Eating disorders Flashcards
What are the 3 types of eating disorders?
- -Anorexia Nervosa (AN)
- -Bulimia Nervosa (BN)
- -Binge Eating Disorder (BED)
Comorbidities to eating disorders may include..
- -mood disorders
- -substance abuse
- -anxiety
- -self injurious behavior
What are positive feedback signals initiated by?
Feeding behavior
In negative feedback signals, increased potency is required to…
terminate eating
What to hormones influence meal size and duration?
- -Cholecystokinin (CKK)
- -Glucagon like peptide (GLP-1)
The biological theory relevant to eating disorders involves what factors?
- -genetics
- -neurotransmitter dysfunction
- -Endorphins
What hormone is involved with neurotransmitter dysfunction? What happens when it is high or low?
- -5-HT serotonin
- -Low: increased food intake
- -high: decreased food intake
What hormone increases food intake and elevates mood?
endorphins
What theory of an eating disorder involves learned patterns or irrational thoughts and beliefs? How can the patient be helped?
- -Cognitive Behavioral Theory
- -changing maladaptive behavior and replacing it with healthier response.
what theory involves unconscious conflicts?
Psychoanalytic Theory
What is a biological risk factor in a person with an eating disorder?
Genetics
What are some sociocultural RF’s for a person with an eating disorder?
- -female
- -age (teens-20’s)
- -dieting
What are some family RF when it comes to eating disorders?
- -Family hx.
- -enablers (not the cause)
- -abuse (childhood/adolescent)
- -interpersonal relationships (pressure form parents for need to succeed)
- -difficulty with conflict resolution
What are 3 similar clinical manifestations between the three types of eating disorders?
- -body image disturbance
- -anxiety
- -ineffective coping skills
what is a potentially life threatening eating disorder where the patient does not eat (or they will purge if they have to eat)?
Anorexia Nervosa (AN)
Anorexia is more common in…
It usually begins at what life stage (age group)
- -females (academics, goals, rigid rules to control weight)
- -teen years
What are the clinical manifestations of anorexia nervosa?
- -Intense fear of weight gain
- -refuse to maintain healthy weight
- -distorted body image
- -self-induced vomiting (if they have to eat)
- -body disturbances
- -cut food in small pieces (pretend to eat)
- -refuse to eat in front of others
What are common substances a person with anorexia may use to lose weight?
- -laxatives
- -diuretics
- -diet pills
A person with anorexia may become malnourished. What signs would the nurse see if a patient is malnourished?
- -brittle hair/nails
- -dry, yellow skin
- -lanugo
- -always cold
Anorexia can cause damage to the brain, heart, and kidneys. What signs would the nurse see if this is to happen?
- -low BP, HR
- -irregular heart rhythms (lead to heart failure)
Clinical therapies for a pt. with Anorexia are…
- -Antidepressants (fluoxetine)
- -antipsychotics
- -mood stabilizers
- -CBT
- -Group, family therapy
What should the nurse advise the pt. of when taking fluoxetine?
- -May take 1-3 weeks to take effect (2 months for max response)
- -avoid operating heavy machinery (until individual side effects are known)
a person with anorexia may have a hard time getting pregnant due to low…
estrogen/testosterone levels
This conditions is described as binging on food or overeating then purging to avoid weight gain.
Bulimia Nervosa (BN)
Bulimics usually get rid of food by way of..
- -vomiting (purging)
- -laxatives
- -enemas
- -diuretics
What clinical manifestations would a bulimic person present?
- -cycle of binging and purging food
- -extreme exercise (compensate for binging)
- -hoard food/large amounts of trash due to overeating
- -secretive
- -menstrual irregularities
Why is bulimia frequently undiagnosed?
Pt. has healthy weight or is obese
The onset of bulimia usually occurs during…
late adolescence or early adulthood
Purging is used for…
- -purification rituals
- -regaining self control
What is the treatment for a pt. with bulimia?
- -Antidepressants (fluoxetine)
- -CBT
- -Family therapy
What disorder describes periods of rapid overeating in a short amount of time with inability to stop?
Binge Eating Disorder (BED)
what separates binge eating from the other two disorders?
Pt. does not purge
during an episode of overeating the patient may feel…
out of control
When a patient binge eats what are usual food choices?
- -junk food
- -fast food
When does a persons binge eating end?
- -when abd. pain becomes severe
- -get interrupted
- -run out of food
what are some clinical manifestations of binge eating?
