Nutrition & Addiction
Anxiolytics for anorexia
-small amounts -may help pts w/ eating if given just before meals when refeeding is occurring
Pts w/ anorexia deliberately refuse to maintain normal body weight d/t what?
intense fear of gaining weight even when dangerously underweight
When type of onset occurs in bulimia?
later onset
What is the initial treatment for bulimia?
medical stabilization and then psychotherapy
Risk factors for anorexia:
-adolescents females (10-19 y/o) -caucasian -childhood sexual/physical abuse
S/S of bulimia
-binge eating followed by compensatory behavior -tooth and gum deterioration -scaly skin -Russell sign -normal body weight -F/E imbalance -swollen salivary glands -menstrual irregularities
What are the F/E imbalances associated w/ bulimia that are significant only if pt is purging?
-dehydration -hyponatremia -hypocholremia -hypokalemia -metabolic alkalosis
Severe S/S of anorexia:
-extreme weight loss -F/E imbalance -lanugo (thin hair) -dry/flaky skin -perfectionism -powerlessness/fatigue -rigid food rituals -amenorrhea -low sex drive/low testosterone -cold intolerance -low vitals
Risk factors for bulimia
-female -late adolescence (15-19 y/o) -childhood sexual/physical abuse -childhood obesity -may develop after anorexia or after a period of dieting
Severe anorexia
BMI 15-15.99
Moderate anorexia
BMI 16-16.99
Extreme anorexia
BMI <15
When teaching a group of adolescents about anorexia nervosa, the nurse should describe this disorder as being characterized by which factors? A. Excessive fear of becoming obese, near-normal weight, and self-critical body image B. Obsession w/ the weight of others, chronic dieting, and an altered body image C. Extreme concern about dieting, calorie counting, and an unrealistic body image D. Intense fear of becoming obese, emaciation, and a disturbed body image
D. Intense fear of becoming obese, emaciation, and a disturbed body image
A community health nurse working with a group of 5th grade girls is planning a primary prevention to help the girls avoid developing eating disorders during their teen years. The nurse should focus on which factor? A. working with the school nurse to closely monitor the girls' weight during middle school B. limiting the girls' access to media images of very thin models and celebrities C. tell the girls' parents to monitor their daughter's weight and media access D. helping the girls accept and appreciate their bodies and feel good about themselves
D. helping the girls accept and appreciate their bodies and feel good about themselves
For pts w/ eating disorders, finding the source of anger or coping skills is NOT the priority. What comes first?
Physical health first, then mental/psychosocial second
What is refeeding syndrome?
a F/E, mineral and metabolic disturbance/shift from extracellular to intracellular spaces that results from introducing nutrition too rapidly to someone who has been starving
FOR MALES: dieting or bingeing is more often r/t what?
a desire to build a lean body for participation in sports ex: competing in a lower weight class in wrestling
What diagnostic abnormalities may show for pts w/ bulimia?
abnormalities in peripheral 5-HT uptake
How does tooth and gum deterioration happen with bulimia?
acid in vomit damages tooth enamel
Mild bulimia
an average of 1-3 episodes of inappropriate compensatory behaviors per week
Many individuals with bulimia also have what other eating disorder?
anorexia
Pts w/ anorexia believe that the nurse's purpose is simply to make them gain weight. So how is the nurse perceived by the pt?
as an enemy *not an ally unlike bulimic pts who are more likely to want help*
How do small, skinny clients w/ anorexia see themselves?
as overweight/obese when in fact they are below minimum weight
How often must the 3 behaviors of bulimia be present?
average of at least once per week, for a minimum of 3 months
Patients with bulimia may start off a binge by eating "marker" food and then vomit until this food comes back up. Why is this ineffective?
b/c food is quickly mixed in the stomach
Before beginning the refeeding program, what must the RN assess?
baseline weight, electrolyte status, BG levels, and vital signs
A nurse is teaching a pt w/ bulimia nervosa about scheduling healthy, balanced meals to avoid what?
