Exam 2: Eating Disorders Flashcards
Eating Disorder
Consistently less than or more tha body’s caloric need to maintain a healthy body weight
Eating disorders are accompanied by…
anxiety and guilt
Eating Disorders occur without…
hunger or failure to product satiety
Eating disorders result in …
physiologic imbalances and medical complications
3 Important eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Binge Eating Disorder
recurrent consumption of large amounts of food - compulsive overeating
no inappropriate compensatory behaviors like purging in bulemia
Anorexia Nervosa
Life threatening condition of distrubed body image, leads to emaciation with the intense fear of becoming obese
How high is the anorexia nervosa mortality rate
Very high mortality rate - 7-10% - with high rates of suicide
Bulimia Nervosa
recurrent pattern of uncontrollable consumption of large amounts of food (binge eating) followed by attempts to eliminate the body of excess calories (purging)
Anorexia causes a very irrational fear of…
obesity
Binge Eating Disorder easting is associated with what characteristics
fast consumption
eating alone
guilt
20-30% of obese individuals report…
having done binge eating
what % of the US population may have anorexia or bulemia
1-4%
Why is it so difficult to assess amounts of eating disorders
most binge and purge in secret and their weight remains WNL (especially bulemia)
What groups and demogrpahics tend to get eating disorders
historically, whites that are well educated adolescents to young adults
Wide distribution among classes and cultures
Can manifest and persist into middle and later adulthood
Incidence of males increasing but higher rate in females
What is the ratio of male to female with anorexia
1M:2F
What is the ratio of male to female with bulemia
1M:3F
What subgroup of males has a higher incidence of eating disorders
homosexual males
What populat emphasis contributes to eating disorders
fitness
lean muscle mass
stringent weight requirements
What group is less likely to seek help for eating disorders, and come to clinic further progressed
males
Etiology of Eating Disorders
varies and is influenced by impaired psychosocial fxns, medical conditions, and psychiatric co-morbidities
Multi-factorial: develops based on interactions with family, individuals, and sociocultural influences
Vuln. pop, uncontrolled dieting,genetics, puberty, major life changes, stressors, family fxning or dysfunction, emphasis in thinness, all can contribute
Main Theory of Eating Disorders
Transactional model of Stress/Adaptation
Transactional Model of Stress/Adaptation
Etiology theory on eating disorders where most likely they are influenced by mult. factors including:
genetic models
psych models
psychosocial influences
biological theories
psychodynamic influences
family theory
Genetic Model of Eating Disorders
A hereditary predisposition to eating disorders hypothizied from genetics
Anorexia nervosa has seen to be more common in what genetic inheretance that has been noticed
More common among sisters and mothers of those with the disorder than it is among the general populations
Psychological Models of Eating Disorders
eating disorders associated with:
low self esteem
self doubts about personal worth
problems with separation
problems with sexuality
Psychosocial influences on eating disorders
unresolved dependency needs
fixation in the oral stage of psychosexual development
Biological theory of ED
Uncertain whether ED or neurochemical disturbances came first
originates in the hypothalamic, hormonal, NT, or biochem disturbances
According to biological theory of ED, OCD, anorexia, bulimia are associated with excessive levels of ____ which is released when?
