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PSYCH > TOPIC 12 - feeding and eating disorders > Flashcards

TOPIC 12 - feeding and eating disorders Flashcards

1
Q

what is to be determined before eating disorders

A

which cognitive distortions made them result in semi starvation

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2
Q

examples of cognitive distortions

A

overgeneralization
all or nothing thinking
catastrophizing
personalization
emotional reasoning

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3
Q

overgeneralization

A

a single event affects unrelated situations
ex : “He didn’t ask me out. It must be because I’m fat.”

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4
Q

all or nothing thinking

A

Reasoning is absolute and extreme, in mutually exclusive terms of black or white, good or bad.

ex : “If I allow myself to gain weight, I’ll blow up like a balloon.”

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5
Q

catastrophizing

A

The consequences of an event are magnified.

ex : “If I gain weight, my whole weekend will be ruined.”

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6
Q

personalization

A

Events are overinterpreted as having personal significance.
ex : “People won’t like me unless I’m thin.”

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7
Q

emotional reasoning

A

Subjective emotions determine reality.
ex : “When I’m thin, I feel powerful.”

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8
Q

contributing factors to eating disorders

A

genes
neurobiological : altered serotonin
cultural
psychological : low self esteem
athletes
co occurring mental illness : depression, anxiety, OCD, personality disorders
perfectionist personality

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9
Q

what affect does serotonin have on diet

A

Altered brain serotonin contributes to dysregulation of appetite, mood and impulse control.

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10
Q

what is trptophan

A

Tryptophan in diets are essential to serotonin synthesis and when tryptophan drops it provides a reward for calorie restriction. Newer brain imaging finds show differences in frontal, temporal, and parietal regions.

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11
Q

criteria for medical admission

A

Rapid weight loss (more than 30% over 6 months or less)
Inability to gain weight as a outpatient (for those previously treated)
Severe hypothermia (temp lower than 96.8 F)
Heart rate less than 40 beats per minutes
Systolic blood pressure less than 70 mm Hg
Hypokalemia (K less than 3 mEq/L) , or other electrolytes not corrected with supplements)
Electrocardiographic changes (especially dysrhythmias)

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12
Q

criteria for psychiatric admission

A

Suicidal or severely out of control, self-mutilating behavior
Out of control drug and/or alcohol use, laxative, and/or diuretic abuse
Failure to comply with treatment contract
Severe depression
Psychosis
Family crisis and dysfunction

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13
Q

acute phase : anorexia nervosa

A

Intensive care unit (ICU), critical care unit (CCU), ED unit (crisis state)
Establishment of trust
Monitoring of weight and eating
Countering distorted ideas
Milieu therapy, counseling, health teaching, and medications
client privileges linked to treatment plan compliance

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14
Q

long term phase : anorexia nervosa

A

Chronic illness
Possible long-term treatment:
Periodic brief hospital stays, outpatient psychotherapy, and medications
Greatest success with a combination of individual, group, family, and couples therapy

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15
Q

acute care for bulimia

A

client is admitted into an inpatient unit.
CBT is highly effective.
Binge and purge cycle is interrupted.
Eating habits are normalized.
Underlying conflicts and distortions are examined.
Co-morbid depression and substance abuse are treated.

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16
Q

long term care for bulimia

A

On discharge, the client is referred for long-term care to solidify goals and to address attitudes and perceptions that maintain the ED.
client and family benefit from connecting with the national network
Psychotherapy is performed.

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17
Q

bulimia vs anorexia nervosa : which is easier to make a relationship with

A

bulimia

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18
Q

CBT goals

A

correcting cognitive distortions
interrupting the binge/purge cycle
stopping disorders eating behaviors

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19
Q

phase 1 client teaching and health promotion

A

meal planning
coping skills
relaxation techniques
healthy diet and exercise
physical and emotional effects

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20
Q

phase 2 client teaching and health promotion

A

long term treatment planning
challenging the clients ability to use newly acquired skills

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21
Q

anorexia nervosa : what is it

A

Refusing to maintain a healthy weight

Expressing an intense fear of gaining weight, leads to self-starvation

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22
Q

two types of anorexia nervosa

A

avoidant or restrictive
binge/purge

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23
Q

avoidant or restrictive

A

individual limits food intake

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24
Q

binge/purge

A

individual overeats then purges

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25
Q

three features of anorexia nervosa

A

eats less
afraid of gaining weight
distorted body image

26
Q

anorexia nervosa assessment guidelines

A

Determine the need for hospitalization
Assess family needs (i.e., resources, education)
Assess client’s acceptance of therapeutic modality
Physical examination & lab results
BMI to determine severity of condition
Obtain client’s dieting history
Assess what value the client attaches to body image