- -loss of control
- -embarrassment, disgust after eating
Binge eating can be treated with…
- -antidepressant (fluoxetine)
- -CBT
What are some diagnostic tests that can be done on a patient with anorexia?
- -Albumin, total protein (hypoalbuminemia)
- -electrolytes (risk hypokalemia)
- -ABG’s
- -CBC (anemia, leukopenia, thrombocytopenia)
- -Bone density (reduced)- risk osteoporosis
- -ECG (prolonged QT interval)
- -Urinalysis (kidney fx.)
- -Kidney, thyroid, liver fx. tests (BUN increased)- dehydration
What are some diagnostic procedures for bulimia?
- -Dental assessment
- -Physical exam
During a dental assessment for bulimia what will the nurse look for?
- -cavities
- -gum infection
- -enamel worn (vomiting)
During the physical exam what will the nurse look for?
- -eyes (broken blood vessels)
- -dry mouth
- -fat cheeks
- -rash/pimples
- -cut/calluses on finger joints
Diagnostic tests for binge eating include..
- -Physical exam
- -blood tests
- -urine test
A patient that has anorexia or bulimia is at risk for what acid base imbalance due to excessive vomiting?
metabolic alkalosis
A patient that has anorexia or bulimia is at risk for what acid base imbalance due to laxative use?
Metabolic acidosis
What are some non-pharm approaches with anorexia?
- -Psychotherapy
- -Maudsley approach
What is the Maudsley approach? Who does it help?
helps with adolescents, the parent takes over feeding the pt.
What non pharm therapy is effective with Bulimia, and binge eating?
CBT
How does CBT help with a patient who has an eating disorder?
Focuses on the problem and how to solve it
What outpatient treatment is the 1st line approach to an eating disorder?
Long term outpatient tx.
In patient therapy is used for…
severe cases
What does inpatient services provide for the patient?
structured, contained environment
What are some other therapies that can help with eating disorders?
- -chamomile tea
- -acupuncture
- -massage
- -yoga
- -biofeedback
When assessing a patient the nurse should not assume the patient has an eating disorder… What should be done before dx. a pt. with eating disorder?
other possible causes
What will the nurse see during a physical assessment of a client with anorexia?
- -emaciated
- -skin dry, have lanugo, yellow in color
- -brittle hair and nails
- -Bradycardia
- -hypotension
- -cardiac dysrhythmias
What will the nurse see during a physical exam of a client with bulimia?
- -cavities
- -tooth erosion
- -hoarse voice
- -dehydrated
What are some signs a patient may be dehydrated?
- -hypotension
- -dry mouth
- -poor skin turgor
- -dizziness
- -weakness
- -reduced UOP
- -concentrated urine
What are 3 nursing Dx. for a patient with an eating disorder?
- -Risk for injury
- -Deficient fluid volume
- -Imbalanced nutrition
What are some priority interventions when caring for a pt. with an eating disorder?
- -Protect client from physiological effects
- -Safety (prevent injury)
- -identify/treat cause of behavior issues
the nurse should encourage healthy ____ and _______.
- -healthy behaviors
- -thought patterns
what type of relationship should the nurse promote with the pt?
Therapeutic
Talking about the disorder may be sensitive and painful to clients but, tx. requires….
–openness
Transition requires patient courage, trust must be established. What are 3 other things that should be established between all parties?
- -Respect
- -consistency
- -patience
The nurse must remember patient preferences when creating the treatment plan, What should the nurse include in the plan?
- -Provide structured and inflexible eating schedule
- -give small frequent meals
- -provide high fiber, low sodium diet
- -limit fatty/gassy foods at start of tx.
- -Administer multivitamins and mineral supplements
- -avoid caffeine
This potentially fatal syndrome is a complication of eating disorders, it occurs when fluids, electrolytes, and carbs are introduced to a severely malnourished pt. and there is a sudden shift in electrolyte and fluid balance.
–Refeeding syndrome
what are nursing actions pertaining to Refeeding syndrome?
- -care for client in hospital;l setting
- -consult with provider and dietician on controlled nutritional support
- -monitor electrolytes
Another complication linked to eating disorders is…
- -cardiac dysrhythmias
- -severe bradycardia
- -hypotension
If a patient has complications pertaining to dysrhythmias, low BP, and HR what should the nursing action be?
- -place client on continuous cardiac monitoring
- -Monitor VS
- -Report changes to provider
