Unit 9 Eating and Feeding Disorders , Anorexia, Bulimia, Binge Eating Chapter 18

Question 1

What is Anorexia

Answer 1

Individuals with anorexia nervosa have an intense fear of gaining weight. Often, there is a misperception that individuals with anorexia refuse to eat despite being hungry.
Obsession with food.

Question 2

What are the signs and symptoms of Anorexia

Answer 2

Low weight
Lower – BP, HR, Temp
-hypotension
-bradycardia
-hypothermia

Amenorrhea-no menstrual cycle
Yellow skin
Lanugo-may have growth of fine, downy hair on face and back
Cold extremities-with mottled look.
Peripheral edema
Muscle weakening
Constipation
Abnormal laboratory values (low triiodothyronine, thyroxine levels)
Anemic pancytopenia
Hypokalemia (<3.5 mEq/L)

Question 3

Do patients with Anorexia have a fear of gaining weight?

A. Yes
B. No

Answer 3

A. Yes

Terror of gaining weight
* Preoccupation with thoughts of food
* View of self as fat even when emaciated
* Peculiar handling of food: cutting food into small bits
* Pushing pieces of food around plate
* Possible development of rigorous exercise regimen
* Possible self-induced vomiting, use of laxatives and diuretics
* Cognition so disturbed that individual judges self-worth by weight

Question 4

What would you suspect a patient with Anorexia Body mass index to be?

A. 22BMI
B. 23BMI
C. 35BMI
D. 16BMI

Answer 4

D. 16BMI

Question 5

Can patients with Anorexia purge?

A. Yes
B. No

Answer 5

A. Yes

Intense fear of weight gain

Distorted body image

Restricted calories with
significantly low BMI

Subtypes of Anorexia:

-Restricting (no consis-tent bulimic features)

-Binge/eating/purging
type (primarily restric- tion, some bulimic behaviors)

Question 6

Do patient with anorexia believe they’re fat?
A. Yes
B. No

Answer 6

A. Yes

although their outwardly appearance and BMI shows otherwise

Distorted body image

Question 7

What is the primary priority for patients with Anorexia?

A. decrease risks for falls
B. Increase nutritional status
C. maintain airway
D. assess level of consciousness

Answer 7

B. Increase nutritional status

Question 8

Is Anorexia a chronic illness?

A. yes
b.no

Answer 8

A. yes

Question 9

Is anorexia easy to treat?

A. yes
B. no

Answer 9

B. no

Anorexia nervosa is difficult to treat.

Even when remission is achieved, the 1-year relapse rate is approximately 50%. Even after 4 years, up to 40% of patients continue to meet some cri- teria for anorexia

Question 10

What are the types of Anorexia?

Answer 10

Subtypes of Anorexia:

-Restricting (no consis-tent bulimic features)
^People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume

-Compensatory Binge/eating/purging
type (primarily restriction, some bulimic behaviors)
^ inappropriate weight control behaviours and are divided into purging behaviours such as self-induced vomiting and the use of laxatives and diuretics, and

NON PURGING BEHAVIORS non-purging behaviours such as the
-use of diet pills,
-excessive exercise and
-dietary restraint.

Question 11

Which of the following Anorexia’s will contribute to the lowest BMI?

A. Restrictive
B. Compensatory

Answer 11

A. Restrictive

Question 12

Restrictive Anorexia

Answer 12

-Restricting (no consis-tent bulimic features)
^People with this type of anorexia nervosa place severe restrictions on the quantity and type of food they consume
-restricts food, calorie counting

Question 13

Compensatory Anorexia

Answer 13

Compensatory Binge/eating/purging
type (primarily restriction, some bulimic behaviors)
^ inappropriate weight control behaviours and are divided into purging behaviours such as self-induced vomiting and the use of laxatives and diuretics, and non-purging behaviours such as the use of diet pills, excessive exercise and dietary restraint.

Question 14

Is there an FDA treatment for anorexia?

A. Yes
B. No

Answer 14

B. No

Question 15

What are some behaviors that can be seen in patients with Anorexia?

Answer 15

• Terror of gaining weight
• Preoccupation with thoughts of food
• View of self as fat even when emaciated

Peculiar handling of food: cutting food into small bits
PLAYING WITH FOOD

• Pushing pieces of food around plate
• Possible development of rigorous exercise regimen
• Possible self-induced vomiting, use of laxatives and diuretics (COMPENSATORY)
• Cognition so disturbed that individual judges self-worth by weight

Question 16

BMI categories for Anorexia

Answer 16

the disorder is considered
-Mild with a BMI of 17 or more,
-Moderate with a BMI of 16 to 17,
-Severe with a BMI of 15 to 16, and
-Extreme when the BMI is less than 15.

