functioning
• mental status and physiological

Question 15

Cognitive distortions: when a patient says “he didnt ask me out. It must be because Im fat” they are displaying..

Answer 15

overgeneralization

Question 16

Cognitive distortions: “If i allow myself to gain weight, I will blow up like a balloon” is an example of..

Answer 16

all or nothing thinking

Question 17

cognitive distortions: “I know everybody is watching me eat”

Answer 17

Personalization

Question 18

Cognitive distortions: “when I am thin, I feel powerful”

Answer 18

Emotional reasoning

Question 19

In acute care when you have a patient with an eating disorder come in and is in a crisis state what is your first action?

Answer 19

safety, check for suicidal ideation and psychiatric symptoms need to be checked

Question 20

what does milieu management look like in eating disorders?

Answer 20

a therapeutic environment to normalize eating patterns, and behaviour management

1. precise meal times
2. adherence to selected menu
3. observation during eating
4. regular scheduled weigh ins
5. monitoring trips to the bathroom

Question 21

which eating disorder is more likely to develop a therapeutic relationship with the nurse?

Answer 21

Bulimia nervosa, because they see they have a problem, while people with anorexia dont

Question 22

other issues that may service in eating disorders

Answer 22

Anxiety
Disturbed body image
Imbalanced nutrition
Powerlessness
Chronic or situational low self-esteem 
Risk for self-mutilation

Question 23

what is the most effective therapy in eating disorders?

Answer 23

CBT

Question 24

Prevention of reefeeding syndrome

Answer 24

1. slow reefeeding
2. gradual increase in nutrition
3. supplemental phosphorus
4. close monitoring of electrolytes and cardiac status

Question 25

criteria for hospitalization for patients with eating disorders

Answer 25

1. weight loss, greater than 85% below ideal body weight
2. rapid decline in weight with food refusal even if not 85% of ideal body weight
3. inability to gain weight in outpatient treatment
4. temp less then 36
5. systolic bp less then 90/60
6. severe dehydration
7. hypokalemia less then 3 mEq/L
8. glucose is less then 60 mg/dL
9. hepatic, renal or cardio organ compromise requiring treatment