Chapter 16: Eating Disorder
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| Categories of Eating Disorders | 1. anorexia nervosa 2. Bulimia nervosa 3. Eating disorders NOC 4. Binge eating disorder
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| characteristics of anorexia nervosa | 1. extreme fear of gaining weight 2. low wt 3. binge eating/purging 4. decrease in food intake
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| Characteristics of bulimia nervosa | 1. repeated episodes of binge eating and compensatory action:
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| How is compensatory actions performed after binge eating in bulimia nervosa? | 1.self-induced vomiting 2.use of laxatives 3.diuretics 4. fasting 5. extreme exercise
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| Characteristics of Eating Disorder NOC | significant disturbance in the perception of body shape and wt but they do not meet the criteria for anorexia nervosa or bulimia
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| Binge eating disorder | repeated episode of binge eating after increased stress but no compemsatory actions
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| Rate of eating disorder is higher in which ethnic groups? | 1. Caucasian 2. Native Americans 3. Hispanics ---- lower in African Americans
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| Age of onset of Eating Disorder is what? | early teens to mid-twenties or ealier
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| Major cause of death among people affected by eating disorder is... | suicide
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| Comorbidity related to eating disorder | 1. depressoin 2. seizure 3. OCD 4. anxiety, social phobias 5. personality disorders -- Cluster C personality with anorexia 6. substance abuse 7. sexual abuse
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| Cluster C personality is seen in patient with which type of eating disorder? | anorexia nervosa
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| what is the S&S of cluster C personality? | 1. avoidant 2. dependent 3. OCD - also seen with bulimic pts 4. passive aggressive
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| what are some etiology of eating disorder | 1. biological - genetic (seen in twin studies) 2. neurobiological - serotonin function r/t appetite, mood, impulse control 3. psychological factors - learned behavior 4. Environmental factors - cultural influences, media
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| Tryptophan is significant in relationship to eating disorder because? | it is amino acid essential to serotonin synthesis -- antidepressants that usually boost serotonin levels do not improve mood symptoms until after an underweight patient has been recovered 90% (tryptophan consumption through diet is important!)
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| What other personality traits may exhibit in pt with eating disorders? | 1. perfactionism 2. obsessive-compulsive 3. dysphoric mood
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| Possible signs and symptoms of anorexia nervosa | 1. low wt 2. amenorrhea 3. anemia 4. muscle weakness 5. lanugo 6. yellow skin (hypercarotenemia) 7. cold extremities 8. peripheral edema 9. constipation 10. abn lab values (low T3/T4) 11. abn CT/EEG 12. low BP/P and HF 13. abn RF 14. low K+/C
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| What is the dx criteria for anorexia nervosa? | 1. refusal of wt gain/wt less than 85% of expected body wt 2. intense fear of gaining wt 3. disturbed self-view of wt/shape 4. postmenarcheal amenorrhea
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| what are subtypes of anorexia nervosa? | 1. binge eating/purging type -recurrent 2. restricting - no recurrent binge eating or purging
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| What is the dx criteria for bulimia nervosa? pt1 | 1. recurrent episodes of binge eating a. eating in a discrete period - large quantity b. a sense of lack of control over eating 2. inappropirate compensatory behavior 3. compensatory behavior occuring at least twice a week for 3 months
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| What is the dx criteria for bulimia nervosa? pt2 | 4. body shape and wt influenced self-evaluation 5. no disturbance during anorexia nervosa episodes
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| What are specific types of bulimia? | 1. purging - vomiting, diuretics, laxatives 2. non-purging - heavy exercise, fasting
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| Diagnostic criteria for eating disorder NOS pt.1 | criteria not meeting anorexia and bulimia 1. female: all the criteria for anorexia nervosa are met except that the individual has regular menses 2. All met except pt's wt is normal in range 3. all for bulimia met but binge
