NURS116_CH18_Eating Disorders

bulimia nervosa S/SX

-normal to slightly low weight -dental caries -tooth erosion - parotid swelling -gastric dilation/ rupture -calluses/ scars on hands (Russell's sign) peripheral edema -muscle weakness

bulimia nervosa

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

most people with bulimia

are within a normal rage of weight

binge eating disorder history of

depression

eating disorders Predisposing factors

-Genetics -neurobiological -psychodynamic influences -family influences -body mass index -psychological factors -environmental factors

interventions for anorexia and bulimia

-Liquid diet -Liquid diet via NGT -2-3 lbs /wk -Monitor Phosphate, calcium, and magnesium (if low) -weigh pt daily (upon arising and 1st void) -stay w/ pt for meals (30 min) and (1hr) following meals -explain privileges and restriction -Strict I&O -asses skin (turgor, color, oral mucus, ) -encourage decision making

Anorexia Nervosa abnormal lab values

-Low triiodothyronine (TSH) ( 0.4-4.0) -low thyroxine levels -abnormal CT scans -electroencephalographic changes -impaired renal function -hypokalemia (Low potassium) -anemic pancytopenia -decreased bone density

eating disorders

-anorexia nervosa - bulimia nervosa -binge eating disorder

binge eating disorder S/SX

-out of control eating -dysfunctional eating patterns -weight over ideal for height and frame -embarrassment of weight -fear of negativity -eats as coping mechanism -eats even when full -anxiety -low self-esteem -powerless -social isolation -hides eating behaviors

2 Types of Anorexia Nervosa (past 3 months)

-restricting (Weight loss through severe dieting or exercising) -binge eating/purging (Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics May engage in eating binges)

bulimia nervosa diagnosis

1 x week for 3 months

A nurse is interviewing a client who has anorexia nervosa. Which of the following findings should the nurse expect? A. Poor personal hygiene habits B. Strenuous exercise regimen C. Grandiose behaviors D. Intense fear of death

B. Strenuous exercise regimen WHY? The nurse should expect this client who has anorexia nervosa to report a strenuous exercise regimen. The client might participate in excessive physical activity due to the perceived need to burn calories and lose weight.

A nurse is providing nutrition counseling to a middle-aged adult client who has a sedentary job. Which of the following factors should the nurse consider? A. The risk of eating disorders increases at this age. B. The client's basal metabolic rate could decrease. C. Daily vitamins will be become necessary to meet nutritional needs. D. Limiting the intake of fish to once per week reduces cardiovascular risks.

B. The client's basal metabolic rate could decrease. WHY? The basal metabolic rate decreases as adipose tissue replaces skeletal muscle mass. This places the client at risk of weight gain if a healthy diet is not maintained.

A nurse at a college campus health clinic is caring for a client who reports manifestations of bulimia nervosa. The client tells the nurse, "I know my eating binges and vomiting are not normal, but I can't control them." Which of the following responses should the nurse provide? A. "Why do you think you are experiencing these behaviors of binges and vomiting?" B. "Are other students in your dorm also experiencing this behavior?" C. "You are feeling helpless about changing this behavior?" D. "You know you must stop because you are endangering your health."

C. "You are feeling helpless about changing this behavior?" WHY? The nurse should use the therapeutic communication technique of restating when responding to the feelings the client has expressed. Restating focuses on the main idea of the client's statement and helps the client understand and explore personal behaviors.

A nurse is developing a plan of care for a client who has anorexia nervosa. Which of the following nursing actions is contraindicated for this client? A. Explaining that tube feeding will be necessary if the client refuses oral intake B. Weighing the client each day prior to any oral intake C. Permitting the client to spend some quiet time alone after each meal D. Refraining from commenting about the client's eating during meal times

C. Permitting the client to spend some quiet time alone after each meal WHY? The nurse should directly observe the client for a minimum of 1 hour following meals. This intervention prevents the client from purging or discarding hidden food. Therefore, permitting the client to have alone time following meals is contraindicated for the plan of care.

A nurse is caring for a client who has anorexia nervosa. The client states, "If I gain weight, I'll never get a boyfriend." Which of the following cognitive distortions is the client displaying? A. Overgeneralization B. Personalization C. Emotional reasoning D. Catastrophizing

D. Catastrophizing WHY? A client displays the cognitive distortion of catastrophizing by assuming the worst possible outcomes will occur.

A nurse is performing an admission assessment for a client who has restricting-type anorexia nervosa. The nurse should expect which of the following findings? A. Recurrent binging B. Compensatory vomiting C. Loss of appetite D. Decreased caloric intake

D. Decreased caloric intake WHY? The nurse should expect the client who has restricting-type anorexia nervosa to have a restricted and decreased caloric intake due to an intense fear of weight gain.

