Week 7 - Eating disorders Flashcards
Define anorexia nervosa
an eating disorder characterised by a constant fear of gaining weight, distorted body image, and a body weight of 85% or more below normal
Distinguish between restricting anorexia and binging/purging anorexia
Restricting - reducing amount of food to lose weight
Binging/purging - cycle of binging large amounts of food then purging (vomiting or laxatives)
Signs and symptoms of anorexia
- 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
Biological causes of anorexia
- abnormalities in neurochemical signals which convey hunger/fullness
- significant impact of genetic heritability
Psychological/environmental causes of anorexia
- peer group pressure
- popular culture
- cultural values thinness
- parenting style
Social media and anorexia
- anorexia typically starts in teen years
- rates higher when exposure to social media is increased
Lifestyle causes of anorexia
- athletes who are focused on body weight/fat
- dancing, modelling, wrestling
Characteristics of anorexia - fear of weight gain
People display a psychological obsession with caloric and fat content of food
this can lead to
* restrictive behaviours
* purging
* excessive exercise
* frequent weight checks
Characteristics of anorexia - food rituals
People consume food in a ritualistic way to maintain a sense of control
* eating in small pieces
* eating food in a specific order
Characteristics of anorexia - social/public eating
- refusal to eat in front of people
- may cook elaborate meals but not eat themselves
Impact of anorexia - Muscles
Anorexia causes significant muscle loss
this can lead to
* low creatinine levels
* fatigue
* diaphragm fatigue - resp distress
Impact of anorexia - Cardiac
Significant cardiac muscle loss
leads to
* bradycardia
* hypotension
* orthostatic hypotension
* congestive heart failure - oedema in feet
Impact of anorexia - electrolytes and vitamins
significant electrolyte and vitamin deficiencies (which can impact things like cardiac function)
* potassium
* magnesium
* phosphate
* vitamin B1
Impact of anorexia - Menstruation
Women may experience amehorrhea
* menstruation stops
* menstruation doesnt start by age 15
Infertility
Impact of anorexia - GIT
The stomach’s ability to tolerate a normal sized meal decreases leading to
* bloating
* N+V
* constipation
Impact of anorexia - Bones
Bone marrow starts shutting down
Fewer WBC –> dampened immune response
Fewer RBC –> low energy
Fewer platelets –> easy bruising and bleeding
Osteoperosis - bones weaken
Impact of anorexia - Skin
- 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
Impact of anorexia - Brain
Atrophy
Encephalopathy (damage or disease to the brain which alters its structure or function)
* ataxia (loss of coordination)
* confusion
* death
Halitosis
Bad breath due to repeated vomiting
Refeeding syndrome
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
Identify and explain non pharmacological treatment of anorexia
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
Pharmacological intervention in conjunction
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
Identify nursing interventions and rationale for people with anorexia
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
Define bulimia nervosa
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
Signs and symptoms of bulimia
- 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
Biological causes of bulimia
- evidence of significant genetic heritability
- lower plasma levels of BDNF gene associated with BN development
- serotonin imbalance
Social/environmental causes of bulimia
- poor self esteem
- controlling personality
- parenting style
- bullying
- abuse
Social media and bulimia
- 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
Lifestyle causes of bulimia
athletes who are focused on body weight/fat
eg. dancing, modelling, wrestling
Other disorders and eating disorders
Those who experience EDs are also likely to experience
* OCD
* depression
* anxiety
These share many overlapping symptoms and risk factors
Impact of bulimia - vomiting
- 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
Impact of bulimia - cardiac
vomiting -> dehydration -> hypotension and tachycardia
Impact of bulimia - Electrolytes
Low
* sodium
* potassium
* magnesium
* chloride
* phosphate
Low K -> muscle weakness and cardiac arrhythmias
* may lead to death
Metabolic alkalosis
Impact of bulimia - Endocrine
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
Identify and describe non pharmacological treatments for bulimia
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
Pharmacological treatments for bulimia and anorexia
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
Identify nursing interventions and rationale for people experiencing bulimia
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
SCOFF questionnaire
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
