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NRSG 126: Mental Health > [Exam 3] Chapter 20: Eating Disorders > Flashcards

[Exam 3] Chapter 20: Eating Disorders Flashcards

1
Q

Anorexia Nervosa: What is this?

A

Characterized by client’s restriction of nutritional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight/becoming fat, disturbed perception of the shape of the body, and steadfast inability or refusal of acknowledging problem.

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2
Q

Anorexia Nervosa: What are the two subtypes?

A

Restricting Subtype

Binge Eating and Purging Subtype

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3
Q

Anorexia Nervosa: What is the restricting subtype?

A

Lose weight primarily through dieting, fasting, or excessive exercising

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4
Q

Anorexia Nervosa: What is the binge eating and purging subtype?

A

Regularly binge eat followed by purging

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5
Q

Anorexia Nervosa: What is binge eating?

A

Consuming large amount of food in discrete period usually 2 hours or less

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6
Q

Anorexia Nervosa: What is purging?

A

Compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics

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7
Q

Anorexia Nervosa: What do those with anorexia believe when experiencing hunger?

A

Experience hunger but ignore it because eating anything will make them fat.

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8
Q

Anorexia Nervosa: Why do those with anorexia cut food into minute pieces or not allow food to touch their lips?

A

These behaviors increase their sense of control.

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9
Q

Bulimia Nervosa: What is this?

A

Eating disorder characterized by recurrent episodes of binge eating followed by inappropriate behaviors to avoid weight gain such as purging, fasting, or excessively exercising

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10
Q

Bulimia Nervosa: Problems with recurrent vomiting?

A

It destroys teeth enamel, and incidences of dental caries and ragged or chipped teeth increases

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11
Q

What is Binge Eating Disorder?

A

Recurrent episodes of binge eating; no regular use of inappropraite compensatory behaviors (purging, excessive exercise), guilt/shame/disgust about eating, and mark psychological distresss

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12
Q

Binge Eating Disorder: Who does this mostly affect?

A

Most often men over the age of 35. Individuals are likely overweight as children

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13
Q

Night Eating Syndrome: What is this?

A

Morning anorexia, evening hyperphagia (consuming 50% of daily calories after last meal) and nightime awakenings (at least once a night) to eat.

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14
Q

Night Eating Syndrome: Associated with what?

A

life stress, low self-esteem, anxiety, depression and adverse reactions to weight loss.

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15
Q

Night Eating Syndrome: What is used to treat this?

A

SSRI Antidepressants shows some limited positive effects

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16
Q

Childhood eating/feeding disorders: What is pica?

A

Persistent ingestion of nonfood substances

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17
Q

Childhood eating/feeding disorders: What is rumination

A

Repeated regurgitation of food that is rechewed, reswallowed, or spit out.

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18
Q

Orthorexia Nervosa: What is this?

A

Obsesion with proper or healthful eating

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19
Q

Orthorexia Nervosa: What do signs of this look like?

A

compulsive checking of ingredients, cutting out increasing numebr of food groups, ibaulity to eat only healthy or pure foods , and hours spent thinking about foods

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20
Q

What psychiatric disorders are seen in these people?

A

Mood disorders, anxiety disorders, and substance abuse/dependence

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21
Q

Most common mood disorders?

A

Depression and OCD

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22
Q

Anorexia and Bulimia are characterized by what?

A

perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low cooperativeness

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23
Q

Specific characteristics for bulimia?

A

high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorders

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24
Q

Eating disorders are often linked to history of what?

A

sexual abuse, especially if abuse occured before puberty

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25
Q

Etiology & Biologic Factors: SHows that disorders run in what type of people?

A

Families

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26
Q

Etiology & Biologic Factors: Family history of what illness placesperson at risk?

A

Mood or anxiety disorders.

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27
Q

Etiology & Biologic Factors: THis is linked to a dysfunction of what part of the brain?

A

Lateral and Ventromedial Hypothalamus , control hunger and satiety.

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28
Q

Etiology & Biologic Factors: What does a deficit or lateral hypothalamus do?

A

Decreased eating and decreased responses to sensory stimuli important to eating

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29
Q

Etiology & Biologic Factors: Whaat does adeficit of the ventromedial hypothalamus do?