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| Diagnostic criteria for eating disorder NOS pt.2 | 4. reapeatedly chewing and spitting out, not swallowing 5. binge eating disorder - recurrent but no compensatory behaviors
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| Physical criteria for anorexia for hospital admission | 1. wt lsos 30%< over 3 month 2. rapid decline in wt 3. inability to gain wt 4. H.R <40bpm 5. hypothermia <96.8 6. S. BP: <70 7. Hypokalemia <5 8. ECG changes
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| Psych criteria for anorexia admission | 1. suicidal/self-mutilating behavior 2. extreme use of laxative, emetics, diuretics 3. noncompliance 4. severe depression 5. psychosis 6. family crisis
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| Nursing care in acute eating disorder phase | 1. establish trust 2. monitor eating patterns 3. med interventions 4. psychosocial intervention/assess suicidal ideation 5. health teaching 6. Milieu management
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| Pharmacological interventions of anorexia | not specific approved by FDA for anorexia - SSRI used for OCD s&s after maintenance wt - antipsychotics work sometimes
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| Cognitive distortions observed in pt with anorexia | 1. overgeneralization - he doesn't like me bc i'm fat 2. all-or-nothing thinking if I eat, I will blow up like a balloon ;; 3. catastrophizing - magnified event 4. personalization - people like me bc im thin 5. emotional reasoning- fat bc I feel fat
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| examples of SSRI used | fluoxetine (prozac) - used to control OCD symptoms after maintenece wt reached - conventional antipsychotics - thorazine - delusional/overactive - atypical (olanzapine/zyprexia) - mood and dec OCD/resistance to wt gain
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| Milieu management of anorexia | 1. used to establish adaptive behavior patterns - normal eating patterns .. achieved by adherence to the menu, wt monitoring/bathroom uses .. privilages linked to wt gain/adherence to tx
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| Factors affecting the stage of recovery | 1. % of wt gained 2. extent of self-worth defined by shape and wt 3. disruption existing in the pt's personal life
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| Bulimia nervosa __________ apear to be physically or emotionally ill | do not
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| What would you find on inspection with pt with bulimia? | 1. enlargement of parotid gland 2. dental erosion 3. caries
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| PHx findings of Pt with bulimia | OCD; family crisis...
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| Thoughts and behaviors associated with bulimia | 1. binge eating 2. compensatory actions 3. hx of anorexia nervosa 4. depressive s/s 5. interpersonal, self-concept, impulsive problems 6. inc. anxiety/compulsivity 7. sub abuse 8. impulsive stealing
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| Clinical presentaion of bulimia | 1. normal to slight low wt 2. caries, tooth erosion (HCl reflux) 3. parotid swelling - inc amylase lvl 4. gastric dilation/rupture 5. calluses, scars on hand 6. p.edema 7. electo imbalance 8. CV abn 9. C. failure - Ipecac intox
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| what is Russell's sign? | callus of knuckles from self-induced vomiting
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| Acute care and milieu management of bulimia nervosa | interruption of the binge-purge cycle, preventio nof disordered eating behaviors through cognitive-behavioral model; normal eating habits, exercise, managing conflicts and perceptions
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| pharmacological interventions of B.N | antidepressent together with cognitive bahavior psychotherapy --- SSRIs/TCAs -- prozac to prevent relapse --wellbutrin contraindicated with purgers (seizures)
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| Psychotherapy is used for bulimia nervosa to correct | faulty perceptions and helping individuals develop accepting attitues toward themselves
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| Diagnostic criteria for binge eating disorder (compulsive overeating) | 1. recurrent binge eating - eating too long/large 2. binge eating assciated with -- eating too rapid -- too full - eating but not hungry - eating alone - disgusted/guilty 3. marked distress 4. at least 2days/wk; 6month 5. no compensation
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| psychological characteristics of binge eaters | atypical depression - affective and personality disorder
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| Treatment for binge eating disorder (eating disorder NOS) | high dose of SSRI - short term - TCA, appetite suppressors, antiepileptic --- cognitive-behavior therapy, behavioral, dialectical behavioral, interpersonal therapies
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