27
Q

how is the severity of anorexia nervosa determined

A

by patients BMI

28
Q

BMI severity levels

A

Mild : ≥17 kg/m2
Moderate : 16 - 16.99 kg/m2
Severe : 15 - 15.99 kg/m2
Extreme : <15 kg/m2

29
Q

thoughts and behaviors associated with anorexia nervosa

A

Terrified of gaining weight
Preoccupied with food
Considers themselves fat, regardless of their actual weight and size
Cuts food into small pieces & moves it around on the plate (but doesn’t eat it)
May eat paper to feel “full”
Judges their self worth by their weight
potential purging
use of laxatives, diuretics or vomiting
vigorous exercise

30
Q

appearance changes in anorexia nervosa

A

Lanugo
Carotenemia
Acrocyanosis
Cachexia
Enlarged parotid glands (in binge/purge type)

31
Q

co existing medical problems with anorexia nervosa

A

osteoporosis
fatty degeneration of liver
amenorrhea
elimination changes : constipation, hematuria, proteinuria

32
Q

carotenemia

A

clinical condition characterized by yellow pigmentation of the skin (xanthoderma) and increased beta-carotene levels in the blood. In most cases, the condition follows prolonged and excessive consumption of carotene-rich foods, such as carrots, squash, and sweet potatoes.

33
Q

acrocyanosis

A

(painless bluish or purple coloring of the hands and feet caused by slow circulation)

34
Q

carotenemia

A

clinical condition characterized by yellow pigmentation of the skin (xanthoderma) and increased beta-carotene levels in the blood. In most cases, the condition follows prolonged and excessive consumption of carotene-rich foods, such as carrots, squash, and sweet potatoes.

35
Q

health problems with anorexia nervosa

A

Lethargy, sluggishness, or feeling tired all the time
Iron deficiency (anemia)
Low body temperature, so the person often feels cold
Dry, yellowish skin (carotenemia)
Growth of fine hair all over the body (lanug0)
Brittle hair and nails
Skipping or no longer having monthly menstruation
Infertility
Muscle wasting and weakness
Low blood pressure, with slow breathing and pulse
Severe constipation and abdominal pain
Thinning of the bones (osteopenia or osteoporosis)
Damage to the heart, including slow heart rate and possible heart rhythm problems
Brain damage or multi-organ failure
Fainting
Dehydration
Increased Urination
Decrease interest in sex
Sleep problems
Sensitive to light, loud noise, and trouble concentrating
Low back pain

36
Q

what ABG is seen in binge/purge AN

A

Hypokalemic alkalosis is seen in binge/purge AN – d/t self-induced vomiting, use of laxatives, and/or diuretics

37
Q

cardiovascular changes with AN

A

Symptomatic hypotension & orthostatic BP changes
Bradycardia
Cardiac murmur
Prolonged QT interval
Sudden cardiac arrest

38
Q

lab value changes with AN

A

Electrolyte imbalances
Hypokalemic alkalosis (primarily seen in binge/purge type)
Low thyroid hormone levels
Elevated cholesterol levels
Leukopenia, anemia
Lymphocytosis

39
Q

nursing interventions for AN

A

Weigh client the same time of day in similar undergarments with the client’s back to the scale (usually done once weekly)

DO NOT share weight with client

Monitor during meals

Ensure clients go to groups right after meals to process cognitive & affective feelings regarding food & eating

Strict I and O

Recognize distorted self image

Avoid a authoritarian or parental role to build alliance and trust (the most effective treatments use a multidisciplinary approach)

40
Q

other nursing considerations for AN

A

Acknowledge emotional and physical difficulties.
Assess for suicidal thoughts and self-injuriousbehaviors.
Monitor physiologic parameters (e.g., vital signs, electrolyte levels).
Weigh the client using strict protocol.
Monitor during and after meals to prevent the throwing away or purging of food.
Recognize the patient’s distorted image andvalue of body shape.
Educate the client regarding the ill effects of low weight and impaired health.
Assist in identifying strengths.

