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Eating Disorders Chapter 14

Terms in this set (36)

Anorexia nervosa
-Intense irrational belies about their shape and weight and they engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance; females with it experience anorexia
-age of onset: early to middle adolescence
- restriction of food leading to weight loss and/or low BMI
- denial of hunger
- fear of becoming "fat"
-distorted view of their body (body dysmorphia)
+ two subtypes:
Restricting only
+binge eating
Anorexia: What to look for
-Wearing baggy clothing (layers)
- counting calories/ weighing food
- fear of eating in public
- obsessed with food
-use of rituals
+ cutting food into small pieces
+ inappropriate use of utensils- putting down btwn bites
Anorexia: What is it about
-control
- perfectionist
- often associated with depression/anxiety or a co-corruing disorder (OCD)
-fear
Anorexia: Clinical
-loss of menstrual cycle
-dehydration/constipation
-peripheral edema
- hair loss/lanugo
-bloating/abdominal discomfort
- dizziness, headaches
-cardiac arrest
- osteoporosis
-death
bulimia nervosa
-repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting;misuse of laxatives, diuretics, or other medications;fasting; or excessive exercise
- age of onset: more typically in late adolescense
-
Binge Eating Disorder
diagnosed when individuals engage in repeated episodes of binge eating, consuming large amounts of calories, after which they experience significant distress
-do not regularly use the compensatory behaviors seen in patients with bulimia nervosa
most effective care for these disorders:
a multidisciplinary team approach that enlists the expertise of various health care sector
Bulimia Nervosa: indicators
- associated with guilt/anger/chaotic family origin
- generally normal weight
- binge and purge cycles
- eating large amounts of food followed by purging (laxatives, diuretics, exercising, vomiting)
Bulimia: What to look for
- freq trips to bathroom
- yellow nails/teeth
- facial edema due to swelling of parotid glands
- redness around eyes due to increased pressure on blood vessels
- assoc with drugs and alc
- isolation
-use of candy, gum, mints
-eating sugary/fatty foods
Anorexia: DSM 5
-Less than 85% IBW
-Intense fear of gaining weight
-Disturbed body image
-No longer mentions amenorrhea (not relevant for those who do not menstruate for other reasons, as well as men)
Bulimia: DSM 5
-Binge eating followed by purging at least once a week for three months
-Purging:
Abuse of laxatives or diuretics and/or
Vomiting
Family types for:
Anorexia
Bulimia
Anorexia: seen as controlling, emphasizing perfection, achievement, and compliance

Bulimia: chaotic and emotionally expressive, particularly in terms of conflict and negativity
cachectic
severely underweight with muscle wasting
lanugo
growth of fine, downy hair on the face and back
Nursing Assessment:
Anorexia
- Cachectic
-Lanugo
- mottled, cool skin
- low BP
- low pulse
-low temp
(all consistent with malnourished and dehydrated state)
Assessment: areas that should be covered with an eating disorder
-perception of the problem
- eating habits
- hx of dieting
- methods used to achieve weight control(restricting, purging, exercising)
- value attached to a specific shape and weight
- interpersonal and social fx
- mental status and physiological parameters
Laxative Abuse: Side Effects
- depletes bones and body of minerals (K, Ca, Na)
- Dehydration
- dependence
-creates feeling of emptiness
- used in conjunction with diuretics and exercise
most compelling nursing dx initially for individuals with anorexia
imbalanced nutrition: less than body requirements
Binge Eating Disorder (BED)
+recurrent persistent episodes of binge eating
-Eating more rapidly than normal
-eating until feeling uncomfortable full
- eating large amounts of food when not hungry
- eating alone out of embarrassment
-feeling disgusted with oneself, depressed, or guilty after overheating
+marked distress regarding binge eating
+ absence of regular compensatory behaviors (such as purging)
(CBT works better than antidepressants)
Other Specified Feeding or Eating Disorder: (OSFED)
-feeding or eating disorders that cause significant distress or impairment, but do not meet criteria for another feeding or eating disorder
EX:
1. atypical anorexia nervosa
2. bulimia nervosa
3. binge eating disorder
4. purging disorder
5. night eating syndrome

-Does cause damage to body (ex htn)
- high mortality rate
Refeeding Syndrome
-potentially catastrophic tx complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiac collapse

- should be done under supervision of dietician and med personnel
- fat to carb metabolism: pt using up protein so cardiac muscle effected
- rapid change in electrolytes and fluid
- increase bar
- increase cardiac workload
- increase in insulin
- very uncomfortable, bloating, dizziness
- restored circulatory system increases cardiac workload of heart which has depleted cardiac muscle. can lead to cardiac collapse
cognitive distortions related to eating disorders
- over-generalizations: a single event that affects unrelated situations (he didn't ask me out. it must be bc I'm fat)

- all or nothing thinking: reasoning is absolute and extreme, in mutually exclusive terms of black or white, good or bad (if i have one popsicle, i must eat 5)

