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Eating Disorder (ATI Ch. 18)
Terms in this set (58)
Client is preoccupied with food and the rituals of eating, along with voluntary refusal to eat. morbid fear of obesity and a refusal to maintain a minimally normal body wight. body weight is less than 85% of expected normal weight for the individual. in the bases of a physical cause.
Anorexia (2 types)
restricting and binge-eating/purging type
Anorexia restricting type
the individual drastically restricts food intake and does not binge or purge. one of the two types of anorexia
Anorexia binge-eating/purging type
the individual engages in binge eating or purging behaviors. one of the two types of anorexia
clients recurrently eat large quantities of food over a short period of time (binge eating), which may be followed by inappropriate compensatory behaviors, such as self-induced vomiting (purging) to rid the body of the excess calories. most clients who have bulimia nervosa maintain a weight within normal range or slightly higher.
Anorexia Nervosa (age)
This condition occurs most often in females from adolescence to young adulthood. predominately in ages 12 to 30 years of age
Bulimia nervosa (age)
the average age of onset in females is 15 to 18 years of age. Most commonly in females but onset generally occurs between 18 and 26 years of age.
Bulimia nervosa (2 types)
purging and non-purging type
Bulimia nervosa purging type
the client uses self-induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight. Is one of the two types of bulimia nervosa
Bulimia nervosa non-purging type
the client may also compensate for binge eating though other means, such as excessive exercise and the misuse of laxatives, diuretics, and/or enemas. is one of the two types of bulimia nervosa
Binge eating disorder
clients recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa. Affects men and women of all ages but is most common in adults age 46 to 55.
binge eating disorder (weight gain)
The weight gain is associated with binge eating disorder increases the client's risk for other disorders, including type 2 diabetes mellitus, hypertension and cancer. Mortality rate for eating disorder is high and suicide is also a risk.
binge eating disorder (Comorbidities)
Include depression, personality disorders, substance use disorder and anxiety.
binge eating disorder (Treatment)
Treatment modalities focus on normalizing eating patterns and beginning to address the issue raised by the illness. Comorbidities include depression, personality disorders, substance use disorder and anxiety.
eating disorder (risk factors)
family genetics, biological, interpersonal relationships, psychological influences, environmental factors, individual history, participation in athletics and history of obesity.
eating disorder (genetics)
family genetics more commonly seen in families who have a history of eating disorders.
eating disorder (biological)
hypothalamic, neurotransmitter, hormonal, or biochemical imbalance, with disturbances of the serotonin neurotransmitter pathways seeming to be implicated.
eating disorder (interpersonal relationship)
influenced by parental pressure and the need to succeed.
eating disorder (psychological influences)
rigidity, ritualism; separation and individuation conflict; feeling of ineffectiveness, helpless, and depression; distorted body image; internal or external locus of control or self-identity; and potential history of physical abuse.
eating disorder (environmental factors)
media influence and pressure from society to have the "perfect body" culture of abundance.
eating disorder (individual history)
has a history of being a picky eater in childhood or a history of obesity.
eating disorder (athletics)
in elite level of competition or in a sport where lean body build is prized (bicycling) or where a specific weight is necessary (wrestling)
eating disorder (S&O data)
clients perception of the issue, eating habits, history of dieting, methods of weight control (restricting, purging, exercising), value attached to a specific shape and weight. Interpersonal and social functioning. Difficulty with impulsivity as well as compulsivity. Family and interpersonal relationships (frequently troublesome and chaotic, reflecting a lack of nurturing.)
eating disorder objective (mental status)
client demonstrates high interest in preparing food, but not eating. Terrified of gaining weight, perception of severely overweight and sees this image reflected in the mirror, low self-esteem, impulsivity, and difficulty with interpersonal relationships, need for an intense physical regimen. Client may experience guilt or shame due to binge eating behavior.
eating disorder (cognitive distortion)
overgeneralization, all or nothing, catastrophizing, personalization and emotional reasoning.
other girls don't like me because I'm fat
all or nothing
if I eat any dessert, I'll gain 50 pounds
my life is over if I gain weight
when I walk through the hospital hallway, I know everyone is looking at me
I know I look bad because I feel bloated
eating disorder (vital signs)
low blood pressure with possible orthostatic hypotension. Decreased pulse and body temperature. Hypertension may be present in clients who have binge eating disorder.
Anorexia nervosa (weight)
have a body weight that is less than 85% of expected normal weight. Clients who have binge eating disorder are typically overweight or obese.
Bulimia nervosa (weight)
have a weight within the normal range or slightly higher.
Eating disorder (hair)
client who have anorexia nervosa may have fine, downy hair (lanugo) on the face and back; yellowed skin; mottled, cool extremities; and poor skin turgor.
Eating disorder (neck&mouth)
enlargement of the parotid gland (if the client has bulimia nervosa). Dental erosion and caries (if the client is purging).
