Ch 18: Eating/Feeding Disorders QUESTIONS (Varcarolis Psych-Mental Health Nursing)

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: a."Do you often feel fat" b."Who plans the family meals" c."What do you eat in a typical day" d."What do you think about your present weight"

"What do you eat in a typical day"

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a.assess lung sounds and extremities. b.suggest use of an aerobic exercise program. c.positively reinforce the patient for the weight gain. d.establish a higher goal for weight gain the next week.

assess lung sounds and extremities

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by implementing which intervention?

teaching the family about the disorder and the client's behaviors

Describe Avoidant/Restrictive food intake disorder

Avoiding or restricting foods starting in childhood Significantly low B.M.I. Dependent on enteral feeding or experiencing nutritional deficiencies No distortion of body image Not medically explained or part of any other mental illness.

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate a."You and I will have to sit down and discuss this problem." b."It bothers me to see you exercising. I am afraid you will lose more weight." c."Let's discuss the relationship between exercise, weight loss, and the effects on your body." d."According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

"According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy a."What are your feelings about not eating foods that you prepare" b."You seem to feel much better about yourself when you eat something." c."It must be difficult to talk about private matters to someone you just met." d."Being thin doesn't seem to solve your problems. You are thin now but still unhappy."

"Being thin doesn't seem to solve your problems. You are thin now but still unhappy."

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis a."I am fat and ugly." b."What I think about myself is my business." c."I'm grossly underweight, but that's what I want." d."I'm a few pounds overweight, but I can live with it."

"I am fat and ugly."

Characteristics of Anorexia Nervosa

1. Intense fear of weight gain 2. Distorted body image 3. Restricted calories with significantly low B.M.I. 4. Sub-types: a. Restricting (no consistent bulimic features) b. Binge/eating/purging type (primarily restriction, some bulimic behaviors)

Identify 2 realistic outcome criteria for a patient with bulimia nervosa.

1. Cardiac pump supports systemic perfusion pressure; electrolytes are in balance 2. Congruence between body reality, body ideal, and body presentation; satisfaction with body appearance. 3. Demonstrates effective coping, reports decrease in stress, uses personal support system, uses effective coping strategies, reports increase in psychological comfort 4. Verbalizes a positive level of confidence, makes informed life decisions, expresses independence with decision-making processes 5. Willing to call on others for assistance, develops a confidant relationship, feels a sense of belonging.

Assessment Guidelines r/t Bulimia Nervosa

1. Determine the patient's perception of the problem, or chief complaint. 2. Perform a complete nursing assessment including VS, ROS, and general appearance 3. Gather a psychosocial history 4. Assess nutritional pattern and fluid intake 5. Assess binging and purging patterns with direct questions. 6. Assess daily activities including exercise 7. Review lab testing, including: Electrolyte levels Glucose levels Thyroid function tests CBC ECG 8. Elicit the patient's goals for treatment

Assessment Guidelines: Anorexia Nervosa

1. Determine the patient's perception of the problem, or chief complaint. 2. Perform a complete nursing assessment including vital signs, review of systems, and general appearance. 3. Gather a psychosocial history 4. Assess nutritional pattern and fluid intake 5. Assess daily activities including exercise 6. Review laboratory testing, including: Electrolyte levels Glucose levels Thyroid function tests CBC ECG 7. Elicit the patient's goal for treatments

Identify 2 realistic outcome criteria for a patient with anorexia nervosa.

1. Nutrients are ingested and absorbed to meet metabolic needs; cardiac pump supports systemic perfusion pressure; electrolytes are in balance; fluids are in balance. 2. Congruence between body reality, body ideal, and body presentation; satisfaction with body appearance. Demonstrates effective coping, reports decrease in stress, uses personal support system, uses effective coping strategies, reports increase in psychological comfort 3. Verbalizes a positive level of confidence, makes informed life decisions, expresses independence with decision-making processes

Characteristics of Bulimia Nervosa

1. Recurrent episodes of uncontrollable binging 2. Inappropriate compensatory behaviors: vomiting, laxatives, diuretics, or exercise 3. Self-image largely influenced by body image

Characteristics of binge eating disorder

1. Recurrent episodes of uncontrollable binging without compensatory behaviors 2. Binging episodes induce guilt, depression, embarrassment, or disgust

One bed is available on the inpatient eating disorders unit. Which patient should be admitted to this bed The patient whose weight decreased from: a.150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg b.120 to 90 pounds over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hg c.110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hg d.90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm Hg

150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg

Which statement is a nurse most likely to hear from a patient diagnosed with anorexia nervosa? a. "I would be happy if I could lose 20 more pounds." b. "My parents don't pay much attention to me." c. "I'm thin for my height." d. "I have nice eyes."