A

Leads to excessive eating, weight gain, and decreased responsiveness to satiety effects of glucose, which are behaviors seen in bulimia.

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30
Q

Etiology & Biologic Factors: What does norepinephrine show?

A

Usually rise in response to eating. Don’t rise during starvation because few nutrients available to metabolize. Also related to decreased HR and BP

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31
Q

Etiology & Biologic Factors: Serotonin and Tryptophan here?

A

Have been linked to increased satiety.

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32
Q

Etiology & Biologic Factors: Low serotonin adn low platelet levels of monamine oxidase found in who?

A

Clients with bulimia and the binge an dpurge subtype of anorexia nervosa

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33
Q

Etiology & Biologic Factors: Treatmet for those with bulimia?

A

SSRI antidepressants because serotonin levels at synapse may be low

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34
Q

Etiology and Developmental Factors: Two tasks adolescents struggle with?

A

Autonomy (exerting control over oneself) and environment (may be overproective or enmeshment (lack of clear role boundries))

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35
Q

Etiology and Developmental Factors: Characteristics of those who developed an eating disorder include what?

A

Disturbed eating habits

Disturbed attitudes toward food

Eating in secret

Preoccupation with food, eaitng, shape, or weight

Fear of losing control over eating

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36
Q

Etiology and Developmental Factors: What is body image?

A

How a person perceives their body, the mental self-image

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37
Q

Etiology and Developmental Factors: How do those with anorexia nervosa view body image?

A

Perceive themselves as fat, unattractive and undesirable even when they are severely underweight

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38
Q

Etiology and Developmental Factors: What is body image disturbance?

A

Occurs where there is an extreme discrepancy between one’s body image and perceptions of others

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39
Q

Etiology and Developmental Factors: How do those with bulimia nervosa view their bodies?

A

Dissatisffaction with body as well as thought that they are fat, unattractive, and undesirable.

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40
Q

Etiology and Family InfluenceS: What is adversity?

A

Physical neglect, sexual abuse, or parental maltreatment that includes little care , affection, and empathy

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41
Q

Etiology and Family InfluenceS: What has childhood adversity been identified as?

A

Significant RF in the development of problems with eating or weight

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42
Q

Etiology and Cultural Considerations: Who is ANorexia less associated with in US?

A

Blacks

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43
Q

Etiology and Cultural Considerations: Where is anorexia and bulimia more prevalent?

A

Industrialized socieites, where food is abundant and beauty is linked with thinness. On Fiji, eating disorders are nonexistent because no tv

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44
Q

Anorexia Nervosa & Onset/Clinical Course : Begins when?

A

Between 14-18

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45
Q

Anorexia Nervosa & Onset/Clinical Course : What does patient do in early stages?

A

Deny having negative body image or anxiety regarding their appearance. Pleased with ability to control their weight

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46
Q

Anorexia Nervosa & Onset/Clinical Course : What happens as disesase progresses?

A

Depression and lability become more apparent. AS dieting increases, patients isolate themselves.

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47
Q

Anorexia Nervosa & Onset/Clinical Course : What percentage achieve full recovery?

A

30-50%

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48
Q

Anorexia Nervosa & Onset/Clinical Course : How much more likely are they to die from medical complications or suicide?

A

6x

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49
Q

Anorexia Nervosa & Onset/Clinical Course : Musculoskeltal issues RT weight loss?

A

Loss of muscle mass, loss of fat, osteoporosis

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50
Q

Anorexia Nervosa & Onset/Clinical Course : Metabolic issues RT weight loss?

A

/hypothyroidism (lack of energy, weakness, intolerance to cold) , hypoglycemia, and dedcreased insulin sensitivity

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51
Q

Anorexia Nervosa & Onset/Clinical Course : Cardiac issues rt weigh loss?

A

bradycardia , hypotension, loss of cardiac muscle, small heart, cardidac arrhythmias

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52
Q

Anorexia Nervosa & Onset/Clinical Course : GI issues rt weight loss?

A

delayed gastric emptying, bloating, constipaiton, abdominal gas

53
Q

Anorexia Nervosa & Onset/Clinical Course : reproductive issues rt weight loss?

A

amenorrhea, and low levels of lutenizing and FSH

54
Q

Anorexia Nervosa & Onset/Clinical Course : dermatologic issues rt weight noww?

