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Ch 32

Mr. D's Eating Disorders

Body image is subjective
Body image is based on the personal perception of self and the reactions of others
Eating disorders are a direct result of perceived body image disturbances
Eating disorders have a deep rooted psychological aspect
Intervention (for eating disorders) is imperative
Mortality rate for eating disorders is high and suicide is also a risk.
True or False? You have to be underweight to have an eating disorder. False
True or False? Only teenage girls and young women are affected by eating disorders. False. 90% women. 10% men
True or False? People with eating disorders are vain. False
True or False? Eating disorders are not that dangerous. False
Eating disorders have the ______ mortality rate of any mental illness. highest
Anorexia nervosa occurs predominantly in females between the ages of 12 to 30
Less than ___% of cases are men. 10%
Anorexia is characterized by a fear of obesity
Symptoms of anorexia nervosa: hypothermia, depression, weight loss, irregular periods, hording food, anxiety, brittle dry hair and nails, fine body hair growth, malnourished, muscle wasting, weakness, severe constipation
2 diagnostic criteria for anorexia nervosa: Binge/purge. Restricting.
Binging Eating a lot of food at one sitting.
Purging Self induced regurgitation or vomiting after eating.
Restricting type Self induced food restriction. < 300-400 calories per day.
Developmental risk factors with anorexia nervosa: May have issues with control.
Family risk factors for anorexia nervosa: Controlling, Strict household with High Expectations.
Bulimia An episodic, uncontrolled, compulsive rapid ingestion of large quantities of food over a short period of time(binge), followed by extreme measures to rid the body of excess calories(purge).
Bulimia is _____ prevalent than anorexia. more
The average age of onset for bulimia nervosa is 15-18
Patients with bulimia nervosa control calories by: diuretics, laxatives, exercise, enema, vomiting
Weight fluctuations are common, however most bulimics are _______ normal weight range. within
Developmental risk factors for bulimia nervosa issues with autonomy
Family risk factors for bulimia nervosa: Too much autonomy. Chaotic, unstructured, permissive, loose household. No one cares about/for you.
Symptoms of bulimia nervosa: Misuse of laxatives, diuretics, and enemas. Live in fear of gaining weight. Preoccupied with body shape and weight. Tooth decay. Eating past point of discomfort.
When conducting a personal history on a client with an eating disorder, you will find that the client with anorexia and bulimia are often described as perfectionists with above-average intelligence and being achievement oriented. They are focused on pleasing others.
General appearance, Anorexia: tired, thin, malnourished, wearing clothes that are 2-3x's larger than normal
General appearance, Bulimia: Look normal
Mood and affect, Anorexia: depression, unhappy, alone, flat bland facial expression
Mood and affect, Bulimia: cheerful, happy, good communication skills, superficial, guilty
Judgment and insight, Anorexia: Very poor insight, very poor self judgment. Still believe that they are fat.
Judgment and insight, Bulimia: Good insight about self problems.
Self-Concept, Anorexia and Bulimia: low self esteem
Labs to check for eating disorders. hypokalemia, anemia and leukopenia, decreased bone density, abnormal thyroid function, abnormal blood glucose, ECG
2 diagnostic criteria for bulimia nervosa: Purging. Non purging.
Nursing Dx for eating disorders: 1 (most important)Imbalanced nutrition less than body requirements. 2 Disturbed body image.
Anorexia diet: Water(6-8 glasses). Protein(lean meat, eggs, vegetables, protein shakes). Multivitamins.
Medications for eating disorders: SSRI
Care after discharge for eating disorders? Encourage client to develop and maintain ___ program. dietary
Care after discharge for eating disorders? Encourage follow-up treatment in an __ setting. outpatient
Care after discharge for eating disorders? Encourage client participation in a ___ _____. support group
Care after discharge for eating disorders? Continue ___ and ___ therapy. individual and family
Criteria for inpatient treatment includes: Rapid weight loss greater than ___% of body weight over ___ months. 30% over 4 months.