ANS: A Patients with eating disorders have distorted body images and cognitive distortions. They see themselves as overweight even when their weight is subnormal. "I'm thin for my height" is therefore unlikely to be heard from a patient with anorexia nervosa. Poor self-image precludes making positive statements about self, such as "I have nice eyes." Many patients with eating disorders see supportive others as intrusive and out of tune with their needs.

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Explore patient needs for health teaching. d. Assess for signs of impulsive eating.

ANS: A For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. The triggers are often anxiety-producing situations. Identifying these triggers makes it possible to break the binge-purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes the highest priority. The question calls for an intervention rather than an assessment.

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a. "I am fat and ugly." b. "What I think about myself is my business." c. "I am grossly underweight, but that's what I want." d. "I am a few pounds overweight, but I can live with it."

ANS: A Patients diagnosed with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually disclose perceptions about self to others. The patient with anorexia will persist in trying to lose more weight.

One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from: a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5° C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg

ANS: A Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36° C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

Physical assessment of a patient diagnosed with bulimia nervosa often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. amenorrhea.

ANS: A Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and are not usually observed in bulimia.

An outpatient diagnosed with anorexia nervosa has begun re-feeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a. assess lung sounds and extremities. b. suggest the use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.

ANS: A Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart's capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected. b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment. c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met. d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.

ANS: B A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient fears of a too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that the patient's needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.

What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs supervision? a. The nurse's comments are nonjudgmental. b. The nurse uses an authoritarian manner when interacting with the patient. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.

ANS: B In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assume the role of a parent. The helpful nurse uses a problem-solving approach and focuses on the patient's feelings of shame and low self-esteem. Referral to a self-help group is an appropriate intervention.

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to: a. eat a small meal after purging. b. avoid skipping meals or restricting food. c. concentrate oral intake after 4 PM daily. d. understand the value of reading journal entries aloud to others.

ANS: B One goal of health teaching is the normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to concentrate intake after 4 PM will lead to late-day bingeing. Journal entries are private.

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating disorder b. Anorexia nervosa c. Bulimia nervosa d. Pica

ANS: B Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. Pica refers to eating nonfood items.

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism

ANS: B Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients diagnosed with eating disorders. The incorrect options are rare in a patient with anorexia nervosa. Inflexibility, controlled emotions, and pessimism are more the norm.

Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of re-feeding. c. Communicate empathy for the patient's feelings. d. Help the patient balance energy expenditure and caloric intake.

ANS: B The nursing intervention of observing for adverse effects of re-feeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety and communicating empathy relate to coping. Helping the patient balance energy expenditure and caloric intake is an inappropriate intervention.

A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patient's oral intake, the nurse should ask: a. "Do you often feel fat?" b. "Who plans the family meals?" c. "What do you eat in a typical day?" d. "What do you think about your present weight?"

ANS: C Although all the questions might be appropriate to ask, only "What do you eat in a typical day?" focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patient's thoughts on present weight explores the patient's feelings about weight.

While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse should emphasize information about:a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. recognizing symptoms of hypokalemia. d. self-esteem maintenance.

ANS: C Hypokalemia results from potassium loss associated with vomiting. Physiologic integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the risk for hypokalemia.

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4 inches tall. Which condition should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stupor

ANS: C The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.

Which nursing diagnosis is more applicable for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements

ANS: D The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat are congruent with height, frame, age, and sex. b. Calorie intake is within the required parameters of the treatment plan. c. Weight reaches the established normal range for the patient. d. Patient expresses satisfaction with body appearance.