Question 17

Which of the following outcomes is most important when treating a patient with Anorexia?
A. Increased lanugo
B. attainment of a safe weight
C. adequate fluid intake
D. decreased diarrhea

Answer 17

from book
The most important outcome is the attainment of a safe weight.

Question 18

What can influence relapse of Anorexic behaviors?

Answer 18

-social media
-culture
-actors or models

Question 19

What of the following complications should you monitor for with a a patient who was admitted with sever malnutrition who was diagnosed with Anorexia?

A. excessive weight gain
B. fluid and electrolyte maintence
C. refeeding syndrome
D. respiratory acidosis

Answer 19

C. refeeding syndrome

Question 20

What is Refeeding Syndrome?

Answer 20

Refeeding Syndrome
 Caution Potentially lethal treatment complication

 May result in fluid-balance abnormalities, abnormal glucose metabolism,
hypophosphatemia, hypomagnesemia and hypokalemia
THE BODY SYSTEMS SLOW DOWN WITH REFEEDING SYNDROME
 Thiamine Deficiency may also occur  Reintroduction of nutrients must be slow to avoid

Question 21

To avoid referring syndrome the nurse must?

A. hastily increase fluid intravenous rate
B. Force feed to decrease malnutrition symptoms
C. reintroduce nutrients slowly
D.monitor food intake 6 hours after ingestion

Answer 21

C. reintroduce nutrients slowly

Reintroduction of nutrients must be slow to avoid

Question 22

What should monitor closely for patient with Anorexia nervosa?

Answer 22

-Close observation before and after meals as well as monitoring weight, movement, and bathroom trips are critical.

-Close monitoring and development of specific parameters for movement or exercise are also warranted.

-Patients may also need monitoring on bathroom trips after see- ing visitors and after any hospital pass to ensure they have not had access to and ingested any laxatives or diuretics.

Question 23

What should you NOT as a nurse for patients with Anorexia Nervosa?

Answer 23

DO NOT DO THAT

As such, strategies they used to address the disorder in the past, such as forcing the patient to eat, negotiating or begging the patient to eat, and removing free choice or privacy to encourage eating have failed.

Question 24

Which of the following treatment methods is used to treat Anorexia nervosa?

A. Therapy
B. Fluoxetine
C. Clozapine
D. Amtriptiline

Answer 24

A. Therapy

INDIVIDUAL OR GROUP THERAPY

There are no drugs approved by the US Food and Drug Administration (FDA) for the treatment of anorexia nervosa.

Question 25

Tx for adolescents with Anorexia nervosa

Answer 25

Advanced practice nurses may provide adolescents with anorexia nervosa with adolescent-focused therapy (AFT).

Question 26

Requirements for Hospitalization

Answer 26

Planning depends on the acuity of the patient’s situation. In gen- eral, two criteria for hospitalization include extreme electrolyte imbalance, example K+: 2.0 or weights below 75% of ideal body weight. The plan is then to provide immediate medical stabilization, most likely on an inpatient unit. Other criteria for hospitalization include less than 10% body fat, a daytime heart rate of less than 50 beats per minute, a systolic blood pressure of less than 90, a temperature of less than 96°F( hypothermia), and arrhythmias

Question 27

Tx after Medical stabilization

Answer 27

Address underlying issues with realistic goals * Weight Restoration program – Focus should be on the eating behavior and
underlying feelings of anxiety, dysphoria, low self-esteem and lack of control * Approach discussions about physical appearance cautiously – pt may
misinterpret * Health promotion – learning more constructive coping skills, decision
making skills, supervised grocery shopping. As patient progresses,
encourage eating in restaurants. * Therapy – Individual, group and family * Psychopharmacological Therapy
 Occurs during different phases
*SSRI – Fluoxetine (Prozac) – helps to reduce obsessive compulsive behavior
but only AFTER the patient has reached a maintenance weight.

Question 28

What charateristics is common with patients with Bulimia Nervosa?
A. Lanugo
B. bradycardia
C. mottled skin
D. BMI 23

Answer 28

D. BMI 23

Normal to slightly low weight

Initially, patients with bulimia nervosa do not appear to be physically ill. They are often at or close to ideal body weight.

Question 29

What is Bulimia Nervosa?

