TOPIC 12 - feeding and eating disorders Flashcards
what is to be determined before eating disorders
which cognitive distortions made them result in semi starvation
examples of cognitive distortions
overgeneralization
all or nothing thinking
catastrophizing
personalization
emotional reasoning
overgeneralization
a single event affects unrelated situations
ex : “He didn’t ask me out. It must be because I’m fat.”
all or nothing thinking
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.”
catastrophizing
The consequences of an event are magnified.
ex : “If I gain weight, my whole weekend will be ruined.”
personalization
Events are overinterpreted as having personal significance.
ex : “People won’t like me unless I’m thin.”
emotional reasoning
Subjective emotions determine reality.
ex : “When I’m thin, I feel powerful.”
contributing factors to eating disorders
genes
neurobiological : altered serotonin
cultural
psychological : low self esteem
athletes
co occurring mental illness : depression, anxiety, OCD, personality disorders
perfectionist personality
what affect does serotonin have on diet
Altered brain serotonin contributes to dysregulation of appetite, mood and impulse control.
what is trptophan
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.
criteria for medical admission
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)
criteria for psychiatric admission
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
acute phase : anorexia nervosa
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
long term phase : anorexia nervosa
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
acute care for bulimia
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.
long term care for bulimia
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.
bulimia vs anorexia nervosa : which is easier to make a relationship with
bulimia
CBT goals
correcting cognitive distortions
interrupting the binge/purge cycle
stopping disorders eating behaviors
phase 1 client teaching and health promotion
meal planning
coping skills
relaxation techniques
healthy diet and exercise
physical and emotional effects
phase 2 client teaching and health promotion
long term treatment planning
challenging the clients ability to use newly acquired skills
anorexia nervosa : what is it
Refusing to maintain a healthy weight
Expressing an intense fear of gaining weight, leads to self-starvation
two types of anorexia nervosa
avoidant or restrictive
binge/purge
avoidant or restrictive
individual limits food intake
binge/purge
individual overeats then purges
three features of anorexia nervosa
eats less
afraid of gaining weight
distorted body image
anorexia nervosa assessment guidelines
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
how is the severity of anorexia nervosa determined
by patients BMI
BMI severity levels
Mild : ≥17 kg/m2
Moderate : 16 - 16.99 kg/m2
Severe : 15 - 15.99 kg/m2
Extreme : <15 kg/m2
thoughts and behaviors associated with anorexia nervosa
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
appearance changes in anorexia nervosa
Lanugo
Carotenemia
Acrocyanosis
Cachexia
Enlarged parotid glands (in binge/purge type)
co existing medical problems with anorexia nervosa
osteoporosis
fatty degeneration of liver
amenorrhea
elimination changes : constipation, hematuria, proteinuria
carotenemia
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.
acrocyanosis
(painless bluish or purple coloring of the hands and feet caused by slow circulation)
carotenemia
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.
health problems with anorexia nervosa
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
what ABG is seen in binge/purge AN
Hypokalemic alkalosis is seen in binge/purge AN – d/t self-induced vomiting, use of laxatives, and/or diuretics
cardiovascular changes with AN
Symptomatic hypotension & orthostatic BP changes
Bradycardia
Cardiac murmur
Prolonged QT interval
Sudden cardiac arrest
lab value changes with AN
Electrolyte imbalances
Hypokalemic alkalosis (primarily seen in binge/purge type)
Low thyroid hormone levels
Elevated cholesterol levels
Leukopenia, anemia
Lymphocytosis
nursing interventions for AN
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)
other nursing considerations for AN
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.
refeeding syndrome cause
treatment for anorexia nervosa
too rapid reintroduction of nutrition
med for anorexia nervosa
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)
priority for bulimia nervosa
does the client need medical stabilization?
bulimia assessment
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)
what is used to determine the severity of bulimia
frequency of compensatory behavior
NOT BMI
severity of bulimia levels
moderate : 4-7 times per day
severe : 8-13 times per day
extreme : 14 or more
thoughts and behaviors associated with bulimia nervosa
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
cardiac complications with bulimia nervosa
Cardiomyopathy (ipecac toxicity)
Cardiac dysrhythmias
Sinus bradycardia
Sudden cardiac arrest
Orthostatic changes
in pulse & blood pressure
dehydration and electrolyte imbalances with bulimia nervosa
metabolic acidosis
hypochloremia
hypokalemia
dental complications with bulimia nervosa
Attrition and erosion of teeth
Loss of dental arch
Diminished chewing ability
GI system complications with bulimia
Parotid gland enlargement
Esophageal tears (result of self-induced vomiting)
Gastric dilation
what is russells sign
knuckle callouses
what non purging behavior do people with bulimia partake in
excessive exercising
bulimia nursing interventions
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
what is the most common eating disorder in the US
binge eating disorder
symptoms of binge eating disorder
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
binge eating disorder
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
assessment of bing eating disorder
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
nursing interventions for binge eating disorder
Assess mood & psychosocial factors
Work with interdisciplinary team to determine treatment objectives
Provide nutritional counseling
interdisciplinary interventions
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
