s3 Unit 2 - Nutrition (anorexia nervosa/ bulimia nervosa)

Term 15 year old Teddy, who has a BMI in the obese category, arrived for his annual well visit at the PCP office. The nurse notices Teddy is limping and unable to place his weight on his left leg. What is the most common cause for this symptom in overweight or obese patients? - slipped capital femoral epiphysis - shin splints - laziness - sprained ankle

- slipped capital femoral epiphysis

Assessment for a patient with a maladaptive response to eating regulation shows: height: 5'3"; weight: 80 pounds; weight loss of 30% over the past 3 months; T: 96.6; BP: 68/40; P:40; R:20; poor skin turgor; lanugo; amenorrhea for 6 months; restricts intake to 350 calories daily; dissatisfied with eating pattern AEB statement, "I need to lose another 10 pounds to be at an ideal weight." These assessment findings are most consistent with the medical diagnosis of: 1. Bulimia nervosa 2. Anorexia nervosa 3. Binge-eating disorder 4. Disturbed body image

2. anorexia nervosa

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? 1 Interrupt the client and weigh her immediately. 2.Interrupt the client and offer to take her for a walk. 3.Allow the client to complete her exercise program. 4.Tell the client that she is not allowed to exercise rigorously.

2.Interrupt the client and offer to take her for a walk. Clients with anorexia nervosa frequently are preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise and place limits on rigorous activities. The correct option stops the harmful behavior yet provides the client with an activity to decrease anxiety that is not harmful. Weighing the client immediately reinforces the client's preoccupation with weight. Allowing the client to complete the exercise program can be harmful to the client. Telling the client that she is not allowed to complete the exercise program will increase the client's anxiety

Which would be treatment goals in anorexia nervosa? Select all that apply. One, some, or all responses may be correct. 1 The development of a calorie-restricted diet plan 2The development of a regular exercise schedule 3 The repairing of family interactions 4. The reinstitution of normal nutrition to counteract a state of malnutrition 5 The correction of deficits and distortions in psychological functioning via psychotherap

3 The repairing of family interactions 4. The reinstitution of normal nutrition to counteract a state of malnutrition 5 The correction of deficits and distortions in psychological functioning via psychotherap

The nurse is performing an assessment on a 16-year-old female client who has been diagnosed with anorexia nervosa. Which statement, made by the client, would the nurse identify as necessitating further assessment on a prioritybasis? 1. "I check my weight every day without fail." 2."I've been told that I am 10% below ideal body weight." 3."I exercise 3 to 4 hours every day to keep my slim figure. " 4."My best friend was in the hospital with this disease a year ago."

3."I exercise 3 to 4 hours every day to keep my slim figure Exercising 3 to 4 hours every day is excessive physical activity and unrealistic for a 16-year-old girl. The nurse needs to immediately assess this statement further to find out why the client feels the need to exercise this much to maintain her figure. It is not considered abnormal to check weight every day. Many clients with anorexia nervosa check their weight 20 times or more each day. A body weight 15% below the ideal weight or less is most significant with anorexia nervosa. Although it is unfortunate that the client's best friend had the disease, this is not considered a major threat to the client's physical well-being

The nurse is caring for a client with anorexia nervosa. Which behavior is characteristic of this disorder and reflects anxiety management? 1.Engaging in immoral acts 2.Always reinforcing self-approval 3.Observing rigid rules and regulations 4.Having the need always to make the right decision

3.Observing rigid rules and regulations Clients with anorexia nervosa have the desire to please others. Their need to be correct or perfect interferes with rational decision-making processes. These clients are moralistic. Rules and rituals help these clients manage their anxiety.

The nurse has developed a plan of care for a client diagnosed with anorexia nervosa. Which client problem would the nurse select as the priority in the plan of care? 1. Disrupted appearance because of weight 2.Inability to feed self because of weakness 3.Pain because of an inflamed gastric mucosa 4.Nutritional imbalance because of lack of intake

4. Nutritional imbalance because of lack of intake The priority client problem for the client with anorexia nervosa is lack of intake and nutritional imbalance since it is the basis of the condition. Although the problems identified in the other options may be considerations in the plan of care for the client with anorexia nervosa, nutritional imbalance is the priority

When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1.Providing a supportive environment 2.Examining intrapsychic conflicts and past issues 3.Emphasizing social interaction with clients who withdraw 4.Helping the client to examine dysfunctional thoughts and beliefs

4.Helping the client to examine dysfunctional thoughts and beliefs Cognitive behavioral therapy is used to help the client identify and examine dysfunctional thoughts and to identify and examine values and beliefs that maintain these thoughts. The remaining options, while therapeutic in certain situations, are not the focus of cognitive behavioral therapy

A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of bingeing. Which clinical manifestation is most important for the nurse to assess? A. Weight gain B. Dehydration C. Hyperactivity D. Hyperglycemia

B. The nurse should be alert for dehydration caused by fluid loss through vomiting in the binge-purge cycle. Weight gain is not expected because purging frequently follows a binge. Hyperactivity is not expected because many individuals with bulimia withdraw and vomit after a binge. Hyperglycemia is not expected because of the vomiting that follows a binge.

