Eating Disorders: Exam 3 Flashcards
Popular media exalts a level of thinness that it’s extremely difficult to obtain—especially if you don’t have a personal chef, personal fitness trainer, hair and makeup crew, and professional photo retouchers.
Societal Factors
____________ __________ can certainly play a role. Children are sometimes taught their self-worth is based upon physical appearance. Parents sometimes model unhealthy attitudes toward food and dieting. Family tensions and enmeshed relationships may also be factors.
Family dynamics
Positive reinforcement is usually given for weight loss (e.g., “Wow! You’ve lost weight. Please tell me how you did it.”). As the weight loss becomes unhealthy, positive reinforcement is still given in the form of giving attention and showing concern.
Cognitive distortions are common in eating disorders. For example, all-or-nothing thinking can make clients believe that if they eat just one cookie, they will fall down a path of ravenous eating and obesity. Clients with anorexia nervosa also have perfectionistic tendencies.
Psychological Factors
Multiple brain structural (e.g., hypothalamus) and neurotransmitter (e.g., serotonin) changes have been proposed as causes of eating disorders. It’s not clear, however, if these abnormalities are the cause or consequence of eating disorders. Some studies suggest that genetic factors are involved.
Biological Factors
What is the nursing diagnoses for eating disorders?
Relevant nursing diagnoses for this lesson include activity intolerance, anxiety, chronic low self-esteem, defensive coping, deficient fluid volume, diarrhea, disabled family coping, disturbed body image, fear, imbalanced nutrition: less than body requirements, ineffective denial, ineffective family therapeutic regimen management, ineffective sexuality pattern, interrupted family processes, and powerlessness.
Clients worry excessively about being overweight, even though they are severely underweight. They implement various strategies to keep weight off. They may severely restrict caloric intake and over exercise. Alternatively, they may eat large quantities of food and then purge (i.e., induce vomiting or misuse laxatives and diuretics). Much of their day is spent focusing on their body and avoiding anything that would make themselves “fatter.”
This disorder is misnamed. The term anorexia means “lack of ________ .” However, clients with anorexia are hungry; many spend a lot of time thinking about food, looking at recipes, and preparing food for others. What is this?
Appetite
Anorexia Nervosa
Clients with anorexia nervosa are underweight (i.e., BMI of ___ or lower). They look emaciated. Their growth and development may be arrested. Bone mineral density is low. Amenorrhea is common.
Bradycardia (due to weakened heart muscle), hypotension, and hypothermia are common. Clients’ skin may be covered with newborn-like ________ (lanugo). This hair helps the body retain heat.
Clients who consume a vegetable-only diet sometimes have a yellowish pigmentation due to excessive intake of beta-carotene (hypercarotenemia). Laxative and diuretic abuse can cause peripheral edema.
17
hair
What are the laboratory findings for Anorexia Nervosa?
Food restrictions and purging can cause serious electrolyte deficiencies, including hypokalemia and hypomagnesemia. Anemia, leukopenia, and thrombocytopenia may also be present.
What is the epidemiology for Anorexia Nervosa?
The lifetime prevalence of anorexia nervosa in the United States is 0.6%. It is three times more common in women. The average age of onset is 18 years.
What are the effective therapies for Anorexia Nervosa?
Psychotherapy
Effective psychotherapies include CBT, psychoanalysis, motivational interviewing, and a form of family therapy called the Maudsley method.
Pharmacotherapy
The standard treatment for anorexia nervosa is nutritional rehabilitation plus psychotherapy. For clients not responding to treatment, pharmacotherapy can be added. Second generation antipsychotics (e.g., olanzapine) can help clients gain weight. SSRIs (e.g., fluoxetine) can help comorbid anxiety and depressive disorders.
Nursing Interventions for Anorexia Nervosa:
Create a therapeutic alliance. Monitor your feelings to avoid becoming frustrated or authoritarian. Convey unconditional positive regard.
Clients who are medically unstable (e.g., unstable vital signs, cardiac dysrhythmias, body weight less than 70% of ideal) are hospitalized. Monitor these clients’ vital signs, fluid volume status, and laboratory values closely.
Weigh hospitalized clients accurately (i.e., in the morning, after voiding, using the same scale, wearing the same clothing). Make sure clients are not hiding __________ objects in their shoes or clothing. Consider having clients stand with their back to the scale.
Help implement the prescribed eating regimen. Ensure all staff members are consistent in their implementation and enforcement of behavioral limits. Avoid arguing or bargaining with clients.
Consider small, frequent meals. These can be less intimidating to clients, encouraging greater compliance. Usually, meals have a time limit (e.g., 30 minutes). Sit with clients during meal times and observe them for at least one hour afterward. _____________ trips must be monitored. Usually, calories that are not consumed in the given time period are counted and given via a nasogastric tube. Speak matter-of-factly about this policy, using a non-threatening tone.
Heavy
Bathroom
Nursing Interventions for Anorexia Nervosa:
Monitor clients’ exercise to ensure it is not excessive.
Two to three pounds of weight gain a week is considered medically safe. More rapid weight gain in malnourished clients can cause _____________ syndrome—a potentially deadly complication. The primary cause of this syndrome is hypophosphatemia. Remember to monitor clients’ electrolyte levels. Acknowledge clients’ feelings of frustration and anger regarding the eating regimen; encourage healthy expressions of these feelings.
Focus conversations on clients’ emotions and feelings. Do not focus on food and eating.
Refeeding
Clients have recurrent episodes (at least once a week) of rapid, uncontrolled eating. These episodes usually occur while alone and are time-limited (e.g., less than a couple hours). After binging, clients try to prevent weight gain by inducing vomiting, misusing laxatives or diuretics, fasting, or extreme exercise. Clients are preoccupied with their weight and body shape. However, unlike clients with anorexia nervosa, they are not significantly underweight—most are a _____________ weight. Clients who have recurrent eating binges but do not engage in compensatory behaviors meet the criteria for ________ eating disorder. What is this?
Normal
Binge
Bulimia Nervosa
Assessment Findings: Excessive vomiting can cause parotid gland enlargement, erosion of dental enamel, and scarring on the _________ (Russell’s sign). Clients with bulimia tend to have ____________ .
Knuckles
Tachycardia
Laboratory Findings: Purging behaviors can cause fluid and electrolyte abnormalities and metabolic ____________. Remember, hypokalemia can cause cardiac dysrhythmias.
Alkalosis