Criteria for inpatient treatment includes: Severe ___ depression
Criteria for inpatient treatment includes: ____ behavior suicidal
Criteria for inpatient treatment includes: Unsuccessful weight ____ in ____ treatment gain outpatient
Treatment modalities for eating disorders. ____ modification. behavior
Treatment modalities for eating disorders. ___ therapy. individual
Treatment modalities for eating disorders. f____ therapy. family
Obesity is not considered a ___ disorder. psychiatric
Genetics: When both parents are obese, there is an __% chance that the offspring will be obese. 80%
Treatment for anorexia nervosa. Reinforce __ behavior. +
Treatment for anorexia nervosa. Educate to inform due to ___ deficit. knowledge
Treatment for anorexia nervosa. Participation in ___ choice. food
Biological influences of eating disorders: Hypothalmus. Serotonin & NE
Psychodynamic causes of eating disorders: Strict controlling family & sexual abuse.
Eating disorders begin and peak in ____ years. teenage high school
Anorexia is ____ common. less
Bulimia is ____ common. more
Anorexia people look ___. emaciated
Bulimic people look ___. normal
Anorexia people are ___ weight. under
Bulimic people may be at ___ weight. normal
Anorexic people are ___ to detect. easy
Bulimic people are ___ to detect. hard
Eating disorder treatments: Patient Focused PERCEPTION OF FOOD. Preoccupied with food and weight. Focus on eating habits. Nutrition meal plan. Include choices in meal plans.
Eating disorder treatments: Treatment of Depression INVOLVE IN ACTIVITIES(keep 'em busy). Anxiety. Find out origin of depression(abuse, bullying, molested). Build trust. Medication(SSRI).
Eating disorder treatments: Restoration of Function ASSES ROLE PRIOR TO DISORDER. Back to baseline(if lose job, find another one). Monitor I&O. Daily and nightly weigh-in. Assist in resume making. Act like a social worker.
Eating disorder treatments: Group Therapy Long term maintenance. Peer relationships, around people who have been there and done that.
Eating disorder treatments: Family Involvement Talk to family about child's eating disorder.
Nsg Dx: Imbalanced nutrition. S & Sx Weight loss. Poor skin turgor. Bradycardia. Hypotension. Cardiac arrhythmias.
Nsg Dx: Imbalanced nutrition. Nsg Ax Determine nutritional requirements. Explain behavior modification plan. Daily weigh-ins and I&O. Asses skin turgor and mucous membranes. Stay with client during meals and 1hr after meals.
Nsg Dx: Imbalanced nutrition. Outcomes Client gains 2-3lbs per week. Nourished and hydrated. Adequate calories. No food stash. No self-induced vomiting.
Nsg Dx: Disturbed body image. S & Sx Distorted body image. Self-depreciating thoughts. Need to excel. Need to prove self to others. Depressed mood. Anxiety. Thoughts of possible failure.
Nsg Dx: Disturbed body image. Nsg Ax Help client develop realistic perception of body image. Allow client independent decision-making. Give + feedback. Help client accept self. Convey knowledge that perfection is unrealistic.
Nsg Dx: Disturbed body image. Outcomes Client acknowledges that image of body as "fat" is a misconception. Client verbalizes positive self-attributes.
Some obese individuals take amphetamines to suppress appetite and help them lose weight. What is an adverse effect associated with amphetamines? Tolerance.
Psychoanalytically, the theory of obesity relates to the individual's unconscious equation of food with: Nurturance and caring.
From a physiological point of view, the most common cause of obesity is probably: More calories consumed than expended.
Nancy, 14yr, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? Imbalance nutrition: Less than body requirements.
What is a physical manifestation that you would expect to asses in a client suffering from anorexia nervosa? Bradycardia, hypotension, hypothermia.
Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the appropriate response by the nurse? "If you continue to refuse to take food orally, you will be fed through a nasogastric tube."
Which medication has been used with some success in clients with anorexia nervosa? Fluoxetine (Prozac).
Jane is hospitalized on the psychiatric unit. She has a history and current diagnosis of Bulimia Nervosa. Which symptoms would be congruent with Jane's diagnosis? Binging, purging, normal weight, hypokalemia.
A hospitalizes client with Bulimia Nervosa has stopped vomiting in the hospital in the hospital and tells the nurse she is afraid she is going to gain weight. What is the most appropriate response by the nurse? "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment."
The binging episode is thought to involve: A release of tension, followed by feelings of depression.
Created by: Sanctus Verus