A

dry, cracking skin due to dehydration, lanugo, edema,

55
Q

Anorexia Nervosa & Onset/Clinical Course : hematologic issues rt weight loss?

A

leukopenai, anemia , thrombocytopenia,

56
Q

Anorexia Nervosa & Onset/Clinical Course : Neuropsychiatric issues rt weight loss?

A

abnormal taste sensation, apathetic depression, mild organic metal symptoms

57
Q

Anorexia Nervosa & Onset/Clinical Course : metbolic issues rt purging?

A

electrolyte imablances (hypokalemia), hypocholermia alkalosis, hypomagnesemai, elevated blood urea nitrogen

58
Q

Anorexia Nervosa & Onset/Clinical Course : gi issues rt purging?

A

salivary gland and pancreas inflammation and enlargement, esophageal and gastric erosion or rupture

59
Q

Anorexia Nervosa & Onset/Clinical Course : dental issues r purging?

A

erosion of dental enamel

60
Q

Anorexia Nervosa & Onset/Clinical Course : neuropsychiatric issues rt purging?

A

seizures, mild neuropathies , fatigue, weakness

61
Q

Anorexia & Treatment/Prognosis: Why are they difficult to treat?

A

Because often resistant, appear uninterested , and deny their problems

62
Q

Anorexia & Treatment/Prognosis: Treatment setting types?

A

inpatient speciality eating disorder units, partial hospitalization or day treatment programs, and outpatient therapy

63
Q

Anorexia & Treatment/Prognosis: Major life threatening complications that show need for hospitilzation include what ?

A

seveere fluid, electrolyte , and metabolic imbalance, cardiovascular imbalance , severe weight loss, and risk for suicide

64
Q

Anorexia & Treatment/Prognosis: short hospital stays effective for who?

A

Who are amenable to weight gain and who gain weight rapidly

65
Q

Anorexia & Treatment/Prognosis: outpatient therapy successful for who?

A

Those who have been ill for fewer than 6 months, are not binging and purging, and parents likely to participate in family therapy

66
Q

Anorexia & Medical Management: What does this focus on?

A

Weight restoration, nutritional rehabilitation , rehydration, and correction of electrolyte imbalance

67
Q

Anorexia & Medical Management: What do clients receive?

A

Nutritionally balanced meals and snacks that graually increase caloric intake.

68
Q

Anorexia & Psychopharmacology: What does Amitripyline (Elavil) and antihistamine cyproheptadine (Pariactin) do?

A

In high doses up to 28 mg/day, can promote with gain in those with anorexia

69
Q

Anorexia & Psychopharmacology: What does Olanzapine (Zyprexa) do?

A

Used bc of antipsychotic effect (on bizzare body image distortions) and associated weight gain

70
Q

Anorexia & Psychopharmacology: What has Fluxetine (Prozac) been effective for?

A

Preventing relapse in clients whose weight has been partially or completely restored.

71
Q

Anorexia & Psychotherapy: When is family therapy beneficial?

A

For clients younger than 18

72
Q

Anorexia & Psychotherapy: What families need this?

A

Those with enmeshment, unclear boundries, difficulty handling emotions and conflict

73
Q

Anorexia & Psychotherapy: What may individual therapy focus on?

A

coping skills, self-esteem, self-acceptance, interpersonal relationships, and assertiveness.

74
Q

Anorexia & Psychotherapy: When is CBT used?

A

For those with bulimia, but now used in adolescents with an orexia and used successfully as inittial tx as well as relapse prevention

75
Q

Anorexia & Psychotherapy: Why is Enhanced CBT been more successful?

A

Addresses perfectionism, m ood intolerance, low-self esteem, and interpersonal difficulites

76
Q

Bulimia and Onset/Clinical Course: When does this begin?

A

Late adolesence or early adulhood, 18-19 years

77
Q

Bulimia and Onset/Clinical Course: What may cause person to start doing this?

A

Frequently begins during or after dieting

78
Q

Bulimia and Onset/Clinical Course: Between binging and purging, what may client eat?

A

Destrictively, choosing salads or low calorie foods

79
Q

Bulimia and Onset/Clinical Course: Are they aware theya re doing this?