Answer 29

Repeated episodes of binge eating followed by inappropriate compensatory**
behaviors** (self-induced vomiting, misuse of laxatives, diuretics, excessive
exercise)

Bulimia is eating between 1500 and 5000 calories within any 2-hour period. The binge eating is followed by compensatory behaviors such as self-induced vomiting; mis- use of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Question 30

Thoughts and Behaviors associated with Bulimia Nervosa

Answer 30

• Binge-eating behaviors
• Often self-induced vomiting (or laxative or diuretic use) after bingeing
• History of anorexia nervosa in one-fourth to one-third of individuals
• Depressive signs and symptoms
• Problems with interpersonal relationships
• Self-concept
• Impulsive behaviors
• Increased levels of anxiety and compulsivity
• Possible substance use disorders
• Possible impulsive stealing

Question 31

Is there a clinical finding for patients with to look emaciated with bulimia nervosa ?

A. No
B. Yes

Answer 31

A. No

Normal to slightly low weight

Initially, patients with bulimia nervosa do not appear to be physically ill. They are often at or close to ideal body weight.

Question 32

Signs and Symptoms of Bulimia Nervosa

Answer 32

If the patient has been inducing vomiting, she may have developed enlarged parotid glands, dental erosion, and dental caries. Calluses on the knuckles or back of the hand due to repeated self-induced vomiting is known as the Russell sign. Esophageal involvement in the form of esophageal tears or a history of esophagitis may be the result of repeated exposure to stomach acids through vomiting.

-Normal to slightly low weight
-Dental caries, tooth erosion
-Parotid swelling
-Gastric dilation, rupture
-Calluses, scars on hand (Russell sign)
-Peripheral edema
-Muscle weakening
-Abnormal laboratory values (electrolyte imbalance, hypokalemia, hyponatremia)
-Cardiac failure (cardiomyopathy)
-Seizure

Question 33

Which of the following medications is the ONLY FDA approved medication for Bulimia Nervosa?

A. Fluoxetine
B. Sertraline
C. Phenlezine
D. Clozapine

Answer 33

A. Fluoxetine

Fluoxetine (Prozac), an SSRI antidepressant, is the ONLY FDA- approved medication for the treatment of bulimia nervosa in adult patients. **

This drug can be helpful for people with bulimia even in the absence of depressive symptoms. Fluoxetine doses tend to be higher when used for this eating disorder in comparison to major depressive disorder.

Question 34

What is the common feeding cycle for a patient with Bulimia Nervosa?

Answer 34

BINGE
GUILT
PURGE
BINGE

Question 35

Nursing Assessment for patients with Bulimia Nervosa?

Answer 35

Assess nutritional pattern and fluid intake * Assess binging and purging patterns with direct questions * Assess daily activities including exercise * Review Labs: Electrolyte levels, glucose level, thyroid function tests, CBC, ECG.

Question 36

Planning for patients with Bulimia Nervosa and Anorexia

Answer 36

Medical Stability-Priority

• Hospitalization
   Syncope, K+ less than 3.2 mEq/L, Chloride less than 88 mEq/L, esophageal tears,
  arrhythmias, intractable vomiting and hematemesis.

Suicide risk also requires hospitalization.

• Structure to normalize eating habits(Monitor eating for 1 hour
• Therapy
• Health Teaching and Promotion
  Pharmacological Tx – ONLY FOR BULMIA NERVOSA -Fluoxetine (Prozac) FDA approved for maintenance

Question 37

What is Binge Eating?

Answer 37

Although individuals who start binge eating may be of normal weight, repeated binge eating inevitably causes obesity in this cohort.

Repeated episodes of binge eating after which they experience significant
distress

short period of time, sitting and indulging more than normal calories in one sitting

Question 38

Is purging common for patients with Binge eating?

A. yes
B. no

Answer 38

B. no

These individuals do not regularly use the compensatory behaviors that are seen in patients with bulimia nervosa.

Question 39

Planning for eating disorder

Answer 39

Care planning may include a focus on rebuilding daily intake, balancing frequency and volume. In addition, plans will focus.
on inclusion of healthy movement and physical activity at a slow pace. Nurses may also encourage patient’s further examination of the emotional components associated with a binge episode. With greater insight, patients can begin developing positive coping mechanisms which address underlying emotional issues or maladaptive behaviors.

Question 40

Other s/s of Binge eating

Answer 40

Physically, episodes of abnormal eating cause gastrointesti- nal problems associated with the
periodic dilation of the stomach. These patients have significant difficulties with
-heartburn,
-dysphagia
-bloating, and
-abdominal pain as well as with
-diarrhea,
-urgency,
-constipation, and a
-feeling of anal blockage.