binge-purge cycles
Russell sign
callusing of the knuckles of the fingers used to induce vomiting
Why should pt admitted for malnutrition avoid exercise?
can cause organ damage
Why does osteopenia/osteoporosis occur for pts w/ anorexia?
d/t prolonged amenorrhea and malnutrition *bone mass loss might be irreversible if the anorexia goes on long enough*
What is anorexia?
eating disorder causing clients to obsess over their weight and what they eat
How is diagnosis made for pts w/ BED?
episodes occur at least once a week for 3 months
For family therapy, if the family denies the problem or is not supportive of treatment, then what may need to be done?
family might be temporarily excluded from the treatment team
For pts w/ bulimia, it is important for RN to check for what?
hidden binging or purging--hidden or trashed food wrappers, laxative boxes in the trash
What is the most common type of foods eaten during a binge with patients experiencing bulimia?
high-calorie, high carbohydrate "snack" food easily ingested in a short period
It is important for RN to monitor F/E imbalances for pts w/ bulimia, specifically what kind d/t risk for cardiac dysrhythmias?
hypokalemia
What is binge-eating disorder (BED)?
periods of rapid and enormous amounts of food consumption with inability to stop/lack of control during a discrete period of time (w/in 2 hours) and DOES NOT purge afterwards
Atypical antipsychotic (olanzapine) for anorexia
promotes weight gain
Pts on a renal diet need to restrict what?
protein, b/c it's a big molecule and makes it harder for kidneys to work
What is bulimia?
recurrent episodes of uncontrolled binge eating followed by self-induced vomiting/purging, use of laxatives, diuretics, excessive exercise and fasting as a way to prevent weight gain
What may be reinforced by positive attention from others for pts w/ anorexia?
rejecting food and losing weight
RESTRICTIVE or VOMIT/PURGER: More often young people in the normal or slightly above normal weight range for height and build before the eating disorder begins
restrictive
RESTRICTIVE or VOMIT/PURGER: may participate in rigid exercise programs to help reduce their weight
restrictive
RESTRICTIVE or VOMIT/PURGER: often withdraw to their rooms and avoid family and friends
restrictive
RESTRICTIVE or VOMIT/PURGER: tend to become hyperactive to lose weight, becoming highly anxious and unable to relax ex: may take an early morning walk d/t insomnia and a need to burn off calories
restrictive
RESTRICTIVE or VOMIT/PURGER: views losing weight as more probable if they simply eat less and avoid social situations in which they are expected to eat
restrictive
Bupropion may be used for what type of pts w/ bulimia?
that do not purge (they use laxatives, etc instead)
How are pts w/ anorexia treated?
through outpatient settings, but may need hospitalization if severe malnutrition occurs
What do patients with bulimia promise themselves after a binge?
to adhere to a strict diet and vow to never binge again *only to return to behavior b/c they find themselves addicted to the high they experience when bingeing*
TRUE or FALSE: anorexia has the highest death rate of all mental health disorders d/t suicide
true
TRUE or FALSE: anorexia is characterized by a distorted body image and fear of being overweight
true
TRUE or FALSE: bulimia includes persistent concern with body image, although body image is usually not distorted
true
TRUE or FALSE: it is important for pts w/ bulimia to keep a food diary during hospitalization
true
TRUE or FALSE: pts w/ BED may participate in excessive exercise but does not purge
true
RESTRICTIVE or VOMIT/PURGER: commonly deny concerns about weight and typically eat normal in social situations ex: after the meal, they retreat to the nearest bathroom and purge themselves of the consumed food, although the amount is not excessive
vomit/purger
RESTRICTIVE or VOMIT/PURGER: dental problems are of concern b/c the acidic vomitus decays the enamel on their teeth
vomit/purger
RESTRICTIVE or VOMIT/PURGER: more often overweight before the eating disorder begins, and their weight tends to fluctuate
vomit/purger
What are the types of binge eating followed by compensatory behavior?
-purging -exercise -enemas -fasting -laxatives -ipecac syrup
What are the interventions used to treat BED?
