Eating Disorders Flashcards
Medical complications of eating disorders
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)
Questions to ask
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?
Crisis management
Remaining in view for periods of times following meals Allowing choice regarding meals Restricting choices Bed rest Restrictive activities Lab values Behavioral contracting
Comorbid mental illnes
Substance use
OCD
Depression
Predisposing factors
- 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
Anorexia as a coping mechanism
- 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
Referring syndrome ***
Oral refeeding of chronically semistarved cause of cardiac insufficiency and neuro complications Ie -fluid overload - glucose intolerance (diabetes) - GI dysfunction - cardiac Dysrythmias
Fluid overload
- Decrease in cardiac mass= change in stroke volume and end diastolic volume, bradycardia, fragmentation, or cardiac myofibrils
- carbohydrate refeeding increases insulin = enhancing Na absorption and H2O absorption
- overload of water can lead to cardiac failure, CHF
Glucose intolerance
- 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
Mineral depletion
- 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
Cardiac Dysrythmias
- ventricular tachyarrythmias and prolonged QT
- terminal Dysrythmia may occur
GI dysfunction
- Starving or semi starving causes structural & functional changes to intestinal mucosa & pancreas
- Refeeding may cause diarrhea, e- disturbance death
Binge eating disorder
engage in repeated episodes of binge eating, followed by significant distress. do not regularly use compensatory behaviours like bulimics
signs of anorexia
- low weight
- amenorrhea
- yellow skin
- lanugo
- cold extremities
- peripheral edema
- muscle weakening
- constipation
- abnormal lab levels (low thyroxine, and triiodothyronine)
- abnormal CT and EEG
- brachycardia, hypotension, heart failure
- impaired renal function
- hypokalemia
- anemic pancytopenia
- decreased bone density
Comprehensive assessment for anorexia
- 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
Cognitive distortions: when a patient says “he didnt ask me out. It must be because Im fat” they are displaying..
overgeneralization
Cognitive distortions: “If i allow myself to gain weight, I will blow up like a balloon” is an example of..
all or nothing thinking
cognitive distortions: “I know everybody is watching me eat”
Personalization
Cognitive distortions: “when I am thin, I feel powerful”
Emotional reasoning
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?
safety, check for suicidal ideation and psychiatric symptoms need to be checked
what does milieu management look like in eating disorders?
a therapeutic environment to normalize eating patterns, and behaviour management
- precise meal times
- adherence to selected menu
- observation during eating
- regular scheduled weigh ins
- monitoring trips to the bathroom
which eating disorder is more likely to develop a therapeutic relationship with the nurse?
Bulimia nervosa, because they see they have a problem, while people with anorexia dont
other issues that may service in eating disorders
Anxiety Disturbed body image Imbalanced nutrition Powerlessness Chronic or situational low self-esteem Risk for self-mutilation
what is the most effective therapy in eating disorders?
CBT
Prevention of reefeeding syndrome
- slow reefeeding
- gradual increase in nutrition
- supplemental phosphorus
- close monitoring of electrolytes and cardiac status
criteria for hospitalization for patients with eating disorders
- weight loss, greater than 85% below ideal body weight
- rapid decline in weight with food refusal even if not 85% of ideal body weight
- inability to gain weight in outpatient treatment
- temp less then 36
- systolic bp less then 90/60
- severe dehydration
- hypokalemia less then 3 mEq/L
- glucose is less then 60 mg/dL
- hepatic, renal or cardio organ compromise requiring treatment