ANS: D Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This consideration is subjective. The other indicators are more objective but less related to the nursing diagnosis.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a. maintaining patients' concentration and attention. b. shifting the patients' focus from food to psychotherapy. c. focusing on weight control mechanisms and food preparation. d. processing the heightened anxiety associated with eating.

ANS: D Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients' focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patients' concentration and attention is important, but not the primary purpose of the schedule.

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a. weigh self accurately using balanced scales. b. limit exercise to less than 2 hours daily. c. select clothing that fits properly. d. gain 1 to 2 pounds.

ANS: D Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient. The focus of an outcome is not on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "Monitor for complications of re-feeding." Which body system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovascular

ANS: D Re-feeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment becomes a necessity to ensure patient physiologic integrity. The other body systems are not initially involved in the re-feeding syndrome.

Which assessment finding for a patient diagnosed with an eating disorder meets a criterion for hospitalization? a. Urine output: 40 ml/hr b. Pulse rate: 58 beats/min c. Serum potassium: 3.4 mEq/L d. Systolic blood pressure: 62 mm Hg

ANS: D Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 ml/hr. A potassium level of 3.4 mEq/L is within the normal range.

A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. "What are your feelings about not eating the food that you prepare?" b. "You seem to feel much better about yourself when you eat something." c. "It must be difficult to talk about private matters to someone you just met." d. "Being thin does not seem to solve your problems. You are thin now but still unhappy."

ANS: D The correct response is the only strategy that attempts to question the patient's distorted thinking.

A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is, "Within 2 weeks the patient will: a. appropriately express angry feelings." b. verbalize two positive things about self." c. verbalize the importance of eating a balanced diet." d. identify two alternative methods of coping with loneliness."

ANS: D The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's current serum potassium is 2.7 mg/dl. Which nursing diagnosis applies? a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia

ANS: D The patient's history and laboratory results support the correct nursing diagnosis. Available data do not confirm that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches. The patient is quiet and says only, "I won't eat until I look thin." What is the priority initial nursing diagnosis? a. Anxiety, related to fear of weight gain b. Disturbed body image, related to weight loss c. Ineffective coping, related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements, related to self-starvation

ANS: D The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-starvation is the priority above the incorrect responses.

Planning: Bulimia Nervosa

Acute Care: Inpatient eating disorder unit Cognitive behavioral principles of treatment. Examine the underlying conflicts and body dissatisfaction Evaluation for treatment of co-morbid disorders such as MDD and Substance abuse Pharmacological Interventions: Antidepressant medication together with CBT fluoxetine tricyclic antidepressants help reduce binge eating and vomiting Health Teaching and Promotion: Health teaching focuses on not only the eating disorder but also meal planning, use of relaxation techniques, maintenance of a healthy diet and exercise, coping skills, the physical and emotional effects of binging and purging and the impact of cognitive distortions

Implementation: Anorexia Nervosa

Acute: Address any acute psychiatric symptoms, such as suicidal ideation immediately. Psychosocial Interventions: Then the patient will begin a weight restoration program As the patients begin to re-feed, they ideally participate in the unit's milieu. The focus should be on the eating behavior and underlying feelings of anxiety, dysphoria, low self-esteem, and lack of control. Pharmacological Interventions: No drugs approved for tx. SSRI fluoxetine (Prozac) has been proven useful in reducing obsessive compulsive behavior after the patient has reached a maintenance weight. Complementary and Integrative Approaches: Massage, biofeedback, acupuncture, or yoga to manage mood. Self-care activities include learning more constructive coping skills, improving social skills, and developing problem-solving and decision-making skills. As the pt. approaches the goal weight, encourage him/her to include eating out in a restaurant, preparing a meal, and eating forbidden foods. Close monitoring of patients includes all trips to the bathroom after eating to prevent self-induced vomiting. Patients may also need monitoring on bathroom trips after visitors to ensure they have not had access to and ingested any laxatives or diuretics

What are the biological factors associated with Eating Disorders?

