UNIT 4 EATING DISORDERS Flashcards
What are eating disorders?
Eating disorder symptoms severe some kind of PURPOSE that goes beyound weight loss, food as comfort, an addition, and beyound a need to feel special or in control
Examples of “purpose”
1. Comfort
2. numbing
3. cry for help
4. self-punishment
5. avoidance of intamacy
ED are NOT….
- Vanity (self love or self absorption)
- Diets
- Obsession w/food
- obsession w/exercise
- fun
- eat to treat
- discriminatory- they affect all cultures and socioeconomic levels
What is disordered eating?
Problematic eating patterns that are not practiced at high enough frequency or severity to merit the formal diagnosis of an eating disorder but it is still very serious in nature
What is the progression of disordered eating?
- no disordered eating thoughts or behaviors
- Some thoughts and behaviors
- Bridesmaid trying to slim down for wedding
- Frequent thoughts and behaviors
- eating disorder
- severe eating disorder?
What are some influential factors of ED?
- Genetics
- Comorbid disorders (occuring at the same time or one after another)
- Anxiety disorder
- Depression
- ADHD/ADD
- PTSD
- OCD– restrictive ED liek anorexia
- Addiction-40% of substance abuse patients have an eating disorder-often binge ED
- Borderline personality disorder
- Significant weight loss as a child or adolesent due to illness
- neonatal and maternal factors (premature, small for gestational age or experiences in utero
- Trauma (changing schools, interpersonal event sexual assult)
- ACE’s
- Media
- sports
- Environment-peers, family drama
What is PICA?
Eating inedible things or craving and chewing substances that have no nutrition value like
- Ice
- clay
- dirt
- paper
- paint
- hair
What is rumination disorder?
Regurgitating and re-swallowing food
May start with GERD
It comforts them
What are risk factors of AN?
- Gender: Females (1:8 <14 y/o are boys)
- Early childhood eating problems (picky eating)
- Personality: perfectionism, anxiety, obsessive
- Competitive athletics (ballet, gymnastics)
- academically high achievers
- conforming and consientious
What is the driving force for those suffering with AN?
Maintaining sense of control (everything else is controlled by the family
What are the clinical manifestations of AN?
- Usually preceded by mood disturbances & behavior changes
- They find achieement through losing weight
- High level of distrust (paranoia)
- “of course im fat”
According to the PSM5 AN is defined as….
- Restriction of energy intake relative to requirement, leading to a significantly low body weight (restrict food intake)
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with them gaining weight
- Distrubance in the way in which ones body weight or shape is experienced
- Persisteant lack of recognition of seriousness of the current low body weight
- Lots of body checking activites “trophies”
What are the 2 subtypes of AN?
- Restricting type
- Weight loss primarily achieved through dieting/fasting/excessive exercise
- Binge-eating/purging type (NOT TESTED ON)
- Eneergy restriction with the presence of episodes of binge eating or purging
True or false: May patients who suffer from AN may have a loss in hunger ques?
True– we shouldn’t wait for them to eat..
What are medical complications of AN?
Cardiovascular (5), Dermatologic (1), GI (1), Endocrine & Metabolic (3)
Cardiovascular:
2. 1. Bradycardia & hypotension
2. Mitral valve porlapse (common)
3. Arrhythmias
4. Refeeding syndrome
5. ECHO changes
Dermatologic
1. Dry skin, alopecia, lanugo hair
GI
1. Constipation
Endocrine & Metabolic
1. Amenorrhea
2. Infertility
3. Osteoprosis
BN is more common in older _____ and ______
1.Adolescent girls and young women
Unlike AN where patients are typically underweight. Patients who have BN are typically….
Average or slightly above average weight
BN patients typically have a ____ personality?
- Outgoing, impulsive
- Aware of problems and want help unlike AN patients who deny anything is wrong
- Prone to acting out behaviors like shoplifting, self-destructive behaviors like excessive drinking and drug use
What is BN?
- Eating disorder characterized by recurrent binge eating followed by purpging (1x/week for x3 months)
Binge eating in BN is defined as?
- Eating a large amount of food in a short period of time (2 hours) with a sense of lack of control
Purging in BN is defined as
- An attempt to rid the body of unwanted food by:
- Vomiting
- laxitives and or diuretics
- fasting for days (following a binge)
- excessive excercise (more common in men)
What are medical complication asscoiated with BN?
Cardiovascular
1. arrhythmias
2. diet pill toxicity: palpatations hypertension
Gastrointestinal
1. Esophageal repture r/t vomiting
2. Constipation r/t laxitive use
3. Dental erosion r/t acidic contents of stomach when they vomit
4. Parotid gland swelling r/t parotid gland helps you salivate… frequent vomiting causes it too be enlarged constantly
Metabolic (typically fatality causes)
1. Hypokalemia
2. Dehydration
3. Metabolic alkalosis
Endocrine
1. Irregular menses (AN is absense of)
Pulmonary
1. Aspiration pneumonia
What is Russel’s sign?
Calluses on hands from a BN patient sticking hand in mouth to puke… not always present in our more chronic BN patients they may be able to puke “on command”
What is binge eating disorder?
- Recurrent episodes of binge eating (1x/week x3 months)
How is binge eating disorder dx
Includes 3 or more of the following
1. Eating more rapidly than normal
2. Eating until feeling comfortably full
3. Eating large amounts of food when not physically hungry
4. Eating alone due to embarrassement of how much one is eating
5. Feeling disgusted, depressed or guilty after a binge
6. DOES NOT include compensatory behvaiors (anything you do to relieve the guild of eating like vomititng with BN)
What is the treatment goal in patients who have binge eating disorder?
