Eating Disorders

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  1. DSM-IV-TR definition of anorexia?
    • Refusal to maintain body weight for height
    • Weight 15%  under ideal body wt. Or 85% of what is should be
    • Fear of gaining weight & becoming fat
    • Denial of seriousness of low body weight
    • Females- amenorrhea**(Absence of 3 consecutive cycles)
  2. Eating habits of anorexia?
    • Consume 500 to 700 calories/day & often as few as 200 cal/day
    • Compulsive about eating habits
    • May eliminate all meat
    • May have bizarre food preferences
    • May cook for family to mask not eating
    • After eats, may go to bathroom to purge
    • May smoke to keep down appetite
  3. Theories of anorexia?
    • Psychoanalytic: conflict over one’s sexual role. 
    • Fears development.
    • Lose control over eating/do not accurately experience hunger/satiety
    • Distorted body image
    • Life out of control and controls self by not eating
    • Western socio-cultural: Values thinness
  4. Ways anorexics hide weight?
    • Overdoes exercise
    • Drinks water before weighing
    • Specific gravity measurements for water loading
    • Tapes quarters or objects under armpits
    • Puts things in underwear
    • Weigh in hospital gowns to prevent pt from weighing down clothing or hiding stuff in it. 
    • Watch slouching especially during height measurement. Get accurate height. 
  5. What are some medical complications related to anorexia?
    • CNS-decreased REM sleep
    • Cortical atrophy
    • Thermoregulation-  they feel cold
    • Renal- Hematuria, proteinuria
    • Hemotologic- Leucopoenia, anemia, decreased platelets
    • Increased cholesterol
    • Metabolic-  dehydration, acidosis,
    • Decrease in K+, Cl-, Ca++, phosphates., Mg,*** (Both anorexia & bulimia can lead to electrolyte imbalance)
    • Osteoporosis
    • Endocrine- decrease in luteinizing hormone & FSH, decrease in thyroid stimulating hormones
    • Deceased pulse
    • Bone loss
    • Postural hypotension
    • Arrhythmias
    • Muscle wasting, leads to sudden death as dysrhythmias
    • Falling off the growth curve for 2 years-underweight- are in greater danger of death ***
  6. Treatments for eating disorders
    • Medical consultation
    • Current body weight
    • Height and growth curve analysis
    • Nutritional consult
    • Assess eating pattern
    • Attitudes about food and weight
    • Nutritional consult
    • Assess distorted thoughts about food
    • Food preferences (may be vegetarian-easier to disguise
    • Psychology consult
    • Evaluate social &  emotional functioning  with peers & family
  7. Emotional/social ssessments for anorexia?
    • Distorted body image
    • Fear of being fat
    • States is fat despite malnourished state
    • Denies severity
    • Does severe exercise 
    • Enmeshed family patterns
  8. Physical assessments for anorexia?
    • Underweight 
    • Lanugo over body
    • Mottled cold skin
    • Low blood pressure, pulse, temperature
    • Dry mucous membranes
    • Absence of 3 or more menstrual cycles
    • Has hollow face, sunken eyes
    • Wears baggy clothing
    • Exhibits delayed psychosexual development
    • Fluid & electrolyte imbalance
  9. Interventions for anorexia?
    • Stabilize physical status first; then psychological
    • Hospitalization  at BMI less than 17 or Weight under 75%
    • Monitor food intake &   exercise 
    • Offer food preferences when possible
    • Monitor 2 hours after eating
    • Design an eating and exercise program
    • Administer medication & monitor side effects
    • --SSRI’s (to help treat underlying anxiety/depression)
    • --Trycyclics
    • --Antipsychotics for agitation & aggression
    • Body tracing: compares perceived body size by drawing imagined outline of body on paper, and then tracing the outline of their actual body in order to compare perception to reality.
    • Discuss starvation as self-destructive
    • Avoid coercing to eat
    • Provide careful praise for weight gain
    • Daily weight
    • Use liquid diets if needed (Boost)
    • Tube feedings
    • Hyperalimentation to restore electrolyte, fluid & nutritional balance
    • Encourage pt to view replacement therapy as medication
  10. What would you use cognitive restructuring for with an anorexic?
    • Preoccupation with food
    • Body image
    • Fear of getting fat
    • Need to be perfect 
    • Control issues
    • Fears of development
  11. What are the outcomes you want from anorexics?
    • Establish healthy eating plan
    • Demonstrate adequate weight for height/age
    • Provide for .5 to 3 pounds weight gain/week
    • Fluid and electrolyte balance
    • Good skin turgor, moist mucous membranes
    • Resumes normal menstrual cycles
    • Resumes normal sleep cycle
    • Maintains healthy exercise
    • Has a realistic body image
    • Verbalizes feels good about self
    • States no longer fearful of weight gain
    • Resolves control issues
    • Resumes sexual interest
    • Is no longer preoccupied with food
    • Resolves family enmeshment
  12. What is the challenge of treating multiple anorexic pts together?
    They may learn strategies to maintain anorexia from each other. 
  13. What is the DSM-IV-TR criteria for bulemia?
    • Within 2 hours:
    • Eats large amount of food
    • Lacks control over eating
    • Binge/purging 2 times weekly for 3 months
    • Recurrent  inappropriate compensatory behavior:
    • Self-induced vomiting
    • Misusing laxatives
    • Misusing diuretics, enemas or medications
    • Fasting
    • Excessive exercise
  14. What is some general process information about bulimia? 
    • Don’t have the severe identity problem anorexics do***
    • They know they have a problem
    • Binge on high fat, high carbohydrates easy to purge
    • Deceased protein intake
    • Around age 40 if not dealt with may not purge and can gain weight
    • Maintains relatively same weight
  15. What are some medical complications related to bulimia? 
    • Parotid swelling
    • Dental erosion
    • Callous on finger 
    • Esophagitis & tears
    • Chronic sore throat
    • Delayed gastric emptying
    • Gastric dilation
    • Pancreatitis
    • Muscle aching & cramping
    • Dehydration
    • Bad breath
    • Lightheaded
    • Fatigue
    • Puffy eyes and broken blood vessels 
    • Diarrhea, skin breakdown
    • Constipation without laxatives
    • Laxative abuse & laxative habit
  16. What are you assessing in bulimia?
    • Assess:
    • Binging & purging episodes
    • Precipitants
    • Use of laxatives, enemas, diuretics
    • Exercise 
    • Engagement in strict dieting/fasting to prevent weight gain
    • Weight stays relatively stable
    • Attempts to conceal binging/purging
    • Dental erosion
    • Fluid & electrolyte imbalance
  17. What outcomes do you want to see with bulimia?
    • Ceases binging/purging episodes
    • Maintains normal weight
    • Establishes an  exercise plan
    • States is comfortable with body weight
    • Eats nutritionally balance meals
    • States is in control of life
  18. interventions for bulimia?
    • Monitor for binging and purging
    • Eat foods harder to purge
    • Observe for 2 hours after eating
    • Limit sweet, soft or sugary foods easily purged
    • Discuss binge/purging as self-destructive
    • Develop coping strategies
    • Eat packaged food to count calories
    • Teach to cut food in small pieces & chew a lot
    • Establish healthy dietary & exercise plan 
    • Praise progress
    • Address self-esteem
    • Administer medications:
    • --Prozac and others (SSRIs)
    • Group therapy
    • Use cognitive therapy
    • Restructure negative thinking
    • Deal with guilt
    • Develop realistic beliefs about food & weight
    • Rispredal & Zyprexa are sometimes used for impulsivity
    • Use hospitalization & nutritional therapy as needed
Card Set
Eating Disorders
Mental Health
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