Anorexia Nervosa: Gene-environmental interaction A difference in the reward and executive function parts of the anorexic brain. Bulimia Nervosa: First-degree relatives Gene variations that are responsible for serotonin Neurotransmitters: serotonin and norepinephrine Increased gray matter in the medial orbitofrontal cortex Binge-eating disorder: Genetic influence and biological abnormalities such as hormonal irregularities

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely a.Binge eating b.Bulimia nervosa c.Anorexia nervosa d.Eating disorder not otherwise specified

Anorexia nervosa

What are the environmental factors associated with Eating Disorders

Anorexia: Society/Culture The habit of losing weight becomes entrenched through a reward cycle Bulimia: Internalization of a thin body ideal Childhood sexual or physical abuse Binge-eating: Adverse childhood events such as sexual abuse; Social pressures to be thin

What are the psychological factors associated with Eating Disorders

Anorexia: learned behavior that has positive reinforcement Bulimia: Anxiety disorder or low self-esteem and temperamental qualities including impulsivity and sensation seeking Binge-eating: Low self-esteem; body dissatisfaction; and reduced levels of coping ability

What is the most important outcome for Anorexia Nervosa?

Attainment of a Safe Weight

A 16 year old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders?

Antidepressants

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa a.Assist the patient to identify triggers to binge eating. b.Provide corrective consequences for weight loss. c.Assess for signs of impulsive eating. d.Explore needs for health teaching.

Assist the patient to identify triggers to binge eating.

Identify 3 life-threatening conditions, stated in terms of nursing diagnoses, for a patient with an eating disorder

At risk for Re-feeding syndrome At risk for Cardiac Failure (cardiomyopathy) At risk for electrolyte inbalance

Thoughts and behaviors associated with bulimia nervosa

Binge-eating behaviors Often self-induced vomiting for laxative or diuretic use after bingeing History of anorexia nervosa in 1/4 to 1/3 of individuals Depressive signs and symptoms Problems with: Interpersonal relationships Self-Concept Impulsive Behaviors Increased levels of anxiety and compulsivity Possible substance use disorder Possible impulsive stealing

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa?

Risk for injury: electrolyte imbalance

Which coping mechanism is used excessively by clients diagnosed with bulimia nervosa to cope with their obsession with their body image?

Denial

A client diagnosed with bulimia nervosa uses enemas and laxatives to purge to maintain weight. What is the likely physiological outcomes of this practice?

Disruption of the fluid and electrolyte imbalance

According to current theory, which statement regarding eating disorders is accurate?

Eating disorders are possibly influences by sociocultural factors

What are Nursing diagnosis r/t Bulimia Nervosa

Electrolyte imbalance Fluid Imbalance Decreased cardiac output Disturbed body image Ineffective coping Powerlessness Chronic low self-esteem Social Isolation

Characteristics of Binge-eating disorder

Engage in repeated episodes of binge eating, after which they experience significant distress. Do not regularly use the compensatory behaviors such as vomiting and laxatives

What is the criteria for hospitalization for patients with Anorexia?

Extreme electrolyte imbalance or weighs below 75% of ideal body weight.. Other criteria includes < 10% body fat, a daytime HR < 50 bpm, a systolic BP < 90, a temp. < 96, and arrhythmias.

Which subjective symptom should the nurse expect to note during assessment of a client diagnosed with anorexia nervosa?

Fear of gaining weight

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight?

Gain a maximum of 3 lb.

Implementation: Binge-Eating

Hospitalization for binge eating is not indicated Pharmacological interventions: Antidepressants: CNS Stimulant: Lisdexamfetamine dimesylate (Vyvanse) used to treat moderate to severe binge eating. Common Side effects: dry mouth and insomnia Other medications such as drugs used to treat overweight and obesity Surgical interventions: Bariatric Surgery (not highly recommended but is an option)

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment finding to support which electrolyte imbalance?

Hypokalemia

Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met?

I am a hard worker and I am very compassionate toward others

A client who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meals daily and engages in a rigorous exercise program. Which nursing diagnosis addresses this assessment data?

Imbalance nutrition: less than body requirements

What are Nursing diagnosis r/t anorexia nervosa ?