vasopressin; which is released during stress of physical or emotional origin
Psychodynamic Influences of ED
suggests that eating disorders result from very early and profound disturbances in mother-infant interactions, resulting in:
- Retarded ego development
- Unfulfilled sense of separation-individuation
Psychosocial Theory of ED
may diet to lose weight to gain enhances in physical appearance and received attn form others - can be positive or negative
Mood disorders, anxiety disorders, low self esteem, perfectionism, perseverance (Determination), avoidance, all appear to be predisposing eating disorder factors
What mental illness has cognitive and behavioral similarities with eating disorders
OCD - ritualistic behaviors, irrational thoguhts and beliefs, anxiety
Family Theory of ED
- Family influences and conflict avoidance - promote and maintain psychosomatic symptoms and the sick child becomes the problem and focus on the conflict is diverted
- Elements of power and control - parental criticism, love, aproval, recognition all influence
S/S of Anorexia Nervosa
Extreme Weight Loss
Amenorrhea, Hypothermia, Bradycardia, Hypotension, edema, Lanugo, and metabolic changes
Family involvement
Amenorrhea is typical and may preceded significant weight loss
Obsession with food - always talking about it
Feelings of anxiety and depression common
Weight loss in anorexia nervosa is usually more tha ___% of expected weight
15%
S/S of Bulimia
episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over short periods (Binging)
Episode followed by inappropriate compensatory behaviors to rid the body of excess calories (self induced, vomiting or the misuse of laxatives, diuretics, or enemas)
Nursing Dx for Anorexia/Bulimia
Imbalanced Nutrition: LESS than body requirements r/t refusal to eat
Deficient fluid volume: Risk for or actual r/t decreased fluid intake, self induced vomiting, and laxative and/or diuretic abuse
Disturbed body image / low self esteem / retarded ego development, dysfunctional family system, or feelings of dissatisfaction w/ body appearance
Ineffective Denial r/t retarded ego development and fear of losing the only aspect of life over which he or she perceives some control (eating)
Imbalanced nutrition - more than body requirements r/t compulsive overeating
Disturbed body image/ low self esteem/ retarded ego development, dysfunctional family system or feelings of dissatisfaction w/ body appearance
Anxiety (moderate to severe) r/t feelings of helplessness and lack of control over life events
What is an emergency situation from anorexia/bulimia
excessive vomiting and laxative or diuretic abuse may lead to problems with ehydration and electrolyte imbalances
Multiple physiological disorders related to the consequences of starvation
Kidney and liver disorders
Goals for Treatment for Anorexia and Bulimia involve what
Client will:
Verbalize knowledge regarding consequences of fluid loss caused by self induced vomiting (or laxative/diuretic abuse) and importance of adequate fluid intake
Verbalizes events that precipitate anxiety and demostrates techniques for its reduction
Verbalizes ways in which (s)he may gain more control of the environment and thereby reduce feelings of helplessness
Expresses interest in welfare of other and less preoccupation with own appearance
Verbalizes that image od body as “fat” was misperception
Demostrates ability to take control of own life without resorting resorting to maladaptive Eating behaviors (anorexia nervosa)
Planning and Implementation of of nursing care for EDs involve…
- Restoring nutritional balance
- emphasis of helping the client GAIN CONTROl over life situation
- self esteem and positive self image are promoted in ways that relate to aspects other than appearance
What is central to the etiology of all eating disorders
Issues of control
For an ED tx program to be successful…
the client must perceived that he or she is in CONTROL of the treatment
Success is observed with the ED patient when …
- The client is allowed to contract privileges based on weight gain, has input into care plan, clearly sees what treatment choices are
- Client has control over eating, amount of exercise, whether to induce vomiting
- Staff and client agree about goals and system of rewards
Treatment Modality for ED: Individual Therapy
helpful when udnerlying psychological problems are contributing to maladaptive behaviors
Treatment Modality for ED: Family Therapy
- Really important to care
Involves eduating the family on the disorders
Assesses the familys impact on maintaining the disorder
Assists in methods to promote adaptive functioning by the client
What cognitive distortions of ED need to be attended to in ED tx
overgeneralizations
all or nothing thinking
catastrophizing
personalization
emotional reasoning
Positive client outcomes for treatment of anorexia/bulimia occur when…
- The client has achieved and maintain at least 80% of expected body weight
- Has VS stability, BP and lab serum students wnL
- Verbalizes importance of adequate nutrition
- Adequacy or usual pattern of nutritional intake
- Body weight, muscle and fat are congruent with gender and age
- Positive body image
PATIENT SHOULD HAVE INSIGHT INTO ADEQUATE NUTRITION OR REALIZATIONS ON THINGS
What % body weight do we want to see after ED tx
80% or more
Psychopharmacology of ED
no medication is specifically indicated for eating disorders
however, various medications ahve been prescribed for associated symptoms such as: Anxiety and Depression
Topamax
Drug with SOME success for treating binge eating disorders
Medications given to ED patients tend to focus on…
depression and anxiety rather than the ED themselves as the emds only ive some success regardin the ladder
It is important to educate the client and family of an ED about what 2 topics
Nature of the illness
Management of the illness
What things about nature of the illness should be taught for ED
symptoms of anorexia and bulimia nervosa
causes of ED
effects of illness or condition on the body
What things about management of the illness should be taught for ED
principles of nutrition
ways client may feel incontrol of life
importance of expressing fears and feelings, rather than holding them inside
alternative coping strategies
Support Services for ED
national association of anorexia nervosa and associated disorders
the american anorexia/bulimia association, inc
What is important about the evaluation of ED post-tx
evaluation of the client with an ED requires reassessment of the behaviors for which the client sought treatment - it is a lifelong battle for them
When trying to heal an ED what will be needed by both client AND family members
behavioral changes
