[Exam 3] Chapter 20: Eating Disorders Flashcards
Anorexia Nervosa: What is this?
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.
Anorexia Nervosa: What are the two subtypes?
Restricting Subtype
Binge Eating and Purging Subtype
Anorexia Nervosa: What is the restricting subtype?
Lose weight primarily through dieting, fasting, or excessive exercising
Anorexia Nervosa: What is the binge eating and purging subtype?
Regularly binge eat followed by purging
Anorexia Nervosa: What is binge eating?
Consuming large amount of food in discrete period usually 2 hours or less
Anorexia Nervosa: What is purging?
Compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics
Anorexia Nervosa: What do those with anorexia believe when experiencing hunger?
Experience hunger but ignore it because eating anything will make them fat.
Anorexia Nervosa: Why do those with anorexia cut food into minute pieces or not allow food to touch their lips?
These behaviors increase their sense of control.
Bulimia Nervosa: What is this?
Eating disorder characterized by recurrent episodes of binge eating followed by inappropriate behaviors to avoid weight gain such as purging, fasting, or excessively exercising
Bulimia Nervosa: Problems with recurrent vomiting?
It destroys teeth enamel, and incidences of dental caries and ragged or chipped teeth increases
What is Binge Eating Disorder?
Recurrent episodes of binge eating; no regular use of inappropraite compensatory behaviors (purging, excessive exercise), guilt/shame/disgust about eating, and mark psychological distresss
Binge Eating Disorder: Who does this mostly affect?
Most often men over the age of 35. Individuals are likely overweight as children
Night Eating Syndrome: What is this?
Morning anorexia, evening hyperphagia (consuming 50% of daily calories after last meal) and nightime awakenings (at least once a night) to eat.
Night Eating Syndrome: Associated with what?
life stress, low self-esteem, anxiety, depression and adverse reactions to weight loss.
Night Eating Syndrome: What is used to treat this?
SSRI Antidepressants shows some limited positive effects
Childhood eating/feeding disorders: What is pica?
Persistent ingestion of nonfood substances
Childhood eating/feeding disorders: What is rumination
Repeated regurgitation of food that is rechewed, reswallowed, or spit out.
Orthorexia Nervosa: What is this?
Obsesion with proper or healthful eating
Orthorexia Nervosa: What do signs of this look like?
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
What psychiatric disorders are seen in these people?
Mood disorders, anxiety disorders, and substance abuse/dependence
Most common mood disorders?
Depression and OCD
Anorexia and Bulimia are characterized by what?
perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low cooperativeness
Specific characteristics for bulimia?
high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorders
Eating disorders are often linked to history of what?
sexual abuse, especially if abuse occured before puberty
Etiology & Biologic Factors: SHows that disorders run in what type of people?
Families
Etiology & Biologic Factors: Family history of what illness placesperson at risk?
Mood or anxiety disorders.
Etiology & Biologic Factors: THis is linked to a dysfunction of what part of the brain?
Lateral and Ventromedial Hypothalamus , control hunger and satiety.
Etiology & Biologic Factors: What does a deficit or lateral hypothalamus do?
Decreased eating and decreased responses to sensory stimuli important to eating
Etiology & Biologic Factors: Whaat does adeficit of the ventromedial hypothalamus do?
Leads to excessive eating, weight gain, and decreased responsiveness to satiety effects of glucose, which are behaviors seen in bulimia.
Etiology & Biologic Factors: What does norepinephrine show?
Usually rise in response to eating. Don’t rise during starvation because few nutrients available to metabolize. Also related to decreased HR and BP
Etiology & Biologic Factors: Serotonin and Tryptophan here?
Have been linked to increased satiety.
Etiology & Biologic Factors: Low serotonin adn low platelet levels of monamine oxidase found in who?
Clients with bulimia and the binge an dpurge subtype of anorexia nervosa
Etiology & Biologic Factors: Treatmet for those with bulimia?
SSRI antidepressants because serotonin levels at synapse may be low
Etiology and Developmental Factors: Two tasks adolescents struggle with?
Autonomy (exerting control over oneself) and environment (may be overproective or enmeshment (lack of clear role boundries))
Etiology and Developmental Factors: Characteristics of those who developed an eating disorder include what?
Disturbed eating habits
Disturbed attitudes toward food
Eating in secret
Preoccupation with food, eaitng, shape, or weight
Fear of losing control over eating
Etiology and Developmental Factors: What is body image?