The nurse is preparing to administer a nasogastric tube feeding to a client via infusion pump. What is the most important assessment the nurse needs to perform before beginning the pump? A. Checking for the last bowel movement B. Checking for residual stomach contents C. Checking to determine time of last medication for nausea D. Checking to make sure the head of bed is elevated at least 15 degrees

B. Checking for residual stomach contents

A 16-year-old high school student who has anorexia nervosa tells the school nurse that she thinks she is pregnant even though she has had intercourse only once, more than a year ago. What is the most appropriate inference for the nurse to make about the student? A. Using magical thinking B. Submitting to peer pressure C. Lying about the last time she had intercourse D. Lacking knowledge that anorexia can cause amenorrhea

D The loss of body fat from anorexia can cause amenorrhea; the client needs information. No data are available to support the fact that the client is using magical thinking, which is characterized by the belief that thinking or wishing something can cause it to occur; in light of the client's diagnosis of anorexia, this is not the first conclusion. Submitting to peer pressure is not related to this type of concern. Although the nurse should question the timeline again, the client's nutritional status should be explored first.

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note? Select all that apply. 1.Dental decay 2.Moist, oily skin 3.Loss of tooth enamel 4.Electrolyte imbalances 5.Body weight well below ideal range

Dental decay Loss of tooth enamel Electrolyte imbalances

The nurse suspects that an adolescent has anorexia nervosa. Which characteristics may have been observed in the adolescent? Select all that apply. One, some, or all responses may be correct 1Denying illness 2 Dismissing food 3Seeking intimacy 4 Being extroverted 5.Maintaining rigid body control

Denying illness Dismissing food Maintaining rigid body control

During a home visit, the nurse suspects that a young daughter of the client is bulimic. The nurse bases this suspicion on which primarycharacteristics of bulimia? 1.Refusing to eat and excessive exercising 2.Eating only vegetables and fruits and fasting 3.Hoarding of food and difficulty controlling food intake 4.Eating a lot of food in a short period of time and misuse of laxatives

Eating a lot of food in a short period of time and misuse of laxatives Eating binges and purging are the characteristic that would be seen in bulimia. Eating only certain types of foods may reflect a preference but does not indicate bulimia. Bulimic persons usually do not refuse to eat; rather, they binge and purge. Hoarding of food may indicate another problem

Which drug is FDA approved for treating BN

Fluoxetine (Prozac)

Clinical Manifestations for anorexia nervosa (chest/thoracic/arms)

Low BP Lanugo-type hair

What is used to assess for eating disorder

SCOFF questionire Do you make yourself sick because you feel uncomfortably full? (2) Do you worry that you have lost control over how much you eat? (3) Have you recently lost more than 6.4 kg (14 pounds or one stone) in a 3-month period? (4) Do you believe yourself to be fat when others say that you are too thin? and (5) Do thoughts and fears about food and weight dominate your life?

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for (select all that apply) a. hypokalemia. b. hypoglycemia. c. hypercalcemia. d. hypomagnesemia. e. hypophosphatemia

a. hypokalemia. d. hypomagnesemia. e. hypophosphatemia

What is the physical manifestation of anorexia nervosa :

bradycardia hypotension hypothermia

Clinical Manifestations for bulimia nervosa ( cranium)

broken blood vessels salivary gland enlargement enamel erosion esophagitis dysrhythmias

Some obese individuals take amphetamines to suppress appetite and help them lose weight.Which of the following is an adverse effect associated with use of amphetamines that makes thispractice undesirable? a. Bradycardia b. Amenorrhea c. Tolerance d. Convulsions

c. Tolerance

bulimia nervosa

characterized by episodes of binge eating with inappropriate compensatory behaviors to avoid weight gain (vomiting, laxative misuse, overexercise)

Anorexia nervosa

characterized by restricting energy intake, difficulties in maintaining an appropriate weight, an intense fear of gaining weight or being fat, and distorted body image.