- catastrophizing: consequences of an event are magnified (if i gain weight, my weekend will be ruined)

- personalization: event s are over interpreted as having personal significance (i know everybody is watching me eat)

- emotional reasoning: subjective emotions determine reality (i know I'm fat bc i feel fat)
How to work with clients that have Eating Disorders
- frequent acknowledgement of difficulty of situation
- establish therapeutic alliance
-AVOID authoritarianism and assumption of parental role
- self care activities to learn more constructive coping skills, social skills and improve problem solving
(these skills can grow through supervised shopping, eating out, preparing meals)
- family members benefit from counseling
How to Answer: "Do I look fat"
do not answer the ?
- there is nothing you can say that will appear the person. There is no right answer and any answer you give will be setting you up for failure
- Rationale: an eating disorder is not about the weight and not about being fat
- what do you say: tell me more about what you're thinking; kind of changing subject without ignoring ?
Saying "you look good today"
In the mind of an anorexic, this means they are fat. Looking good is equivalent with being healthy and healthy people don't have eating disorders. If I don't have an eating disorder then I am fat or I need to starve myself more so I can be thinner.
Saying : "Just eat"
Okay, this is ridiculous and you might as well tell a diabetic not to have diabetes. If it was that simple...eating disorders would not exist. A lot of times eating can bring up painful and often unbearable feelings that are suppressed when the person is empty.
Saying " I am frustrated with you"
-This would be okay, if it were true. You are not frustrated with them, you are frustrated with their eating disorder. It is very important to know the difference. One of the keys to recovery is separating from your eating disorder so start now.

-Would never say to any pt I am frustrated with you- (would maybe say frustrated with behavior with certain illnesses)

- MAIN ISSUE: CONTROL**- give them choices (narrow down to 2-3 choices)

so give more control- if you don't purge for a week we will monitor less, etc
What are Pro ANA and Pro MIA
websites that encourage continuation of eating disorder; view it as a lifestyle
"thinspiration"
Nursing Interventions for eating disorder
- Safety first- (looking at if suicidal)/cardiac screening
- Medical and physical needs above all else
- work with client on a meal plan/nutritional needs
- monitor- tracking weight, if they're eating, etc
- things to know and what to do: what nurses and staff need to be aware of
Milieu Therapy: Goals for Bulimic
Primary Goal: interruption of binge/purge cycle (this allows underlying feelings to surface/be examined) and prevention of the disordered eating behaviors
- observation during and after meals to prevent purging
- normalization of eating patterns
- maintenance of appropriate amounts of exercise are integral elements of tx
Milieu Therapy: Goals for Anorexia
- normalize eating patterns and begin to address issues raised by illness
- organized to assist the pt in establishing more adaptive behavioral patterns, including normalization of eating
-provides precise mealtimes
-adherence to selected menu
-observation during and after meals
- regularly scheduled weighing
- close supervision of pt includes trips to bathroom and after eating to ensure no self induced vomiting
Which of the following is an example of all or nothing thinking, which is a frequent cognitive distortion of patients with an eating disorder?
A. If i allow myself to gain weight, Ill become immense
B. Im unpopular because I'm fat
C. When I'm thin I'm powerful
D. When ppl say i look better, they're really thinking i look fat
Out of the choices provided the BEST answer that is an example of all-or-nothing thinking is: #1 "If I allow myself to gain weight, I'll become immense."
Typical goals of inpatient hospitalization for an anorexic patient do not include:
A. Stabilization of patient's immediate condition
B. Limited weight restoration
C. Determination of the causes of the eating disorder
D. Restoration of normal electrolyte balance
C. Determination of the causes of the eating disorder
Which patient with an eating disorder would be at greatest risk for hypokalemia? A patient with...
A. Anorexia who loses weight by restricting food intake
B. Anorexia or bulimia who purges to promote weight loss
C. Bulimia whose predominant pathological behavior is excessive nocturnal eating
D. An eating disorder who exercises intensely more than four hours per day but maintains a normal electrolyte balance
B anorexia or bulimia who purges to promote weight loss
Which medication is likely to be used in the treatment of patients with eating disorders? An:
A. SSRI such as fluoxetine
B. Antipsychotics such as risperidone
C. Anxiolytic such as alprazolam
D. Anticonvulsant such as carbamazepine
A. SSRI such as fluoxetine
Fluoxetine (Prozac) has been regarded as the "gold standard" in the treatment of bulimia as it has a very favorable side effects compared to other pharmacological agents. Be cautious of risk of suicide
Which of the following is least likely to contribute to building an effective therapeutic alliance between the nurse and an anorectic patient?
A. Establishing disciplined eating through the nurse's authoritarian approach with the patient.
B. Avoiding the stance of a parental role in order to foster a sense of empowerment.
C. Offering a highly structured approach in treating severely underweight patients.
D. Contracting with the outpatient person about treatment terms
A. Establishing disciplined eating through the nurse's authoritarian approach with the patient.
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