Chapter 18 Eating and Feeding DIsorders

Comorbidity of binge eating

Bipolar, major depressive, anxiety, and substance use disorders

Psychological Factors of anorexia

Based on a learned behaviors.

Co Morbidity of Anorexia

Bipolar, depressive. and anxiety disorders. Obsessive compulsive, alcohol and substance use disorders.

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

Patients with bulimia often appear at a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

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

Denial Denial of incongruence between body reality, body ideal, and body presentation is the mainstay of the client diagnosed with bulimia nervosa.

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

Hypokalemia Vomiting causes loss of potassium, leading to hypokalemia.

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

inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries.

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

Fear of gaining weight Fear of weight gain is the only subjective data listed, and it is universally true of clients diagnosed with anorexia nervosa.

Characteristics of bulimia nervosa

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

Anorexia Nervosa

Refuse to maintain a minimally normal weight for height and express intense fear of gaining weight. Some people with anorexia restrict their intake of food while others engage in binge eating and purging.

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

Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. This electrolyte imbalance is potentially life threatening.

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

Serotonin imbalance The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse.

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 Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member.

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

Weight restoration Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status.

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." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem.

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 The antidepressant fluoxetine (Prozac, an SSRI) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight.

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

Disruption of the fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives.

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

Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size.

Binge eating disorder

Engage in repeated episodes of binge eating after which they experience significant distress. This is the most common eating disorder.

Bulmia Nervosa

Engage in repeated episodes of binge eating followed by inappropriate compensatory behavior such as self induced vomiting misuse of laxatives, diuretics, or other medications. Fasting or excessive exercise.

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. The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when which assessment data is observed?

Has systolic blood pressure less than 70 mm Hg. Systolic blood pressure of less than 70 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise.

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

Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of this diagnosis.

Characteristics of anorexia nervosa

Intense dear of gaining weight distorted body image restricted calories with significantly low BMI

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. Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression.

Psychological factors for binge eating

Low self esteem and body dissatisfaction.

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

Maintaining a normal weight Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight.

Comorbidity of bulimia

Major depressive disorder, bipolar disorder, anxiety disorders, Borderline or histrionic personality disorder.

Biological factors for binge eating

Tends to run in families may also be hormonal irregularities

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 their weight

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

Weigh fully clothed before breakfast. Clients should be weighed daily first week, then three times weekly wearing only bra and panties or underwear before ingesting any food or fluids in the morning