-reduce excessive exercise -CBT
What are the 2 types of anorexia?
-restrictive -vomit/purger
What is the purpose of SSRIs (fluoxetine) for pts w/ bulimia?
-safer and more effective than anxiolytics -reduces bingeing, purging, and depression -effective in both depressed and non depressed pts -short term use
Why is hospitalization needed in extreme cases for BED?
-to treat problems caused by severe malnutrition -to ensure that severely underweight patients are eating -to establish new eating patterns in supportive environment
A diagnosis of bulimia includes a minimum of ___ binge eating episodes per week for at least 3 months
2
The nurse is planning an eating disorder protocol for hospitalized clients experiencing bulimia and anorexia. Which elements should be included in the protocol? SATA A. Clients must eat within view of staff member B. Clients are not told their weight and cannot see their weight while being weighed C. Clients must rest within view of staff member for one-half hour to an hour after eating D. Clients may not go to the bathroom for one-half hour to an hour after eating E. Clients cannot participate in any groups after admission until they gain 1 lb
A. Clients must eat within view of staff member B. Clients are not told their weight and cannot see their weight while being weighed C. Clients must rest within view of staff member for one-half hour to an hour after eating D. Clients may not go to the bathroom for one-half hour to an hour after eating
A young adult female client is Brough to the emergency department by her roommate to seek treatment for GI problems. The client reveals that she attends college and works at a coffee shop each evening. A diet hx indicates that the client has unhealthy eating habits, commonly eating large amounts of carbohydrates and junk food with few fruits and vegetables. "Her stomach is upset a lot." The roommate says. She further reports that the client is "in the bathroom all the time." Which referral is most important for the nurse to make for the client? A. a mental health clinic B. a weight loss program C. an overeating support group D. the client's HCP
A. a mental health clinic
Extreme bulimia
An average of 14 or more episodes of inappropriate compensatory behaviors per week
Moderate bulimia
An average of 4-7 episodes of inappropriate compensatory behaviors per week
Severe bulimia
An average of 8-13 episodes of inappropriate compensatory behaviors per week
A client diagnosed w/ bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. What should the nurse do next? A. schedule daily family therapy sessions B. enroll client in a coping skills group C. work with the client to limit her purging D. obtain a PRN prescription for lorazepam to reduce binge eating urges
B. enroll client in a coping skills group
Mild anorexia
BMI >17
What is the purpose of anxiolytics for pts w/ bulimia?
decreases anxiety that fuels bingeing and purging
Why may bulimia develop after anorexia or after a period of dieting?
dieting predisposes the individual to binge eating, and purging develops as a means of compensating for calories ingested during the binge in attempt to prevent weight gain
Is there a psychopharmacologic agent approved specifically for anorexia?
no
TRUE or FALSE: the anxiety present before the binge is replaced with guilt after the binge in patients with bulimia
true
How do pts w/ BED feel after bingeing?
uncomfortably full, eats along to avoid embarrassment, and feels disgusted
What are the primary objectives in treating pts w/ anorexia?
-increasing weight to at least 85-90% of the average body weight for the pt's height -helping pts reestablish appropriate eating behavior -increasing self esteem, so pts do not need to attain the perfection that they believe thinness provides
ipecac syrup
-induces vomiting -dangerous/fatal cardiomyopathy can result
Severe S/S of anorexia: extreme weight loss
-less than 75% of expected weight -25% below normal weight
Severe S/S of anorexia: low vitals
-low temperature -low BP -low HR
S/S of anorexia:
-malnutrition -performing vigorous exercise -use of diet supplements and laxatives -might engage in bizarre behavior such as hoarding food or preparing elaborate meals for others but not eating the food they prepare -constipation if not using laxatives -osteopenia/osteoporosis
Severe S/S of anorexia: F/E imbalance
-monitor for hypokalemia d/t risk for cardiac dysrhythmias
What are the complications of BED?
-obesity/overweight -high cholesterol -DM2 -heart disease
If pt is admitted for malnutrition, then what does RN need to monitor?