41
Q

refeeding syndrome cause

A

treatment for anorexia nervosa

too rapid reintroduction of nutrition

42
Q

med for anorexia nervosa

A

olanzapine (atypical antipsychotic) Affects weight gain and can improve cognition & body image

TCA’s and SSRI’s also used

Zyprexa (olanzapine) EBP findings to support treatment for anorexia

Prozac (fluoxetine) EBP findings for treatment of bulimia (decrease obsessive thoughts and vomiting)

43
Q

priority for bulimia nervosa

A

does the client need medical stabilization?

44
Q

bulimia assessment

A

Physical examination & labs (electrolytes (BMP), glucose, thyroid, CBC, ECG)

Psychiatric evaluation(screen for depression, anxiety, suicidal ideation)

Ask directly about use of weight-loss aids(e.g., laxatives, diuretics, diet pills, amphetamines, energy pills, energy drinks, or diet teas)

45
Q

what is used to determine the severity of bulimia

A

frequency of compensatory behavior

NOT BMI

46
Q

severity of bulimia levels

A

moderate : 4-7 times per day
severe : 8-13 times per day
extreme : 14 or more

47
Q

thoughts and behaviors associated with bulimia nervosa

A

Binge eating
Frequent vomiting after binging
Laxative and diuretic abuse
Depression
Issues with interpersonal relationships
Poor self-concept
Impulsive behaviors (stealing)
Anxiety and compulsivity
Possible chemical dependency

48
Q

cardiac complications with bulimia nervosa

A

Cardiomyopathy (ipecac toxicity)
Cardiac dysrhythmias
Sinus bradycardia
Sudden cardiac arrest
Orthostatic changes
in pulse & blood pressure

49
Q

dehydration and electrolyte imbalances with bulimia nervosa

A

metabolic acidosis
hypochloremia
hypokalemia

50
Q

dental complications with bulimia nervosa

A

Attrition and erosion of teeth
Loss of dental arch
Diminished chewing ability

51
Q

GI system complications with bulimia

A

Parotid gland enlargement
Esophageal tears (result of self-induced vomiting)
Gastric dilation

52
Q

what is russells sign

A

knuckle callouses

53
Q

what non purging behavior do people with bulimia partake in

A

excessive exercising

54
Q

bulimia nursing interventions

A

Assess mood and presence of suicidal thoughts/behaviors

Monitor vitals and electrolyte levels as needed

Monitor weights as needed

Educate the client that fasting can lead to continuation of the binge/purge cycle

Monitor client during and after meals

Acknowledge the patient’s overvalued ideals of body shape and size without minimizing or challenging patient’s perceptions

Encourage client to keep a journal of thoughts and feelings

55
Q

what is the most common eating disorder in the US

A

binge eating disorder

56
Q

symptoms of binge eating disorder

A

Repeated binge eating, feeling a lack of control over eating, and feeling distressed by it
Eating alone due to embarrassment
Eating large amounts when not physically hungry
Eating more rapidly than normal
Eating until uncomfortably full
Feeling disgust, sadness, or guilt after binge eating

57
Q

binge eating disorder

A

Recurrent episodes of thinking about and eating large amount of food occur in a short period

Involves eating large amounts of food even when not physically hungry

Binge eaters report that binge eating is soothing and helps regulate moods

Feelings of disgust, depression, and guilt are expressed after binging

Clients with binge-eating disorder often eat alone due to embarrassment

Binge-eating disorder does not involve regular purging, heavy exercise, or fasting

58
Q

assessment of bing eating disorder

A

Repeated binge eating
Feeling a lack of control over eating, and feeling distressed by it
Eating alone due to embarrassment
Eating large amounts when not physically hungry
Eating more rapidly than normal
Eating until uncomfortably full
Feeling disgust, sadness, or guilt after binge eating

59
Q

nursing interventions for binge eating disorder

A

Assess mood & psychosocial factors
Work with interdisciplinary team to determine treatment objectives
Provide nutritional counseling

60
Q

interdisciplinary interventions

A

Milieu inpatient therapy: CBT/DBT (cognitive distortions are challenged)
Individual, group, or family therapy (CBT/DBT); psychodynamic therapy
Self-care promotion (improving social skills, coping skills, decision-making, problem-solving abilities)
Health teaching
Health promotion

PSYCH (15 decks)

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