A

Yes, and go to great lengths to hide this form others

80
Q

Bulimia and Onset/Clinical Course: Examples of what they do with fast food?

A

Order a normal amount of fast food, but stop at 5-6 places in 1-2 hours

81
Q

Bulimia and Onset/Clinical Course: Recovery rate?

A

45%

82
Q

Bulimia and Onset/Clinical Course: When is hospital admission indicated?

A

If binging and purging behaviors are out of control and the clients medical status is compromised.

83
Q

Bulimia and CBT: Why is this used?

A

Most effective tx for bulimia

84
Q

Bulimia and CBT: How does this work?

A

REquires a detailed manual to guide treatment. Designed to change client’s thinkings and actions about food focus on interrupting the cycle of deiting, binging, and purging

85
Q

Bulimia and Psychopharmacology: Examples of drugs used?

A

Desipramine (Norpramin)

Imipramine (Tofranil)

Amitriptyline (Elavil)

Notriptyline (Pamelor)

Phenelzine (Nardil)

Floxetine (Prozac)

86
Q

Bulimia and Psychopharmacology: What did the study about antidepressants show?

A

THey improved mood and reduced preoccupation with shape and weight. Most results were short term though

87
Q

Nursing Process & Assessment: When is the Eating Attitudes Test used?

A

In studies or anorexia and builimia. Can be used at the end of treatment to evaluate outcomes

88
Q

Nursing Process & History: Family members described them how?

A

AS perfectionists with above-average intelligence who are achievement oriented , dependable, eager to please and seeking approval

89
Q

Nursing Process & History: While those with anorexia show no troubling signs, what signs do those with bulimia show?

A

impulsive behavior such as substane abuse, shoplifting, as well as anxiety, depression, and personality disorders

90
Q

Nursing Process & General Appearance/Motor: How do those with anorexia appear?

A

slow, lethargic, fatigued and may be emaciated. Slow to respond to questions and difficulty deciding what to say. Wear loose fititng clothes and eye contact may be limited

91
Q

Nursing Process & General Appearance/Motor: How do those with bulimia appear?

A

underweight or overweight, but close to expected body weight for age and size

92
Q

Nursing Process & Mood: Avoid bad food gives them what feelings?

A

sense of power and control over their bodies

93
Q

Nursing Process & Mood: What mood does binging and purging give them?

A

anxiety, depression, and feelings out of control.

94
Q

Nursing Process & Mood: How do those with eating disorders often appear?

A

sad, anxious and owrried

95
Q

Nursing Process & Mood: Physical appearance of those with anorexia?

A

seldon smile, laugh, or enjoy attempts at humor.

96
Q

Nursing Process & Thought Process/Content: Those ith eating disorders spend most of their time thinking about what?

A

dieting, food, and food related behavior. Preoccupied with atetmpts to avoid eating.

97
Q

Nursing Process & Thought Process/Content: What signs will a patient who is severly malnourished show?

A

Confusion, slowed mental processes and difficulty with concentration

98
Q

Nursing Process & Judgement/Insight: How do anorexia patients feel about this mental illnesS?

A

Do not believe they have a problem. Rather, they believe others are trying to interfere with their ability to lose wieght

99
Q

Nursing Process & Judgement/Insight: How do bulimic patients feel about this mental illness?

A

Ashamed of binge eating and purging. Recognize this as abnormal and go to great lengths to hide this.

100
Q

Nursing Process & Self-Concept: How to they view themselves?

A

Have low self-esteem. They see themselves only in terms of ability to control their food intake and weight. Harsh of themselves if they eat bad food

101
Q

Nursing Process & Relationships: What will happen to someone with anorexia?

A

May begin to fail at school. Withdrawn from peers nad pay little attention to friendships. Believe others will not understand

102
Q

Nursing Process & Relationships: How do clients with bulimia feel?

A

Great shame about binge eating. Tend to live secret lives that include sneaking snacks .

103
Q

Nursing Process & Physiological and Self-Care considerations: What may they experience?

A

May exercise excessively. May have sleep disturbances such as insomnia.

104
Q

Intervention & Establishing Nutritional Eating Pattern: Inpatient treatment is for who?

