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HNN222 Exam > Week 7 - Eating disorders > Flashcards

Week 7 - Eating disorders Flashcards

1
Q

Define anorexia nervosa

A

an eating disorder characterised by a constant fear of gaining weight, distorted body image, and a body weight of 85% or more below normal

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2
Q

Distinguish between restricting anorexia and binging/purging anorexia

A

Restricting - reducing amount of food to lose weight

Binging/purging - cycle of binging large amounts of food then purging (vomiting or laxatives)

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3
Q

Signs and symptoms of anorexia

A
  • weight 85% below normal
  • restrictive behaviours OR binging/purging
  • excessive exercise
  • frequent weight checks
  • food rituals
  • refusal to a eat in public
  • low self esteem
  • perfectionist behaviour
  • desire for control
  • difficulty managing stress
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4
Q

Biological causes of anorexia

A
  • abnormalities in neurochemical signals which convey hunger/fullness
  • significant impact of genetic heritability
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5
Q

Psychological/environmental causes of anorexia

A
  • peer group pressure
  • popular culture
  • cultural values thinness
  • parenting style
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6
Q

Social media and anorexia

A
  • anorexia typically starts in teen years
  • rates higher when exposure to social media is increased
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7
Q

Lifestyle causes of anorexia

A
  • athletes who are focused on body weight/fat
  • dancing, modelling, wrestling
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8
Q

Characteristics of anorexia - fear of weight gain

A

People display a psychological obsession with caloric and fat content of food

this can lead to
* restrictive behaviours
* purging
* excessive exercise
* frequent weight checks

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9
Q

Characteristics of anorexia - food rituals

A

People consume food in a ritualistic way to maintain a sense of control
* eating in small pieces
* eating food in a specific order

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10
Q

Characteristics of anorexia - social/public eating

A
  • refusal to eat in front of people
  • may cook elaborate meals but not eat themselves
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11
Q

Impact of anorexia - Muscles

A

Anorexia causes significant muscle loss

this can lead to
* low creatinine levels
* fatigue
* diaphragm fatigue - resp distress

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12
Q

Impact of anorexia - Cardiac

A

Significant cardiac muscle loss

leads to
* bradycardia
* hypotension
* orthostatic hypotension
* congestive heart failure - oedema in feet

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13
Q

Impact of anorexia - electrolytes and vitamins

A

significant electrolyte and vitamin deficiencies (which can impact things like cardiac function)
* potassium
* magnesium
* phosphate
* vitamin B1

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14
Q

Impact of anorexia - Menstruation

A

Women may experience amehorrhea
* menstruation stops
* menstruation doesnt start by age 15

Infertility

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15
Q

Impact of anorexia - GIT

A

The stomach’s ability to tolerate a normal sized meal decreases leading to
* bloating
* N+V
* constipation

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16
Q

Impact of anorexia - Bones

A

Bone marrow starts shutting down

Fewer WBC –> dampened immune response
Fewer RBC –> low energy
Fewer platelets –> easy bruising and bleeding

Osteoperosis - bones weaken

17
Q

Impact of anorexia - Skin

A
  • Skin can become dry and scaly
  • lanugo (extreme biological attempt at thermoregulation when not enough muscle mass to metabolise)
  • hair becomes brittle and falls out easily
18
Q

Impact of anorexia - Brain

A

Atrophy

Encephalopathy (damage or disease to the brain which alters its structure or function)
* ataxia (loss of coordination)
* confusion
* death

19
Q

Halitosis

A

Bad breath due to repeated vomiting

20
Q

Refeeding syndrome

A

Refeeding stimulates the secretion of INSULIN
* causes the cells to take in POTASSIUM, MAGNESIUM, PHOSPHATE (already low in the blood)
* concentration of these ions becomes dangerously low
* can lead to cardiac arrhythmias and death

Requires careful continuous medical monitoring and ECG during the refeeding process

21
Q

Identify and explain non pharmacological treatment of anorexia

A

CBT specifically beneficial in BN

Medicalised approach to careful weight gain

Psychotherapy and CBT
* for the individual and family if required
* can aim to improve self esteem
* helps to cope with the stress and social pressures by teaching calming/coping strategies
* teaching to identify thought patterns which might be influencing their illness

22
Q

Pharmacological intervention in conjunction

A

Olanzapine in small doses (antipsychotic) - increases appetite and weight gain is common