How a person perceives their body, the mental self-image
Etiology and Developmental Factors: How do those with anorexia nervosa view body image?
Perceive themselves as fat, unattractive and undesirable even when they are severely underweight
Etiology and Developmental Factors: What is body image disturbance?
Occurs where there is an extreme discrepancy between one’s body image and perceptions of others
Etiology and Developmental Factors: How do those with bulimia nervosa view their bodies?
Dissatisffaction with body as well as thought that they are fat, unattractive, and undesirable.
Etiology and Family InfluenceS: What is adversity?
Physical neglect, sexual abuse, or parental maltreatment that includes little care , affection, and empathy
Etiology and Family InfluenceS: What has childhood adversity been identified as?
Significant RF in the development of problems with eating or weight
Etiology and Cultural Considerations: Who is ANorexia less associated with in US?
Blacks
Etiology and Cultural Considerations: Where is anorexia and bulimia more prevalent?
Industrialized socieites, where food is abundant and beauty is linked with thinness. On Fiji, eating disorders are nonexistent because no tv
Anorexia Nervosa & Onset/Clinical Course : Begins when?
Between 14-18
Anorexia Nervosa & Onset/Clinical Course : What does patient do in early stages?
Deny having negative body image or anxiety regarding their appearance. Pleased with ability to control their weight
Anorexia Nervosa & Onset/Clinical Course : What happens as disesase progresses?
Depression and lability become more apparent. AS dieting increases, patients isolate themselves.
Anorexia Nervosa & Onset/Clinical Course : What percentage achieve full recovery?
30-50%
Anorexia Nervosa & Onset/Clinical Course : How much more likely are they to die from medical complications or suicide?
6x
Anorexia Nervosa & Onset/Clinical Course : Musculoskeltal issues RT weight loss?
Loss of muscle mass, loss of fat, osteoporosis
Anorexia Nervosa & Onset/Clinical Course : Metabolic issues RT weight loss?
/hypothyroidism (lack of energy, weakness, intolerance to cold) , hypoglycemia, and dedcreased insulin sensitivity
Anorexia Nervosa & Onset/Clinical Course : Cardiac issues rt weigh loss?
bradycardia , hypotension, loss of cardiac muscle, small heart, cardidac arrhythmias
Anorexia Nervosa & Onset/Clinical Course : GI issues rt weight loss?
delayed gastric emptying, bloating, constipaiton, abdominal gas
Anorexia Nervosa & Onset/Clinical Course : reproductive issues rt weight loss?
amenorrhea, and low levels of lutenizing and FSH
Anorexia Nervosa & Onset/Clinical Course : dermatologic issues rt weight noww?
dry, cracking skin due to dehydration, lanugo, edema,
Anorexia Nervosa & Onset/Clinical Course : hematologic issues rt weight loss?
leukopenai, anemia , thrombocytopenia,
Anorexia Nervosa & Onset/Clinical Course : Neuropsychiatric issues rt weight loss?
abnormal taste sensation, apathetic depression, mild organic metal symptoms
Anorexia Nervosa & Onset/Clinical Course : metbolic issues rt purging?
electrolyte imablances (hypokalemia), hypocholermia alkalosis, hypomagnesemai, elevated blood urea nitrogen
Anorexia Nervosa & Onset/Clinical Course : gi issues rt purging?
salivary gland and pancreas inflammation and enlargement, esophageal and gastric erosion or rupture
Anorexia Nervosa & Onset/Clinical Course : dental issues r purging?
erosion of dental enamel
Anorexia Nervosa & Onset/Clinical Course : neuropsychiatric issues rt purging?
seizures, mild neuropathies , fatigue, weakness
Anorexia & Treatment/Prognosis: Why are they difficult to treat?
Because often resistant, appear uninterested , and deny their problems
Anorexia & Treatment/Prognosis: Treatment setting types?
inpatient speciality eating disorder units, partial hospitalization or day treatment programs, and outpatient therapy
Anorexia & Treatment/Prognosis: Major life threatening complications that show need for hospitilzation include what ?
seveere fluid, electrolyte , and metabolic imbalance, cardiovascular imbalance , severe weight loss, and risk for suicide
Anorexia & Treatment/Prognosis: short hospital stays effective for who?
Who are amenable to weight gain and who gain weight rapidly
Anorexia & Treatment/Prognosis: outpatient therapy successful for who?