-strict record of protein and calorie intake -stay w/ the client during each meal and 1 hour after -morning weights prior to oral intake -help the client identify triggers -NO exercise -monitor for refeeding syndrome
How long do you monitor pt with bulimia for after each meal to prevent purging?
1 hour
Bulimia is characterized by what 3 behaviors?
1. Recurrent episodes of binge eating 2. Continuing inappropriate compensatory behaviors to avoid weight gain 3. An elevation of self that is significantly influenced by body weight and shape
Patients with BULIMIA or ANOREXIA are more likely to want help?
Bulimia
The parents of an adolescent client newly admitted with anorexia nervosa are meeting with the nurse during the admission process. Which remarks should the nurse interpret as typical for parents of a client w/ anorexia nervosa? A. "We've given her everything, and look how she repays us!" B. "She's had behavior problems for the past year both at home and at school" C. "She's been a model child. We've never had any problems with her" D. "We have five children, all normal kids with some problems at times"
C. "She's been a model child. We've never had any problems with her"
A client newly diagnosed with bulimia is attending the nurse-led group at the mental health center. She tells the group that she came only b/c her husband said he would divorce her if she did not get help. Which response by the nurse is appropriate? A. "You sound angry with your husband. Is that correct?" B. You'll find that you like coming to group. These people are a lot of fun." C. "Tell me more about why you're here and how you feel about that." D. "Tell me something about what has caused you to be bulimic."
C. "Tell me more about why you're here and how you feel about that."
A hospitalized adolescent diagnosed w/ anorexia nervosa refuses to comply with her daily before breakfast weigh-in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse's best response to the client? A. "You're here to gain weight so that will work in your favor" B. "Don't drink or eat for 2 hours, and then I'll weigh you" C. "You must weigh in everyday at this time. Please step on the scale" D. "If you don't get on the scale, I'll be forced to call your HCP"
C. "You must weigh in everyday at this time. Please step on the scale"
An adolescent client is being admitted with an eating disorder. Which initial assessment finding is of greatest concern for the nurse? A. a systolic BP of 100 mmHg B. a weight loss of 10% over 6 months C. a potassium level of 2.5 mEq/L D. a HR of 57 bpm
C. a potassium level of 2.5 mEq/L
A nurse works w/ a client diagnosed w/ bulimia. What is the most appropriate long-term client goal for this client? A. eat meals at home without bingeing or purging B. be able to eat out without bingeing or purging C. manage stress in life without bingeing or purging D. be able to attend college without bingeing or purging
C. manage stress in life without bingeing or purging
What is the most effective therapy for pts with bulimia?
CBT
TRUE or FALSE: refeeding syndrome can result in severe CV and neurologic complications d/t the too rapid replacement of calories
true
TRUE or FALSE: refeeding syndrome typically occurs at the beginning of treatment when pts are reintroduced to a health diet
true
RESTRICTIVE or VOMIT/PURGER: prone to dangerous methods of weight reduction, such as induction of vomiting or excessive use of laxatives or diuretics
vomit/purger
What is the focus for the acute phase of treatment for anorexia nervosa?
weight restoration
What type of onset occurs in pts w/ anorexia?
early onset
What are the primary objectives in treating bulimia?
-stabilizing weight without purging -helping pts reestablish appropriate eating behavior -increasing self esteem, so pts do not need to attain the perfection that they believe thinness provides
A nurse is working with a client w/ bulimia. Which goals should be included in the care plan? SATA A. the client will maintain normal weight B. the client will comply w/ medication therapy C. the client will achieve a positive self-concept D. the client will acknowledge the disorder E. the client will never have the desire to purge again
A. the client will maintain normal weight B. the client will comply w/ medication therapy C. the client will achieve a positive self-concept
The nurse discovers that an adolescent client w/ anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do first? A. Explain to the client how diet pills can jeopardize health B. Listen to the client discuss of losing control of eating while being treated C. Talk with the client about how weight loss worry the HCPs D. Inquire about worries of the client's family concerning the client's health
B. Listen to the client discuss of losing control of eating while being treated
