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49 Cards in this Set
- Front
- Back
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Population at risk across the lifespan for eating disorders
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Older adults-78% of those who die from AN are >65
Middled aged women-400% increase in past 10 years. Often it is recurrence of disease. Adult men-also develop "reverse anorexia" a.k.a. "muscle dysmorphia" -Children and adolescents-85% of eating disorders have onset prior to age 20 |
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Role of Neuroendocrines in eating disorders
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AN: increased cortisol in CSF, decreased dopamine regulation, hypothalmic disorder
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Role of Neurochemicals in eating disorders
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AN: increase in endogenous opioids in CSF
BN: 5HT and NE involvement Both decreased serotonin -Seem to respond to SSRI treatmet, but it only lasts for awhile |
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Role of genetics in eating disorders
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AN: more commmon in sisters and mothers than in general population
AN & BN: increased incidence of first degree relative with mood DO BN: increased incidence of relatives with substance abuse/dependance |
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Potential psychodynamic etiologies of eating disorders
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-Unfulfilled sense of separation-individuation
-Deficits in autonomy -Deficits in personal identity |
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What are some of the psychological factors that may cause eating disorders?
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Psychodynamic:
-Unfulfilled sense of separation-individuation -Deficits in autonomy -Deficits in personal identity Cognitive-Behavioral: -Learning and conflict theory -Eating and binging, brings a sense of relief -Learn behavior from others |
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What are some of the common family dynamics that may cause eating disorders?
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-Conflict avoidance
-Rigidity -Overprotectiveness -Enmeshment -Addictive behavior in family -OCD and phobias -One parent is more controlling than the other -Closed off and guarded |
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What are some common personality traits that you might find with someone who has an eating disorder?
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-Identity struggles
-Immature -Low self-esteem -Don't ever disagree -Poor self-concept -Very serious -Perfectionism -Mood instability -Poor boundaries -Low impulse control -Social phobia -Over-control of emotions |
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What is Anorexia Nervosa (AN)?
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-SELF STARVATION
-Delusional disturbance of body image -Pursuit of thinness -Intense fear of weight gain |
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What is the Epidemiology of AN?
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-More frequentin females
-0.5-1.0% late adolescent/early adult meet full criteria -Onset often associated with stressful event -Course and outcome variable -Long-term mortality 10% -Most prevalent in industrialized societies |
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What are some predisposing factors for AN?
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-Ambivalent mother-daughter relationships
-History of family problems/difficulties -Rigid, controlling style -Family inability to display feelings -Conflict resolution skills lacking (Family needs to be involved in recovery process, if that occurs) |
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What are the cinical features of AN?
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-Severe and profound weight loss
-Obssessive-compulsive traits -Overachiever, perfectionist -DENIAL, repression, regression -Use of innappropriate compensatory behaviors -Amenorrhea (and other medical complications) -BMI < 17.5 -Less than 85% of ideal weight |
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What are some innapropriate compensatory behaviors of eating disorders?
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-Misuse of medications (laxatives, enemas, diuretics, syrup of ipacec)
-Excessive exercise -Fasting -Self-induced vomitting |
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What is the diagnostic criteria of Anorexia Nervosa?
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-Refusal to maintain body weight
-Intense fear of gaining weight -Disturbance in the way in which one's body weight or shape is experienced -Post-menarcheal females-amenorrhea -Specify subtype: *Restricting *Binge eating/purging |
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What is Bulimia Nervosa(BN)?
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-Binge purge syndrome
-Episodic rapid consumption of large amounts of food in a short time -Followed by innapropriate compensatory behaviours |
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What is the epidemiology of BN?
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-1-3% of adolescents and young adult females
-90% females/10% males -Males with BN, have often been priorly obese |
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What are some predisposing factors of BN?
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-Aspirations of sports careers
-Sexual abuse-particularly in bulimia -Family History: *eating disorders *affective disorder *substance abuse -Previous obesity |
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What are the clinical features of BN?
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-Binging episodes 2x weekly to several tmes a days
-Food often high in calories (20,000-30,000 per day) -Usually high in fat, calories, sugar -Binging/purging done in secret -Approximate 'normal' weight |
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What are the different types of bulimia?
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Purging:
-Self-induced vomitting -Diuretics -Laxatives -Enemas Non-Purging: -Fasting -Excessive exercise |
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What is the diagnositc criteria for BN?
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-Recurrent episodes of binge eating
-Recurrent innappropriate compensatory behaviors -3 months (average 2x week) -Self-evaluation unduly influenced by body shape/weight |
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Eating Disorder NOS
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-Meets all criteria EXCEPT patient has regular menses
-Meets all criteria EXCEPT weight is in normal rang -Meets all criteria for BN EXPECT for the time requirement -Regular use of innappropriate compensatory behaviors by an individual of normal weight after eating small amounts of food -Repeatedly chewing and spitting out food -Binge eating disorder |
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How is obesity defined?
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-Not classified as an eating disorder
-20% above ideal weight -Morbid obesity is 100% of ideal weight -U.S. dietary guidelines define overweight as 25.5-29.9 -WHO defines obesity as BMI of 30 or greater |
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What is the epidemiology of obesity?
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-80% of obese children have obese parents
-<5% of childhood obesity is attributed to underlying medical condtions |
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Percentage of Obesity Across the Lifespan
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-Prepubescent 25-35%
-Adolescent 18-25% -Adult: 59% female 69% male |
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What are some contributing factors for obesity?