Those who have been ill for fewer than 6 months, are not binging and purging, and parents likely to participate in family therapy
Anorexia & Medical Management: What does this focus on?
Weight restoration, nutritional rehabilitation , rehydration, and correction of electrolyte imbalance
Anorexia & Medical Management: What do clients receive?
Nutritionally balanced meals and snacks that graually increase caloric intake.
Anorexia & Psychopharmacology: What does Amitripyline (Elavil) and antihistamine cyproheptadine (Pariactin) do?
In high doses up to 28 mg/day, can promote with gain in those with anorexia
Anorexia & Psychopharmacology: What does Olanzapine (Zyprexa) do?
Used bc of antipsychotic effect (on bizzare body image distortions) and associated weight gain
Anorexia & Psychopharmacology: What has Fluxetine (Prozac) been effective for?
Preventing relapse in clients whose weight has been partially or completely restored.
Anorexia & Psychotherapy: When is family therapy beneficial?
For clients younger than 18
Anorexia & Psychotherapy: What families need this?
Those with enmeshment, unclear boundries, difficulty handling emotions and conflict
Anorexia & Psychotherapy: What may individual therapy focus on?
coping skills, self-esteem, self-acceptance, interpersonal relationships, and assertiveness.
Anorexia & Psychotherapy: When is CBT used?
For those with bulimia, but now used in adolescents with an orexia and used successfully as inittial tx as well as relapse prevention
Anorexia & Psychotherapy: Why is Enhanced CBT been more successful?
Addresses perfectionism, m ood intolerance, low-self esteem, and interpersonal difficulites
Bulimia and Onset/Clinical Course: When does this begin?
Late adolesence or early adulhood, 18-19 years
Bulimia and Onset/Clinical Course: What may cause person to start doing this?
Frequently begins during or after dieting
Bulimia and Onset/Clinical Course: Between binging and purging, what may client eat?
Destrictively, choosing salads or low calorie foods
Bulimia and Onset/Clinical Course: Are they aware theya re doing this?
Yes, and go to great lengths to hide this form others
Bulimia and Onset/Clinical Course: Examples of what they do with fast food?
Order a normal amount of fast food, but stop at 5-6 places in 1-2 hours
Bulimia and Onset/Clinical Course: Recovery rate?
45%
Bulimia and Onset/Clinical Course: When is hospital admission indicated?
If binging and purging behaviors are out of control and the clients medical status is compromised.
Bulimia and CBT: Why is this used?
Most effective tx for bulimia
Bulimia and CBT: How does this work?
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
Bulimia and Psychopharmacology: Examples of drugs used?
Desipramine (Norpramin)
Imipramine (Tofranil)
Amitriptyline (Elavil)
Notriptyline (Pamelor)
Phenelzine (Nardil)
Floxetine (Prozac)
Bulimia and Psychopharmacology: What did the study about antidepressants show?
THey improved mood and reduced preoccupation with shape and weight. Most results were short term though
Nursing Process & Assessment: When is the Eating Attitudes Test used?
In studies or anorexia and builimia. Can be used at the end of treatment to evaluate outcomes
Nursing Process & History: Family members described them how?
AS perfectionists with above-average intelligence who are achievement oriented , dependable, eager to please and seeking approval
Nursing Process & History: While those with anorexia show no troubling signs, what signs do those with bulimia show?
impulsive behavior such as substane abuse, shoplifting, as well as anxiety, depression, and personality disorders
Nursing Process & General Appearance/Motor: How do those with anorexia appear?
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
Nursing Process & General Appearance/Motor: How do those with bulimia appear?
underweight or overweight, but close to expected body weight for age and size
Nursing Process & Mood: Avoid bad food gives them what feelings?
sense of power and control over their bodies
Nursing Process & Mood: What mood does binging and purging give them?
anxiety, depression, and feelings out of control.
Nursing Process & Mood: How do those with eating disorders often appear?
sad, anxious and owrried
Nursing Process & Mood: Physical appearance of those with anorexia?
seldon smile, laugh, or enjoy attempts at humor.
Nursing Process & Thought Process/Content: Those ith eating disorders spend most of their time thinking about what?
dieting, food, and food related behavior. Preoccupied with atetmpts to avoid eating.
Nursing Process & Thought Process/Content: What signs will a patient who is severly malnourished show?
Confusion, slowed mental processes and difficulty with concentration
Nursing Process & Judgement/Insight: How do anorexia patients feel about this mental illnesS?