- Interrupt and reduce eating binges and achieve healthy eating habits
True or false: You can easily identify a patient with a binge eating disroder because they will be overweight?
False: While a strong link existis between obesity and binge eating, binge eating can occur in non-obese individuals
What is ARFID?
Eating or feeding distubance as manifested by persistent failure to meet appropriate nutritional/energy needs associated with 1 or more of the following
- Significant weight loss
- Significant nutrtional deficiency
- Dependance on enteral feeding or oral nutrtional supplements
- Marked interference with psychosocial functioning
There is no evidence of a disturbance in the way one’s body or shape is experienced
Not attrubtable to a concurrent medical condition
ARFID is… review
- Is a distubance of feeding behavior in which the individual eats very little and/or avoids certain foods
- Resulting in failure to grow and develope as expected and/or significant weight loss
- Nutritional deficiencies are common and may become life-threatening
- Patients present with lack of interest in food or abnormal rejection of food due to its sensory properties
- The individual has no distorted body image or drive for thinness, nor does he or she fear gaining weight or have boyd image distoration.
What are other specified feeding or eating disorders (OSFED)?
Night eating syndrome
- Eating large amounts of food after awakening from sleep.
- associated w/low melatonin levels
What is food addiction?
Experience pleasure from the anticipation of eating, the abailabliltiy of of foods, or the actual eating of foods. Uncontrollable cravings surrounded highly palatable food or excessive eating
What are drunkorexia?
- Self-imposed starvation or binge eating/purging combined with alcohol abuse. It can result in alcohol intoxiation and electrolyte imbalance.
What is pregorexia?
Attempting to remain slim through their pregnancy in order to drop the weight qucikly following childbirth
What is post-bariatric surgery transitions?
They may experience eating avoidance following surgery (grazing, nibbling, picking) and fear of gaining weight.
What is diabulimia?
- Individuals who have type 1 diabetes who redue their insulin to lose weight.
What is orthorexia nervosa?
Obession with the “healthfulness” of foods and this interferes with daily life
Extreme rigidity surrounding food content and food preparation
Identity and spirituality are footed in food.
The treatment team for eating disorders includes?
- Medical professional- preferably a doctor that works w/eating disorders
- Mental Health professionial
- Registered Dietitian/Nutritionist– not all registed dietitans work well with eating disorders
Levels of care when treating ED?
- Outpatient
- intensive outpatient care
- Partial hospitalization
- Residential treatment
- inpatient hospitalization
Nutrtional therapy for ED consists of..
- Treat malnutrition and resotre dietary stability
- May require IV therapy or tube feedings
- Avoid refeeding syndrome in which replacment is given too rapidly (a preventable complication)
- Goal: Weight gain of 0.5-1 pound per week
Just review: How do you refeed?
- Correct electrolyte levels before initiating nutritonal support
- Resotre circulatory volume and closely monitor vitals
- NEVER administer rapid IV fluids (d/t sodium balance)
- Daily labs to monitor electorlytes for 1-2 weeks when caloric intake increased (phosphorous, k+, and mg+)
- Start 1400-1600 kcal/day and increase by 300-400 kcal every 3-4 days until goal weight
What is dialectical behavioral therapy?
- Teaches skills such as emotional regulation, distress tolerance and effectiveness in relationships
- It combines acceptance skills for stressful cirucmstances that cant be immediately changed and change skills to better manage emotions or relationship issues
Basically– accepting negative emotions…feeling them… and learning to let them go.
What is cognitive behavioral therapy?
- Addressess altered perceptions through understanding the relationship between thoughts, feelings and behaviors
- Is a key method of treatment, focusing on recognizing and coping with binge eating triggers and challenging and chan ging cognitive disortions (body weight and shape)
What is food jounaling?
What they ate and drank and how they feel about it
What is behavioral contracts?
An agreement that the patient makes with others to change a maladaptive behavior
It is a written contract that places the responsibility for weight gain or other behavioral change on the patient
True or false: Pharmacotherapy has limited efficacy with AN?
True
SSRI’s have been more successful when used in patients with….
BN and binge eating disorder to treat depression and suicidal ideation
1. Fluoxetine (prozac)
2. Sertraline (zoloflt)
3. Citalopram (celexa)
4. escitalopram (Lexapro)
What are some SE of SSRI’s
- Headache
- dry mouth
- weight gain
- nervousness
- sexual dysfunction
BTricyclic antideressants (TCA) are used for….
BN
What are examples of Tricyclic antidepressants (TCA)
Think DIMBA
- Desipramine
- Imipramine
- Amitriptyline
- Monoamine oxidase inhibitors
- Buispirone
Selective Norepinephrine Reuptake inhibitors (SNRIs) have shown some efficacy for treating….
Binge-Eating disorders
What are some examples of selective norepinehrine reuptake inhibitors (SNRIs)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
What are some anticonvulsants have shown decreases in binge eating episodes?
- Topiramate (topamax)
- Zonisamide (Zonegran)
Antipsychotics reduce what in Ed
Distorted thinking related to the eating diorder
What is an example of an antipyschotic used to ED?
- Olanzapine (zyprexa)
What are some nursing interventions ED?
- Weigh patient
- Supervise meals during and 2 hours after
- Seek staff when feel the need to vomit
- Monitor vital signs, fluid intake and output
- Encourage food journaling
- Be supportive yet firm
- Structed environment- consistency, avoid manipulation, continuity
- Encourage the patient by providing education and activites and strength self esteem