Imbalanced nutrition: less than body requirement Decreased cardiac output Risk for injury a.e.b. electrolyte imbalance Risk for imbalanced fluid volume Disturbed body image Ineffective coping Chronic low self-esteem Powerlessness

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges a.Powerlessness b.Ineffective coping c.Disturbed body image d.Imbalanced nutrition: less than body requirements

Imbalanced nutrition: less than body requirements

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies a.Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b.Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c.Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d.Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis. a.Anxiety related to fear of weight gain b.Disturbed body image related to weight loss c.Ineffective coping related to lack of conflict resolution skills d.Imbalanced nutrition: less than body requirements related to self-starvation

Imbalanced nutrition: less than body requirements related to self-starvation

Planning: Binge-Eating

Includes the usual diet and exercise elements for all weight loss programs. Help patients manage dysregulation of the entire gastrointestinal tract

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication?

It will be prescribed at a higher than typical dose.

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented a.Amenorrhea b.Alopecia c.Lanugo d.Stupor

Lanugo

S & S Anorexia Nervosa

Low weight Amenorrhea Yellow skin (hypercarotenemia) Lanugo Cold extremities Peripheral Edema (hypoalbuminemia) Muscle Weakening Constipation Cardiovascular abnormalities: hypotension, bradycardia, heart failure) Impaired Renal Function Hypokalemia (<3.5 mEq/L) Anemic pancytopenia Decreased bone density (Estrogen deficiency, low cal) Abnormal lab values: Low triiodothyronine and thyroxine levels Abnormal CT scans Electroencephalographic changes

the client experiencing bulimia differs from the client diagnosed with anorexia nervosa by exhibiting which characteristic?

Maintaining normal weight

S & S Bulimia Nervosa

Normal to slightly low weight Dental caries, tooth erosion Parotid swelling Gastric dilation, rupture Calluses, scars on hand (Russell's sign) Peripheral edema Muscle weakening Cardiovascular abnormalities (cardiomyopathy, ECG changes) Cardiac failure (cardiomyopathy) Abnormal lab values (electrolyte imbalance, hypokalemia, hyponatremia)

Identify 2 realistic outcome criteria for a patient with binge-eating disorder

Nutrient intake meets metabolic needs Congruence between body reality, body ideal, and body presentation; satisfaction with body appearance Demonstrates effective coping, reports decrease in stress, uses personal support system, uses effective coping strategies, reports increase in psychological comfort Verbalizes a positive level of confidence; makes informed life decisions, expresses independence with decision-making processes Willing to call on others for assistance, develops a confidant relationship, feels a sense of belonging.

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight a.Assess for depression and anxiety. b.Observe for adverse effects of refeeding. c.Communicate empathy for the patient's feelings. d.Help the patient balance energy expenditures with caloric intake.

Observe for adverse effects of refeeding.

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor a.Weight, muscle, and fat congruence with height, frame, age, and sex b.Calorie intake is within required parameters of treatment plan c.Weight reaches established normal range for the patient d.Patient expresses satisfaction with body appearance

Patient expresses satisfaction with body appearance

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain a.Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. b.Patient involvement in decision making increases sense of control and promotes compliance with treatment. c.Because of increased risk of physical problems with refeeding, the patient's permission is needed. d.A team approach to planning the diet ensures that physical and emotional needs will be met.

Patient involvement in decision making increases sense of control and promotes compliance with treatment.

Which statement is true of the eating disorder referred to as bulimia?

Patients with bulimia often appear at a normal weight.

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa a.Carefree flexibility b.Rigidity, perfectionism c.Open displays of emotion d.High spirits and optimism

Rigidity, perfectionism

Describe Rumination Disorder

Rumination disorder is an eating disorder in which a person -- usually an infant or young child -- brings back up and re-chews partially digested food that has already been swallowed. In most cases, the re-chewed food is then swallowed again; but occasionally, the child will spit it out. *Check Lead Levels*

Biological theorists suggest that the cause of eating disorders may be related to which factors?

Serotonin imbalance

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization a.Urine output 40 mL/hr c.Serum potassium 3.4 mEq/L b.Pulse rate 58 beats/min d.Systolic blood pressure 62 mm Hg

Systolic blood pressure 62 mm Hg

Thoughts and Behaviors associated with Anorexia Nervosa

Terror of gaining weight Preoccupation with thoughts of food View of self as fat even when emaciated Peculiar handling of food: cutting food into small bits Pushing pieces of food around plate Possible development of rigorous exercise regimen Possible self-induced vomiting, use of laxatives and diuretics Cognition so disturbed that individual judges self-worth by his or her weight.

