Eating Disorders (Anorexia, Bulimia, Obesity)

Cardiovascular manifestations in anorexia vs bulimia?

Anorexia - hypotension, thready pulse, dysrhythmias Bulimia - Dysrhythmias, broken blood vessels in eyes

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

Anorexia Nervosa

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

Bulimia Nervosa

BMI 19-24 BMI 25-29 BMI 30-39 BMI 39 +

Healthy Overweight Obese Super Obese

an excessively high amount of body fat or adipose tissue

Obesity

Abnormal diagnostic findings anorexia?

Osteopenia Iron-Def. Anemia (hgb, hct, serum iron) ↑ BUN Leukopenia ↓ potassium ↓ blood sugar ↓ sodium ↓ phosphorus ↓magnesium

Abnormal diagnostic findings bulimia?

↓ potassium metabolic acidosis ↑ serum amylase

3. 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. a. Denying illness b. Dismissing food c. Seeking intimacy d. Being extroverted e. Maintaining rigid body control

a. Denying illness b. Dismissing food e. Maintaining rigid body control Anorexia nervosa is a complex disorder that can result in morbidity and mortality. Denying the illness, dismissing food, and maintaining rigid control of the body are characteristics observed in adolescents with anorexia nervosa. Seeking intimacy and being extroverted are characteristics of bulimia nervosa.

5. Which behavior is seen in anorexia nervosa? a. Personalization and emotional reasoning b. Repetitive motor mechanisms c. Depersonalization and derealization d. Dirty clothes and disheveled appearance

a. Personalization and emotional reasoning Individuals with anorexia often overgeneralize (one event affects unrelated events), personalize (person is the center of events), or catastrophize (events are magnified). They are also prone to all-or-nothing thinking (events are good or bad) and emotional reasoning (emotions determine reality). Repetitive motor mechanisms are associated with autism. Depersonalization and derealization are associated with individuals with schizophrenia. Clients with eating disorders are usually meticulous about dress and physical appearance.

4. A female adolescent has anorexia nervosa and is malnourished and severely underweight. Which statement indicates that she is experiencing secondary gains from her behavior? a. "I'm huge; I'm as big as a house." b. "I get straight A's in all my subjects." c. "My mother keeps trying to get me to eat." d. "My hair is beginning to fall out in clumps."

c. "My mother keeps trying to get me to eat." The client's behavior has gotten the mother's attention; this is a secondary gain because it provides a sense of power and control. The adolescent verbalizes a disturbed perception about her body ("I'm huge"). Although clients with anorexia nervosa are concerned about social acceptance, perfectionism, and achievement, and may obtain high grades in school, good grades are not a secondary gain related to the eating behaviors associated with anorexia nervosa. Hair falling out in clumps is a result of starvation, not a secondary gain.

2. The nurse is caring for an underweight adolescent girl with a diagnosis of anorexia nervosa. Which common characteristics would the nurse recognize when obtaining a health history and performing a physical assessment? Select all that apply. One, some, or all responses may be correct. a. Fatigue b. Pyrexia c. Metabolic alkalosis d. Heat intolerance e. Secondary amenorrhea

a. Fatigue e. Secondary amenorrhea Fatigue results because inadequate nutritional intake results in electrolyte imbalances and a decreased red blood cell count. Many of these clients have lowered body temperature and are intolerant of cold. Bulimia (not anorexia) nervosa clients will present to the clinic with metabolic alkalosis due to frequent self-induced vomiting. Amenorrhea occurs because of endocrine imbalances resulting from starvation; it is thought that severe starvation damages the hypothalamus.

10. The nurse provides instructions to a group of adolescents about ways to prevent obesity. Which statements made by an adolescent indicates a need for further learning? Select all that apply. One, some, or all responses may be correct. a. "I should avoid trans fats." b. "I should limit portion sizes." c. "I should consume a high-fat diet." d. "I should eat highly refined starch food." e. "I should watch television for 4 hours only."

c. "I should consume a high-fat diet." d. "I should eat highly refined starch food." e. "I should watch television for 4 hours only." A high-fat diet should be avoided by adolescents. Highly refined starches and sugars should be avoided because they are rich in calories. Adolescents should be advised to watch less than 2 hours of television per day. Most dietitians and nutrition experts recommend a diet with no trans fats. Adolescents should limit portion sizes to improve body weight.

8. The nurse educates an obese adolescent about healthy dietary habits and risk associated with obesity. Which statement by the adolescent indicates the need for further counseling? a. "I should do exercise." b. "I should play more outdoor games." c. "I should watch more TV to reduce the stress." d. "I should modify my diet and have lots of vegetables and water."

c. "I should watch more TV to reduce the stress." The cause of obesity can be stress, but rather than watching TV to reduce stress, some other activities like dancing, which involve physical movements, can be done. Any type of physical exercise helps in fat burning. Playing outdoor games not only is a physical exercise but also helps reduce stress. Reducing the consumption of a fat-rich diet and replacing it with vegetables will reduce the amount of fat consumed by the adolescent, and drinking a high amount of water helps detoxify the body.

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

c. The repairing of family interactions d. The reinstitution of normal nutrition to counteract a state of malnutrition e. The correction of deficits and distortions in psychological functioning via psychotherapy Clients with anorexia nervosa have a strong fear of becoming overweight. This is characterized by reduced nutritional food intake, causing progressive weight loss and malnutrition. These clients usually have impaired family interactions due to low self-esteem. The treatment goals should consist of repairing family interactions, reinstituting normal nutritional meals, and correcting deficits and distortions in psychological functioning.

9. Which would the nurse consider before confronting the problem of obesity with individual children? a. Enjoyment of specific foods is inherited. b. Childhood obesity is not usually a predictor of adult obesity. c. Children with obese parents and siblings are destined for obesity. d. Familial and cultural influences are deciding factors in eating habits.

d. Familial and cultural influences are deciding factors in eating habits. Studies have shown that culture and family eating habits have an effect on a child's eating habits. Inheritance is not known to influence eating habits, although it is believed that hereditary factors may be associated with obesity. Childhood obesity is a known predictor of adult obesity. Although there is a trend toward asserting that children with obese parents and siblings are destined for obesity, with intervention this can be prevented.

6. Which conclusion would the school nurse make about a female teenager who has anorexia nervosa and states that she thinks she is pregnant even though she has had intercourse only once, more than a year ago? a. Is using magical thinking b. Is submitting to peer pressure c. Is lying about the last time she had intercourse d. Is lacking knowledge that the disease can cause amenorrhea

d. Is lacking knowledge that the disease can cause amenorrhea The nurse would make the conclusion that the client is lacking knowledge that the disease can cause amenorrhea. 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 might question the timeline again, the client's nutritional status would be explored first.

7. Which initial action would the nurse take for a young client with anorexia nervosa who phones home just before each mealtime and then refuses to eat food that has gotten cold? a. Insist that the client eat the food. b. Revoke the client's phone privileges. c. Hang up the phone when meals are served. d. Schedule a family meeting to discuss the problem.

d. Schedule a family meeting to discuss the problem. The initial action is to schedule a family meeting to discuss the problem. By talking to the client on the phone at mealtimes, the family is enabling the client to continue the self-destructive behavior; the client and family must be included in discussion of and possible solutions to the problem. Insisting that the client eat the food is a punitive approach that does not address the underlying problem and can provoke a power struggle between the nurse and client. Revoking the client's phone privileges is a behavior modification approach that may be used if talking to the family does not produce needed change. Hanging up the telephone when meals are served is a punitive initial approach that does not address the underlying problem.