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24 Cards in this Set
- Front
- Back
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Anorexia description
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Morbid fear of obesity
Gross distortion of body image Preoccupation with food Refusal to eat foods with high fat or calorie value Wt loss = discipline; wt gain = failure Can lead to amenorrhea, cardiac arrest |
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Bulimia Description
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Fear of weight gain, dissatisfaction with body
Binging . High fat, high sweet food Secrecy Shame and guilt Compensatory actions: Induced vomiting Laxative use Diuretics Diet pills |
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Compulsive overeating description
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Binge eating
Depression, guilt Increasing weight Loss of control Same triggers as Bulimia Complications: hypertension, cardiac, type 2 diabetes, arthritis, clinical depression |
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Cognitive distortions involved in eating disorders
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Selective abstraction -“I’m still too fat; see my big hands and feet?”
Overgeneralization- “Only thin people get ahead in life.” Magnification -“If I gain 2 pounds, I won’t make the swim team.” Superstitious thinking -“If I lose weight, my boyfriend will love me.” Dichotomous thinking -“I’m not thin, I’m fat.” |
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Eating disorders often are accompanied by other mental illness
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depression (biological link)
mood disorders social phobia obsessive-compulsive disorder panic disorder substance abuse dissociative disorders borderline avoidant |
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Anorexia nervosa is an ego-________ disorder. This means:
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systonic.
Pt wants to not eat to feel thin, so she doesn't eat. |
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Bulimia nervosa is an ego-________ disorder. This means:
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dystonic.
Pt wants to not eat to feel thin, but she does opposite by eating. |
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Characteristic of pt with Anorexia
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Isolative
Perfectionist Competitive Academically successful People-pleasing Model child/person Deny their sexuality Affective instability emotionally reactive to external events poor coping skills to manage feelings Interoceptive deficits: inability to identify and respond to bodily sensations: * hunger * satiety * fatigue * pain |
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Physiological Sx r/t Anorexia
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bradycardia, hypotension, cardiac arrythmias, hypokalemia, hypocalcemia, hypoglycemia, amenorrhea, dehydration, lanugo, dry skin, hypothermia, hair loss, osteoporosis, constipation
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Physiological Sx r/t Bulimia
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bradycardia, hypotension, arrythmias, hypokalemia, hyponatremia, Irregular menses, hypoglycemia, dehydration, hoarseness, dental caries, enlarged parotid glands, constipation, esophagitis
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Interventions for eating disorders
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Safety first!!
Then work on physiological problems prevent self-harm promote nutritional restoration show the meaning of client’s behavior teach coping skills refocus attention |
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Interventions r/t refeeding procedure
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Offer a choice (food, supplements, IVs, tube feedings)
Prevent purging by monitoring client for 1 hour after eating Structured refeeding with clear expectations & consequences Positive reinforcement more effective than punishment Behavioral contracting/limiting setting to: Reinforce appropriate eating Prevent harmful behaviors (e.g. purging) |
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Refeeding procedure (threats)
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Pt eats 75% of her meal on Day 1 or she will receive 3 dietary supplements on Day 2.
Supplements will continue until pt eats 75% of meal. If supplements are not finished on day 2, pt tube fed on day 3. Tube feeding will continue until 75% of all meals are eaten for 1 day Client will be discharged if tube feeding is refused |
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Refeeding syndrome pathology
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Starvation causes fat/protein catabolism and muscle loss, with low insulin production. Refeeding (PN, “forced” meals) shifts back to carbohydrate metabolism with high glucose-> high insulin -> cellular uptake of glucose and electrolytes, esp. Mg, Ph and K, causing life-threatening depletion.
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S/S of Refeeding syndrome
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< K, Ph and Mg
Weakness, seizure, paresthesia, altered mental status, paralysis, tetany Myalgia Thrombocytopenia, platelet dysfunction, anemia, infections, bleeding Hypoxia Anorexia, abdominal pain, constipation, diarrhea Dysrhythmia, hypotension Edema, high BUN and creatinine Alkalosis, acidosis Vitamin deficiency, low albumin & prealbumin |
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Interventions for Refeeding syndrome
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Monitor lytes – get baseline
Assess VS Replete. Rehydrate Closely monitor refeeding rate Patient (& family) education Monitor especially K, MG and Ph daily for 1 wk or until stable Assess vitamin levels Meticulously record fluid in & out, and weight Monitor blood glucose levels Monitor for neuro S&S |
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Nursing Dx for eating disorders
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Imbalanced nutrition (more or less)
Deficient fluid volume (risk or actual) Disturbed body image Anxiety Depression Ineffective denial |
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Outcomes for eating disorders
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Maintained <= 80% of expected weight
Labs and vitals WNL Verbalizes importance of adequate nutrition and understanding of consequences of vomiting/laxatives/pills Verbalizes events triggering anxiety and shows techniques to reduce it Verbalizes ways to control the environment and reduce stress Expresses less preoccupation with self and appearance |
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Psychotherapy for eating disorders should focus on
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Body-image
Self-esteem/self-confidence Self-control Decision making Relationship with peers and family Build trust Explore perfection-seeking Firm, professional, compassionate approach Avoid power struggles Consistency is crucial |
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This therapeutic approach has been shown to be more effective with Bulimia
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Cognitive Behavioral
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T or F: There are many meds effective in treating Anorexia
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F. Pharmacological intervention has been disappointing
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________ have helped some anorexics reduce food anxiety
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Anxiolytics
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These meds are used to treat Bulimia
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SSRI's, MAOIs, Tricyclics, anxiolytics
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These meds are used to treat compulsive overeating
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SSRIs
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