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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)
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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
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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
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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.
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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 ***
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Treatments for eating disorders
anorexia/bulimia
- 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
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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
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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
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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
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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
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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
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What is the challenge of treating multiple anorexic pts together?
They may learn strategies to maintain anorexia from each other.
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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
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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
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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
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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
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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
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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
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