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed a.The nurse interacts with the patient in a protective fashion. b.The nurse's comments to the patient are compassionate and nonjudgmental. c.The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d.The nurse refers the patient to a self-help group for individuals with eating disorders.

The nurse interacts with the patient in a protective fashion.

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction a.Renal c.Integumentary b.Endocrine d.The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction a.Renal c.Integumentary b.Endocrine d.Cardiovascular

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction a.Renal c.Integumentary b.Endocrine d.Cardiovascular

Describe Pica

The persistent eating of substances such as dirt or paint that have no nutritional value after maturing past toddlerhood Not culturally sanctioned Not part of any other mental illness **Monitoring eating habit is essential**

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa?

Weigh fully clothed before breakfast

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa?

Weight restoration

Planning Care for Anorexia Nervosa

When a patient is experiencing extreme electrolyte imbalance or weighs below 75% of ideal body weigh, the plan is to provide immediate medical stabilization, most likely on an inpatient unit. If a specialized eating-disorder unit is not available, hospitalization on a cardiac or medical unit is usually brief, providing only limited weigh restoration and addressing only the acute complications and acute psychiatric symptoms. With the initiation of therapeutic nutrition, malnourished patients may need tx. on a medical unit. Monitor for re-feeding syndrome Monitor phosphate and magnesium levels Monitor thiamine levels Remember!!! Reintroduction of nutrients must proceed slowly to avoid these syndromes Once the patient is medically stable, the plan addresses the issues underlying the eating disorder. Usually addressed on an outpatient bases which will include individual, group, and family therapy, as well as psycho-pharmacological therapy. Discharge planning is a critical component in tx. Family members benefit from counseling. The discharge process includes living arrangements, school, work, the feasibility of independent financial status, applications for state and/or federal program assistance, and follow-up outpatient tx.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client a. weighs 10% below ideal body weight. b. has a serum potassium level of 3 mEq/L or greater. c. has a heart rate less than 60 beats/min. d. has systolic blood pressure less than 70 mm Hg.

d. has systolic blood pressure less than 70 mm Hg.

What is the criteria for hospitalization for patient with Bulimia?

syncope serum potassium < 3.2 mEq/L serum chloride <88 mEq/L esophageal tears arrhythmia's intractable vomiting hematemesis Suicide risk

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a.weigh self accurately using balanced scales. b.limit exercise to less than 2 hours daily. c.select clothing that fits properly. d.gain 1 to 2 pounds.

gain 1 to 2 pounds.

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to: a.self-monitoring of daily food and fluid intake. b.establishing the desired daily weight gain. c.how to recognize hypokalemia. d.self-esteem maintenance.

how to recognize hypokalemia.

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will: a.appropriately express angry feelings. b.verbalize two positive things about self. c.verbalize the importance of eating a balanced diet. d.identify two alternative methods of coping with loneliness.

identify two alternative methods of coping with loneliness.

Assessment of a client suspected of experiencing bulimia nervosa calls the nurse to perform...

inspection of the oral cavity

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient: a.to eat a small meal after purging. b.not to skip meals or restrict food. c.to increase oral intake after 4 PM daily. d.the value of reading journal entries aloud to others.

not to skip meals or restrict food.

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach The patient: a.now weighs 196 pounds. b.says, "I am using contraceptives." c.says, "I feel full after eating a small meal." d.reports problems with dry mouth and constipation.

now weighs 196 pounds.

Physical assessment of a patient diagnosed with bulimia often reveals: a.prominent parotid glands. c.thin, brittle hair. b.peripheral edema. d.25% underweight.

prominent parotid glands.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a.maintaining patients' concentration and attention. b.shifting the patients' focus from food to psychotherapy. c.promoting processing of anxiety associated with eating. d.focusing on weight control mechanisms and food preparation.

promoting processing of anxiety associated with eating.