Antidepressants - Common comorbid depression with EDs, and may be useful in addressing certain psychological causes of EDs and preventing relapse

23
Q

Identify nursing interventions and rationale for people with anorexia

A

supervise/provide support during mealtimes

build rapport

MSE and risk assessment

Collaborate with consumer to develop a plan based on their goals for recovery

Provide psychoeducation

Monitor for refeeding syndrome

Blind weights

Promote coping/soothing strategies

Promote healthy exercise for mental health

Promote postive body image

24
Q

Define bulimia nervosa

A

an eating disorder characterised by rapid out of control binge eating beyond levels of comfort, ofllowed by pueging through vomiting, laxatives or diuretics

Must occur once a week for three months to be diagnosed

25
Q

Signs and symptoms of bulimia

A
  • Low self esteem
  • normal or overweight
  • strong desire for control over weight
  • fixation on food
  • eating rapidly
  • russells signs
  • hiding/hoarding food
  • feelings of dysphoria
  • lack of control
  • eating alone
  • frequent dieting
26
Q

Biological causes of bulimia

A
  • evidence of significant genetic heritability
  • lower plasma levels of BDNF gene associated with BN development
  • serotonin imbalance
27
Q

Social/environmental causes of bulimia

A
  • poor self esteem
  • controlling personality
  • parenting style
  • bullying
  • abuse
28
Q

Social media and bulimia

A
  • high incidence of bulimia in adolescence
  • higher rates of bulimia where media exposure increases
  • enterainment and body goals
  • thinness is valued as a cultural norm
29
Q

Lifestyle causes of bulimia

A

athletes who are focused on body weight/fat
eg. dancing, modelling, wrestling

30
Q

Other disorders and eating disorders

A

Those who experience EDs are also likely to experience
* OCD
* depression
* anxiety

These share many overlapping symptoms and risk factors

31
Q

Impact of bulimia - vomiting

A
  • erosion of teeth enamel
  • halitosis
  • swelling of parotid gland
  • russels sign

Mallory Weiss syndrome
* tears to distal oesophagus and stomach
* causes abdominal pain and haemataemesis

32
Q

Impact of bulimia - cardiac

A

vomiting -> dehydration -> hypotension and tachycardia

33
Q

Impact of bulimia - Electrolytes

A

Low
* sodium
* potassium
* magnesium
* chloride
* phosphate

Low K -> muscle weakness and cardiac arrhythmias
* may lead to death

Metabolic alkalosis

34
Q

Impact of bulimia - Endocrine

A

Amenorrhea

High risk of Diabetes Mellitus
* purging = food restriction -> places cells in state of starvation
* DM makes glucose more difficult to enter cells due to insulin insensitivity -> worsens state of starvation

35
Q

Identify and describe non pharmacological treatments for bulimia

A

Medical apporach to careful nutrition is important

Psychoeducation
* individual can understand their condition, what are the triggers and how to best manage them

Psychotherapy and CBT
* For the individual and family if necessary
* To guide individual in structuring a new relationship with food
* Eg. encouraging consuming a small amount of a ‘forbidden’ food → consciously noticing the absence of negative consequences

36
Q

Pharmacological treatments for bulimia and anorexia

A

SSRIs in conjunction with therapy - have been shown to reduce the frequency of binging and purging
Also can tackle the depressive psychological tendencies which might contribute to ED

37
Q

Identify nursing interventions and rationale for people experiencing bulimia

A

Understand that person’s priorities

Recovery based approach

Work with individual on strategies to support their feeding process

Encourage support/connections

supervise/provide support during mealtimes

build rapport

MSE and risk assessment

Collaborate with consumer to develop a plan based on their goals for recovery

encourage a food diary

Provide psychoeducation

Blind weights

Promote coping/soothing strategies

Promote healthy exercise for mental health

Promote postive body image

38
Q

SCOFF questionnaire

A

S - do you ever make yourself sick because you feel uncomfortably full
C - Do you worry you have lost cnotril over how much you eat
O - Have you recently lost more than 6kg in a three month period
F - do you believe yourself to be fat when others say you are too thin
F - would you say that food dominates your life

One or two postive answers should raise suspicion - full assessment for eating disorder and consultation with an eating disorder or mental health clinician is needed

HNN222 Exam (8 decks)

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