Question 41

Is hospitalization needed to treat binge eating

A. Yes
B.no

Answer 41

B.no

Although obesity puts patients in this population at risk for diabe- tes, hypertension, and heart disease, hospitalization to treat the binge eating itself is not indicated.

Question 42

Health teaching and Promotion for Binge eating

Answer 42

Patients struggling with binge-eating disorder have been using food to regulate their mood and will have to learn new coping strategies for the challenges in their lives.

Education centered on healthy eating and exercise will have to be reinforced within a caring nurse-patient relationship.

At first, the focus of change will be the binge eating itself.

Once abstinence has been estab- lished, the focus may change to slow and steady weight loss to improve the person’s overall health.

Question 43

Drug therapy for Binge eating

Answer 43

Lisdexamfetamine dimesylate (Vyvanse) It also has FDA approval for the treatment of moderate to severe binge-eating disorder in adults

. Lisdexamfetamine is correlated with an sig- nificantly lower risk of relapse in binge episodes compared with placebo at 6-month follow-up (Brownell & Walsh, 2017).

SIDE EFECTS
In adults with binge-eating disorder, the most common side effects are dry mouth, insomnia, decreased appetite, increased heart rate, constipation, feeling jittery, and anxiety.

Possible for Abuse
The FDA includes a black box warning on lisdexamfetamine’s label due to concern for “abuse and dependence.”

Question 44

Which of the following drugs is FDA approved for Binge Eating?
A. fluoxetine
B.Lisdexamfetamine
C. Phenelezine
D. Amtriptiline

Answer 44

B.Lisdexamfetamine

Question 45

What is a side effect for Lisdexamfetamine?

A. diarrhea
B. increased oral secretions
C. heart rate 109
D. increased appetite

Answer 45

C. heart rate 109

dry mouth,
insomnia,
decreased appetite, increased heart rate, constipation,
feeling jittery,
anxiety.

Question 46

Lisdexamfetamine is this drug warned for possible abuse?

A. yes
B.no

Answer 46

A. yes

The FDA includes a black box warning on lisdexamfetamine’s label due to concern for “abuse and dependence.”

Question 47

Which of the following procedures is controversially used for patients with Binge eating disorders?

A. Electronic Compulsive Treatment
B. Cholecystectomy
C. Laparoscopy
D. Bariatric Surgery

Answer 47

D. Bariatric Surgery

Bariatric surgery is a controversial option for the treatment of obesity due to binge-eating disorder. Potential complications from this surgery require individuals to consider it carefully (Mitchell et al., 2015). Such complications include impaired fasting glucose levels, high triglycerides, and urinary incontinence.

Question 48

What is PICA

Answer 48

Pica is defined as the ingestion of substances that have no nutritional value, such as dirt or paint

. Eating nonfood items can also be dangerous.

-Paint may contain lead, which can cause brain damage.

-Objects that cannot be digested, such as stones, can cause intestinal blockage.

-Sharp objects such as paper clips or nails can cause intestinal damage or laceration.
-Bacteria from dirt or other soiled objects can lead to serious infection and dental prob- lems.

-Enamel on teeth may be eroded from taking in and chewing on abrasive and erosive substances.

 Tx – Behavior Modification, tx anxiety and
depression as needed

Question 49

What is Rumination

Answer 49

Rumination is characterized by undigested food being returned to the mouth. It is then rechewed, reswallowed, or spit out.

Diagnosed after 1 month of symptoms

• Intellectual development disorder is associated w/
   Neglect is a predisposing factor
   Frequently remit spontaneously but may become a habit – can result
  in severe malnutrition and even death

Question 50

Interventions for Rumination

Answer 50

Interventions include teaching parents appropriate feeding techniques,
repositioning infant or child during feeding

improving the interaction
between child and caregiverchild and making mealtimes a pleasant experience

Distracting the child when the behavior starts can also be helpful

 Family therapy may be needed

Question 51

What is Avoidant/Restrictive Disorder

Answer 51

In avoidant/restrictive food intake disorder, the consequences are serious and can result in significant weight loss, nutritional deficiency, dependence on supplements or enteral feeding, and marked interference with functioning. Children and adolescents who have not completed their growth may not grow along their developmental trajectory.

Question 52

Treatment for avoidant disorder

Answer 52

The primary treatment modality is some form of behavioral modification to increase regular food consumption.

-CHILDREN WHO ARE PICKY EATERS-
-INTRODUCE FOOD OF ALL TEXTURES

Families caring for a child with a feeding disorder often need support and education in specific behavioral techniques, but family therapy is not usually necessary.

The treatment of anxiety and depressive symptoms may be helpful in some cases.