Do not believe they have a problem. Rather, they believe others are trying to interfere with their ability to lose wieght
Nursing Process & Judgement/Insight: How do bulimic patients feel about this mental illness?
Ashamed of binge eating and purging. Recognize this as abnormal and go to great lengths to hide this.
Nursing Process & Self-Concept: How to they view themselves?
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
Nursing Process & Relationships: What will happen to someone with anorexia?
May begin to fail at school. Withdrawn from peers nad pay little attention to friendships. Believe others will not understand
Nursing Process & Relationships: How do clients with bulimia feel?
Great shame about binge eating. Tend to live secret lives that include sneaking snacks .
Nursing Process & Physiological and Self-Care considerations: What may they experience?
May exercise excessively. May have sleep disturbances such as insomnia.
Intervention & Establishing Nutritional Eating Pattern: Inpatient treatment is for who?
Clients with anorexia nervosa who are malnourished and for clients with bulimia whose binge eating/purging are out of control
Intervention & Establishing Nutritional Eating Pattern: When client can eat, diet of how much is ordered?
1200-1500 calories/day with gradual increases until clients ingesting adequate amounts. Split up into 3 meals and 3 snacks
Intervention & Establishing Nutritional Eating Pattern: What happens to patients after they are finished eating?
Nurses monitor them for 1-2 hours to ensure they don’t vomit
Intervention & Establishing Nutritional Eating Pattern: What happens with checking weight?
Clients are weighed only once daily, usually upon awakening and after emptying bladder.
Intervention & Establishing Nutritional Eating Pattern: Clients with bulimia are treated in what setting?
Outpatient basis
Intervention & Establishing Nutritional Eating Pattern: What does the nurse do for someone with bulimia?
Works to establish normal eating patterns and to interrupt the binge-and-purge cycle
Intervention & Identifying Emotions and Developing Coping Strategies: What is alexithymia?
Difficulty identifying and expressing feelings
Intervention & Identifying Emotions and Developing Coping Strategies: What do those with anorexia struggle with?
self-awareness and have alexithymia. Often express feelings in terms of somatic complaints suhc as feeling fat or bloated.
Intervention & Identifying Emotions and Developing Coping Strategies: What should the nurse not ask?
Are you sad? Are you anxious? Because they will most often agree
What should a nurse do broadly with establishing nutritional eating patterns?
Sit with client during meals
Offer liquid protein supplement
Adhere to treatment program guidelines
Observe following meals
Weight in uniform
What shoul da nurse do broadly with helping client identify emotions and develop non-food-related coping strategies?
ASk client to identify feelings
self-monitoring using journal
Relaxaito technique
distraction
assist with changing stereotypical beliefs
what should a nurse do broadly with helping client deal with body image issues?
recognize benefits of a more near-normal weight
assist in viewing self in ways not related to body image
identify personal stregnths
Intervention & Identifying Emotions and Developing Coping Strategies: What is self-monitoring?
CBT for those with bulimia. HElp identify behavior patterns and then implement techniques to avoid or replace them.
Intervention & Identifying Emotions and Developing Coping Strategies: How do self-monitoring techniques help?
raise clients awareness about behavior and help them regain a sense of control. Encourage client to keep track of all food.
Intervention & Identifying Emotions and Developing Coping Strategies: What will eventually happen to patient with self-monitoring?
BEgin to see connections between emotions and siutations and eating behaviors. Nurse can help clients develop ways to manage emotions
Intervention & Dealing with Body Image Issues: How does a nurse help here?
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.
Intervention & Providing Family Education: What does a nurse teach?
Teaches about basic nutritional needs and the effects of restrictive eating, dieting, and binge-and-purge cycle
Intervention & Providing Family Education: What to teach for client who purges?
Information about harmful effects of purging by vomiting and laxative abuse . Explains that its an ineffective way of weight control
Community Based Care: Why may someone be admitted?
If low weight, electrolyte imbalance
OR cannot control cycle of binge eating/purging.
What is Anorexia?
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.
What is bulimia?
eating disorder that involves recurrent episodes of binge eating and compensatory behaviors such as purging ,using laxatives, and diuretics
Percentage of eating disorder patients gender?
90% female
What is most effective for someone with anorexia?
Family therapy
What is most effective for someone with bulimia?
CBT
What are some interventions for clients with eating disorders?
Establish nutritional eating patterns
Help client identify emotiosn and develop coping strats
Help client deal with body image issues
Provide client/fam education