Clinical Manifestations for anorexia nervosa (cranium )

dizziness confusion hair losss enamel erosion

Clinical Manifestations for bulimia nervosa (mid section)

dysrhythmias callus on hand

Clinical Manifestations for bulimia nervosa (lower extremities)

edema in lower leg

Anorexia nervosa in clinic assessment:

fatigue low body temperature (interlace to cold) secondary amenorrhea

Abnormal laboratory values for BN

hypokalemia, metabolic alkalosis, and increased serum amylase

Lab values normally associate with anorexia nervosa

hypokalemia.,hypomagnesemia, hypophosphatemia

Manifestations of potassium deficiency

include muscle weakness, dysrhythmias, and renal failure. Leukopenia; hypoglycemia; and decreased sodium, magnesium, and phosphorus may be present.

Characteristics of Bulimia nervosa :

seeking intimacy being extrovert recognized illness impulsive

A clinic nurse is monitoring a client with anorexia nervosa. Which client statement should indicate to the nurse that treatment has been effective? 1."I'll eat until I don't feel hungry. " 2."I no longer have a weight problem. " 3."I don't want to starve myself anymore. " 4."My friends and I went out to lunch today."

" 4."My friends and I went out to lunch today." In anorexia nervosa, the client tries to establish identity and control by self-imposed starvation. The correct option is a measurable action that can be verified. The remaining options are verbalizations of the client's intentions

Which roommate choice is least appropriate for a client diagnosed with anorexia nervosa who is in a state of starvation? 1.A client with pneumonia 2.A client who had back surgery 3.A client with a fractured pelvis 4.A client who has had a myocardial infarction

1.A client with pneumonia The client who has been starving has a compromised immune system. Having a roommate with pneumonia would put the client at risk for infection. The other clients are acceptable because their health problems do not compromise the immune system of the client with starvation

Which assessments should the nurse closely monitor when caring for a hospitalized client diagnosed with bulimia nervosa? Select all that apply. 1.Electrolyte levels 2.Exercise patterns 3.Intake and output 4.Pupillary response 5.Elimination patterns 6.Deep tendon reflexes

1.Electrolyte levels 3.Intake and output 5.Elimination patterns The client with bulimia nervosa is likely to induce frequent vomiting and use diuretics and laxatives excessively. This places the client at risk for fluid and electrolyte imbalances. The nurse should monitor for both of these in this client. Excessive exercise is a characteristic of anorexia nervosa, not a characteristic of clients with bulimia. Changes in pupillary response and deep tendon reflexes are monitored in other disorders but are not associated with bulimia.

A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A newly admitted client will be assigned to this client's room. Which client would be the bestchoice as a roommate for the client with anorexia nervosa? 1.A client with pneumonia 2.A client undergoing diagnostic tests 3.A client who thrives on managing others 4.A client who could benefit from the client's assistance at mealtime

2.A client undergoing diagnostic tests The client undergoing diagnostic tests is an acceptable roommate. The client with anorexia nervosa is most likely experiencing hematological complications, such as leukopenia. Having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. The client with anorexia nervosa should not be put in a situation in which the client can focus on the nutritional needs of others or be managed by others, because this may contribute to sublimation and suppression of personal hunger.

A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior? 1.Normal behavior 2.Evidence of the client's disturbed body image 3.Regression as the client is moving toward the community 4.Indicative of the client's ambivalence about hospital discharge

2.Evidence of the client's disturbed body image Disturbed body image is a concern with clients with anorexia nervosa. Although the client may struggle with ambivalence and show regressed behavior, the client's coping pattern relates to the basic issue of disturbed body image. The nurse should address this need in the support group

The nurse monitors a client diagnosed with anorexia nervosa understanding that the client manages anxiety by which action? 1.Engaging in self-mutilating acts 2.Observing rigid rules and regulations 3.Always reverting to the independent role 4.Constantly striving to avoid making decisions

2.Observing rigid rules and regulations Clients with anorexia nervosa have the desire to please others. Rules and rituals help them manage their anxiety. Their need to be correct or perfect interferes with rational decision-making processes. These clients generally don't engage in self-mutilation.

When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1.Providing a supportive environment 2.Examining intrapsychic conflicts and past issues 3.Emphasizing social interaction with clients who withdraw 4.Helping the client to examine dysfunctional thoughts and beliefs

4.Helping the client to examine dysfunctional thoughts and beliefs. Cognitive behavioral therapy is used to help the client identify and examine dysfunctional thoughts and to identify and examine values and beliefs that maintain these thoughts. The remaining options, while therapeutic in certain situations, are not the focus of cognitive behavioral therapy

female athlete triad

eating disorders, amenorrhea, and osteoporosi

Clinical Manifestations for anorexia nervosa (Abd./lower extremities)

loss of menses stool retention dry brittle nails, muscle wasting, diminishing DTR, osteoporosis, dry skin

Common assessment findings for anorexia

malnutrition, extreme thinness, hypothermia, and muscle weakness

Anorexia bulimia clinical assessment:

metabolic alkalosis amenorrhea Vomitting