A

Clients with anorexia nervosa who are malnourished and for clients with bulimia whose binge eating/purging are out of control

105
Q

Intervention & Establishing Nutritional Eating Pattern: When client can eat, diet of how much is ordered?

A

1200-1500 calories/day with gradual increases until clients ingesting adequate amounts. Split up into 3 meals and 3 snacks

106
Q

Intervention & Establishing Nutritional Eating Pattern: What happens to patients after they are finished eating?

A

Nurses monitor them for 1-2 hours to ensure they don’t vomit

107
Q

Intervention & Establishing Nutritional Eating Pattern: What happens with checking weight?

A

Clients are weighed only once daily, usually upon awakening and after emptying bladder.

108
Q

Intervention & Establishing Nutritional Eating Pattern: Clients with bulimia are treated in what setting?

A

Outpatient basis

109
Q

Intervention & Establishing Nutritional Eating Pattern: What does the nurse do for someone with bulimia?

A

Works to establish normal eating patterns and to interrupt the binge-and-purge cycle

110
Q

Intervention & Identifying Emotions and Developing Coping Strategies: What is alexithymia?

A

Difficulty identifying and expressing feelings

111
Q

Intervention & Identifying Emotions and Developing Coping Strategies: What do those with anorexia struggle with?

A

self-awareness and have alexithymia. Often express feelings in terms of somatic complaints suhc as feeling fat or bloated.

112
Q

Intervention & Identifying Emotions and Developing Coping Strategies: What should the nurse not ask?

A

Are you sad? Are you anxious? Because they will most often agree

113
Q

What should a nurse do broadly with establishing nutritional eating patterns?

A

Sit with client during meals

Offer liquid protein supplement

Adhere to treatment program guidelines

Observe following meals

Weight in uniform

114
Q

What shoul da nurse do broadly with helping client identify emotions and develop non-food-related coping strategies?

A

ASk client to identify feelings

self-monitoring using journal

Relaxaito technique

distraction

assist with changing stereotypical beliefs

115
Q

what should a nurse do broadly with helping client deal with body image issues?

A

recognize benefits of a more near-normal weight

assist in viewing self in ways not related to body image

identify personal stregnths

116
Q

Intervention & Identifying Emotions and Developing Coping Strategies: What is self-monitoring?

A

CBT for those with bulimia. HElp identify behavior patterns and then implement techniques to avoid or replace them.

117
Q

Intervention & Identifying Emotions and Developing Coping Strategies: How do self-monitoring techniques help?

A

raise clients awareness about behavior and help them regain a sense of control. Encourage client to keep track of all food.

118
Q

Intervention & Identifying Emotions and Developing Coping Strategies: What will eventually happen to patient with self-monitoring?

A

BEgin to see connections between emotions and siutations and eating behaviors. Nurse can help clients develop ways to manage emotions

119
Q

Intervention & Dealing with Body Image Issues: How does a nurse help here?

A

Help client accept more normal body image including: Clients agree to weigh more than they would like, to be healthy, and stay out of hospital.

120
Q

Intervention & Providing Family Education: What does a nurse teach?

A

Teaches about basic nutritional needs and the effects of restrictive eating, dieting, and binge-and-purge cycle

121
Q

Intervention & Providing Family Education: What to teach for client who purges?

A

Information about harmful effects of purging by vomiting and laxative abuse . Explains that its an ineffective way of weight control

122
Q

Community Based Care: Why may someone be admitted?

A

If low weight, electrolyte imbalance

OR cannot control cycle of binge eating/purging.

123
Q

What is Anorexia?

A

Life-threatening eating disorder characterized by body weight less than below minimum expectations, intense fear of being fat, severly distorted body image, and refusal to eat.

124
Q

What is bulimia?

A

eating disorder that involves recurrent episodes of binge eating and compensatory behaviors such as purging ,using laxatives, and diuretics

125
Q

Percentage of eating disorder patients gender?

A

90% female

126
Q

What is most effective for someone with anorexia?

A

Family therapy

127
Q

What is most effective for someone with bulimia?

A

CBT

128
Q

What are some interventions for clients with eating disorders?

A

Establish nutritional eating patterns

Help client identify emotiosn and develop coping strats

Help client deal with body image issues

Provide client/fam education

NRSG 126: Mental Health (24 decks)

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