Eating disorder (cardiovascular)
irregular heart rate (dysrhythmias noted on cardiac monitor), heart failure, cardiomyopathy and peripheral edema.
Eating disorder (musculoskeletal)
Eating disorder (gastrointestinal)
constipation, self-induced vomiting and excessive use of diuretics or laxatives.
Eating disorder (acute care criteria)
rapid weight loss or weight loss of greater than 30% of body weight over 6 month. Unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract. Vital signs demonstrating heart rate less than 40/min, systolic blood pressure less than 70 mm Hg, body temperature less than 36C or 96.8F. ECG changes, electrolyte disturbance. Psychiatric criteria-severe depression, suicidal behavior, family crisis, or psychosis
is common among those who have bulimia nervosa. A direct loss of potassium due to purging (vomiting). Dehydration stimulates increased aldosterone production, which leads to sodium and water retention and potassium excretion.
eating disorder (lab test)
Anemia and leukopenia with lymphocytosis, impaired liver function, evidenced by increased enzyme levels. elevated cholesterol, abnormal thyroid, elevated carotene levels (yellow skin), decreased bone density (osteoporosis), abnormal blood glucose level and ECG changes.
eating disorder (electrolyte)
this type of imbalance associated with bulimia nervosa is common and may depend on the client's method of purge. Laboratory abnormalities in hypokalemia, hyponatremia and hypocholremia.
eating disorder (screening tools)
eating disorder inventory, body attitude test, diagnostic survey for eating disorders and eating attitude test.
eating disorder (nursing care me)
perform self-assessment regarding possible feeling of frustration regarding clients eating behaviors, the belief that the disorder is self-imposed, or the need to nurture rather than care for the client.
eating disorder (1 nursing care)
provide highly structured milieu in an acute care unit for the client requiring intensive therapy. Develop a trusting nurse/client relationship through consistency and therapeutic communication. use a positive approach and promote client self-esteem and positive self-image. encourage client decision making and participation in the plan of care to allow for a sense of control. Establish realistic goals for weight loss or gain. 1
eating disorder (cognitive-behavioral therapies)
cognitive reframing, relaxation techniques, journal writing and desensitization.
eating disorder (2 nursing care)
monitor the clients vital signs, intake and output and weight. Use behavioral contracts to modify client behavior. Reward client for positive behaviors, such as completing a meal or consuming a set number of calories. monitor closely to prevent purging after eating, may have to accompany client to the bathroom. monitor for appropriate exercise. Teach and encourage self-care activities. incorporate the family in client education and discharge planning. 2
eating disorder (3 nursing care)
work with a dietitian to provide nutrition education to include correcting misinformation regarding food, meal planning, and food selection. consider the client's preferences and ability to consume food when developing the initial eating plan. A structured and inflexible eating schedule at the start of therapy, only permitting food during scheduled times, promotes new eating habits and discourage bing or bing-purge behavior. 3
eating disorder (4 nursing care)
provide small, frequent meals, which are better tolerated and will help prevent the client form feeling overwhelmed. provide diet high in fiber to prevent constipation. provide diet low in sodium to prevent fluid retention. Limit high-fat and gassy foods during the start of treatment. Administer a multivitamin and mineral supplement. 4
eating disorder (caffeine)
Instruct the client to avoid caffeine to reduce the risk for increase energy, resulting in difficulty controlling eating disorder behaviors. Caffeine also can be used by clients a substitute for healthy eating.
eating disorder (5 nursing care)
make arrangements for the client to attend individual, group, and family therapy to assist in resolving personal issues contributing to the eating disorder. 5
eating disorder (mediations)
SSRI's such as fluoxetine (prozac)
eating disorder (mediation considerations)
instruct the client that medication may take 1 to 3 weeks for initial response, with up to 2 month for maximal response. Instruct the client to avoid hazardous activities. Instruct the client to notify the provider if sexual dysfunction occurs and is intolerable.
eating disorder (team work)
a registered dietitian should be involved to provide the client with nutritional and dietary guidance. Consistency of care among all staff is important.
eating disorder (after discharge care)
assist client to develop and implement a maintenance plan related to weight management. Encourage follow-up treatment in an outpatient setting. Encourage client to participate in a support group and continue individual and family therapy as indicated.
is the potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to a severely malnourished client.
refeeding syndrome (nursing actions)
care for the client in a hospital setting, consult with the provider and dietitian to develop a controlled rate of nutritional support during initial treatment. Monitor serum electrolytes, and administer fluid replacement as prescribed.
cardiac (nursing actions)
cardiac dysrhythmias, severe bradycardia and hypotension. Nurse need to place the client on continuous cardiac monitoring, monitor the client's vital signs frequently and report changes in the client's status to the provider.
THIS SET IS OFTEN IN FOLDERS WITH...
ATI Mental Health
Depressive Disorders ATI
Personality Disorder (ATI Ch. 15)
Psych ATI - Eating Disorders
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