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-Calorie intake consistently exceeds requirements
-Genetics -Medical disease-thyroid -Socio-cultural-some cultures are bigger, celebrating holidays with food -Psychological-attachments to food, pleasure, bored, lonely |
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What are the increased risks associated with obesity?
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-Psychosocial-fat kid getting picked on
-HTN, CAD, CVA, DM, colorectal cancer -Orthopaedic problems -Weight affects respiratory capacity, so they are fatigued and become more inclined to inactivity |
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What are some reasons that a client with eating disorder might be admitted to the hospital?
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-Below 20% or above 40% of ideal weight would lead to increased physical problems
-Below 40% or above 100% of ideal body weight = potential life threatenting problems |
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What are some of the medical complications of AN, BN and binge eating disorders?
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-Amenorrhea-->estrogen deficiency
-Osteoporosis-drop in estrogen leads to depleted levels of calcium -Hypothermia-hypometabolism: Low HR, BP, temp -Dehydration - laxatives, not drinking or eating -Malnutrition -Endocrine deficiences-decreased thyroid, decreased glucose |
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Medical Complications of Eating Disorders
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Gastric, esophogeal and stomach abnormalities (bleeding and ulcers)
-Dental problems -Parotid enlargement -Brittle nails, hair breakage, lanugo |
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Mental Health Complications of Eating Disorders
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-Depression/dysthymia
-Suicide (bulimia) -Psychosis (anorexia) -Obsessive Compulsive Disorder -Impulsivity, anxiety and substance abuse -Sexual Conflicts: Anorexic-asexual Bulimia-hypersexual, looking for validation by engaging in sexual activity |
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Subjective Assessment Health History
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-History of Eating Disorder
-Eating patterns -Food and/or weight preoccupation -Use of laxatives, diuretics and/or diet pills -Body weight distortion -Menstrual history -Sexual history |
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Subjective Assessment Health History Cont'
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-Exercise pattern
-Sleep pattern -Social functioning -Related mood disorders -Addictive behavior -Family functioning |
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Objective Assessment Health History
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-VS, weight
-Hair, nails, skin (scabbed knuckles) |
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Hospitilization is Necessary with:
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-Severe Malnutrition-40% below ideal weight
-Electrolyte disturbances-K+ of 3 or < = admission OR urine output of <30cc hr -Psychiatric distrubances -Arrythmias |
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Nursing Diagnosis:
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-Alterations in nutrition: Less than body requirements
-Disturbance in self-concept: Body image or Self-esteem -Ineffeective individual coping |
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Therapeutic Management: Focus of Interventions
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-Increase interventions
-Decrease self-hatred -Set reachable goals to counter perfectionism and profound sense of ineffectiveness -Begin to identify emotions counter inner emptiness |
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Therapeutic Management: Cognitive-Behavioral Techniques
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-Substitution: healthy alternative behaviors
-Visualization: positive mental images -Contracting: agreed upon rules and consequences (not being able to exercise if too skinny) -Reframing: substituting irrational beliefs -Reinforcement: reward/consequences (for maintaining, not purging) -Assertiveness training (never learned to be individual) |
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Therapeutic Management: Body Immage Enhancement
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-Assertiveness
-Confidence -Esteem |
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Therapeutic Management: Psychosocial Interventions
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-Nutrition and exercise counseling (normal behaviors)
-Health teaching about severity of disease -Group therapy/counseling -Milieu-safet, supervision, contracts -Family therapy/counseling-more involvement from family the better, sooner the diagnosis the better |
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Therapeutic Management: Pharmacological Intervention
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Antidepressants:
*SSRI's-usually the only one they use *TCA's-easy to overdose, so they must monitor *MAOI's(bulimia only-very effective Mood stabilizers *Lithium (bulimia only) |
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Therapeutic Management: Other misc medications
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-Anti-anxiety
-MVI's -Mineral and calcium supplements -Hormone replacement-used in young clients who are experiencing amenorrhea |
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Family Therapies
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Goal:Develop Adaptive Coping for Family
-Psycho-education -Insight orientated -Support Best Prognosis:Combination of Individual/Family/Group |
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Hypovolemia in Eating Disorders
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Use of diuretics, laxatives and vomitting lead to decreased plasma and intersitial fluid volume and decreased Na which leads to hypovolemia
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Edema in Eating Disorders
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Occurs from not eating properly and also purging; there is a water retention imbalance which causes the feet and hands to swell
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Hyponatremia in Eating Disorders
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-Use of diuretics, laxatives and vomitting lead to decreased plasma and intersitial fluid volume and decreased Na which leads to hypovolemia. Symptoms can include heart palpitations, cramping, and paralysis
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Hypokalemia in Eating Disorders
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Important to the function of the nerve and muscle cells, including the heart. Caused by excessive K+ loss with vomitting or excessive use of laxatives.
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Metabolic Acidosis in Eating Disorders
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-Laxative ---> HCO3 loss---> Metabolic Acidosis
-Nutritional Fasting---> Metabolic Acidosis |
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Water Toxicity in Eating Disorders
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Excessive O2 intake can lead to dilutional hyponatremia
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Metabolic Alkalosis
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Metabolic alkalosis results from either acid loss (which may be caused by severe vomiting or by the use of potent diuretics [substances that promote production of urine]) or bicarbonate gain (which may be caused by excessive intake of food
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