What are 4 types of eating disorders?
- Anorexia nervosa
- Bulimia nervosa
- Obesity (not in DSM 5)
- Binge-eating disorder (BED)
Who is anorexia nervosa predominately in?
girls and women, 12-30 years old
What is more prevalent: Bulimia nervosa or anorexia nervosa?
Bulimia nervosa
What is the onset of bulimia nervosa?
Late adolescence or early adulthood
What is obesity defined as?
BMI of 30 or greater
What disorder: morbid fear of obesity and a grossly distorted body image
Anorexia nervosa
Anorexia nervosa patients have a _________ and a refusal to ___
Preoccupation with food; refusal to eat
T/F: Anorexia patients may experience amenorrhea
Anorexia nervosa
What are anorexia patients obsessed with?
Food
- talk about it, cook it, exchange recipes, etc…just don’t eat it!
- as a nurse, don’t talk about food with them!!
What are co-morbid disorders that go with anorexia?
Anxiety and depression
What is weight % of anorexia?
15% or more under ideal weight
Anorexia patients look ______.
Emaciated
look like cancer pts, concentration camp people, etc.
Anorexia: Hypothermic or hyperthermic?
Hypothermic
Anorexia: Bradycardia or tachycardia?
Bradycardia
Anorexia: Hypotension or hypertension
Hypotension
Why do anorexic patients have edema?
Low protein
What kind of hair do anorexia patients have?
Lanugo (fine hair on skin–like babies)
Dry, brittle hair
What color is anorexia patients skin?
Yellow
Do anorexia patients experience constipation or diarrhea more?
Constipation
T/F: Anorexia patients can get HF.
True
Anorexia patients have normal or abnormal labs? How is their electrolyte balance? What about muscles?
Abnormal labs
Electrolyte IMBALANCE
Muscle WEAKNESS
What is a characteristic of the diagnosis of anorexia nervosa? A. Obsession with weight gain B. Body image disturbance C. Disregard for the feelings of others D. Healthy family relationships
B. Body image disturbance
What eating disorder: binging followed by purging
Bulimia
How do bulimia patients rid body of excess calories?
Self-induced vomiting
Bulimia patients do self induced vomiting. How else may the rid the body of excess calories?
May misuse laxatives, diuretics, and/or enemas
Do bulimia patients ever fast?
Yes, they may
Do bulimia patients exercise?
Yes, may excessively exercise
What are comorbid disorders with bulimia?
Depression
Anxiety
Substance abuse
What is weight like for bulimia?
Normal to slightly low weight
Bulimia patients may have ______ from all the acid they’ve purged
Dental erosion
What kind of edema do bulimia patients have and why?
Parotid edema; food particles get stuck in those parotid glands when they are throwing up
They look like chipmunks
*they also have peripheral edema
Why would bulimia patients have calluses on their hands?
Due to sticking fingers down throat
Why do bulimia patients have low Na and K labs?
Lose Na during throw up
Lose K during diarrhea
What kind of heart problem do bulimia patients have? (3)
Cardiomyopathy, ECG changes, cardiac failure
Anoriexia patients have muscle weakness. Do bulimia patients have that too?
Yes
Which assessment finding would the nurse expect in clients diagnosed with bulimia? A. Below normal weight B. Binge when they experience hunger C. Will be highly motivated to seek help D. Are within their normal weight range
D. They are able to maintain a normal weight by purging after binging
Obesity patients are increased risk for what?
- Diabetes
- Heart disease (hyperlipidemia)
- Resp. insufficiency
- Osteoarthritis
The DSM-5 identifies binge eating disorder as _______
An eating disorder that can lead to obesity
What happens with BED?
The individual binges on large amounts of food (as in bulimia) but DIFFERS from bulimia in that the individual does NOT engage in behaviors to rid the body of the excess calories
What are some nursing diagnosis for eating disorders? (5)
- Imbalanced nutrition: less than body requirements
- Deficient fluid volume
- Ineffective denial
- Disturbed body image/low self esteem
- Anxiety (moderate to severe)
A client is 5’8 tall and weights 105 lbs. The client has been taking laxatives daily, and self induces vomiting after eating. Which is the priority nursing diagnosis for this client?
A. Ineffective denial
B. Disturbed body image
C. Low self esteem
D. Imbalanced nutrition: less than body requirements
D.
Eating disorders: Planning
- Stabilize patient ___
- ____ increments
- Address issues underlying ____
- What are the realistic goals?
- What is the goal?
- Stabilize pt. MEDICALLY
- SMALL increments
- Address issues underlying EATING DISORDER
- Gain 2-3 lbs/week
- Goal: Normalize eating habits!
Eating disorders: Implementation
- When do they get weighed?
- How long do you stay with patient after meals?
- Ok to exercise?
- Explain what?
- Weighed: Early AM after voiding (use same scale)
- Stay with pt. 30min-1hr after meals
- Limit exercise
- Explain PRIVILEGES AND RESTRICTIONS
Implementation:
- Establish?
- Ok to argue or bargain with them?
- Promote what feelings?
- Help them develop what?
- Encourage them to what?
- Trust
- Dont argue or bargain
- Promote feelings of CONTROL
- Help them develop a REALISTIC PERCEPTION OF SELF
- Verbalize feelings
What are some cognitive-behavioral therapies for eating disorders? (4)
- Cognitive reframing
- Relaxation techniques
- Journal writing
- Desensitization exercises
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions are appropriate for the nurse to include in the assessment? (SATA)
A. What is your relationship like with your fam?
B. Why do you want to lose weight?
C. Would you describe your current eating habits?
D. At what weight do you believe you will look better?
E. Can you discuss your feelings about your appearance?
A, C, E