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

D. History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to decreased bone density, increasing the risk of fractures.

A nurse is caring for a client who was just admitted for the treatment of anorexia nervosa. Which of the following actions should the nurse take? A. Discuss the nutritional value of foods during meal times B. Weigh the client 3 mornings per week C. Allow the client to exercise for up to 1 hr per day D. Monitor the client for 1 hr following meals and snacks

D. Monitor the client for 1 hr following meals and snacks WHY?The nurse should monitor the client after eating meals and snacks to prevent purging.

psychopharmacology

SSRI -fluoxetine (AN and BN) -high doses of SSRI for BED

anorexia nervosa characterized by

morbid fear of obesity -isolate themselves -obsessed with food -hoard food -compulsive behavior (handwashing)

binge eating disorder

significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa

Anorexia Nervosa Symptoms

-low weight -amenorrhea (absence of menstruation) -yellow skin -lanugo (prenatal thin soft hair) -cold extremities -peripheral edema -muscle weakness - constipation

bulimia nervosa abnormal lab values

-electrolyte imbalance -hypokalemia -hyponatremia

binge eating disorder interventions

-food diary -discuss feelings associated witheating -eating plan -realistic goals (weight loss 1-2 lbs/wk) -assess history of trauma -privacy -identify positive self-attributes

anorexia nervosa cardiovascular abnormalities

-hypotension -bradycardia -heart failure

BMI (body mass index)

-Normal : 20-24.9 -Overweight : 25-29.9 -Obese : >30 -Models: 18 -Anorexia nervosa : <17 -Extreme Anorexia nervosa: <15

treatment for eating disorders

-behavior modification -psychotherapy: cognitive and dialectical behavior therapy -family treatment -psychopharmacology: SSRI (Fluoxetine)

bulimia nervosa cardiovascular abnormalities

-cardiomyopathy -electrocardiographic changes -cardiac failure (cardiomyopathy) (can lead to death)

A nurse is providing discharge teaching to the parent of an adolescent client who has bulimia nervosa and has been hospitalized for several weeks. Which of the following statements should the nurse identify as an indication that the parent understands the teaching? A. "I should allow my child to make independent decisions." B. "I should give my child a laxative every evening." C. "I should make sure my child takes the antipsychotic medication several times daily." D. "I should discourage my child from exercising."

A. "I should allow my child to make independent decisions." WHY? Clients who have bulimia nervosa often demonstrate low self-esteem. The family should support the client emotionally and should encourage increasing independent decision making.

A nurse is providing discharge teaching to the parent of an adolescent client who has bulimia nervosa and has been hospitalized for several weeks. Which of the following statements should the nurse identify as an indication that the parent understands the teaching? A. "I should allow my child to make independent decisions." B. "I should give my child a laxative every evening." C. "I should make sure my child takes the antipsychotic medication several times daily." D. "I should discourage my child from exercising.

A. "I should allow my child to make independent decisions." WHY? Clients who have bulimia nervosa often demonstrate low self-esteem. The family should support the client emotionally and should encourage increasing independent decision making

A nurse is caring for an adolescent male client who has anorexia nervosa. The client asks, "Have I done any permanent damage to my body?" Which of the following responses should the nurse provide? A. "What concerns do you have about your physical health?" B. "Let's wait to discuss that until after you're feeling better." C. "Unconsciously, you're admitting you're worried about your physical appearance." D. "I'm glad to hear that you're concerned about the physical effects of your illness."

A. "What concerns do you have about your physical health?" WHY? The nurse should use therapeutic communication when discussing the client's concerns. This statement by the nurse is an example of exploring, which is a therapeutic communication technique that encourages the client to talk further about personal feelings and perceptions.

A nurse on an eating disorders acute care unit is assessing a client and observes the presence of lanugo on her skin. The nurse should identify that this finding is consistent with which of the following eating disorders? A. Anorexia nervosa B. Bulimia nervosa C. Binge eating disorder D. Pica

A. Anorexia nervosa WHY? Anorexia nervosa is an eating disorder associated with severe food restriction. Clients who have anorexia nervosa are often underweight and might have lanugo (fine, downy hair) on the back and face.

A nurse on an eating disorders acute care unit is assessing a client and observes the presence of lanugo on her skin. The nurse should identify that this finding is consistent with which of the following eating disorders? A. Anorexia nervosa B. Bulimia nervosa C. Binge eating disorder D. Pica

A. Anorexia nervosa WHY?Anorexia nervosa is an eating disorder associated with severe food restriction. Clients who have anorexia nervosa are often underweight and might have lanugo (fine, downy hair) on the back and face.

A nurse is organizing a therapeutic support group for individuals who have bulimia nervosa. Which of the following tasks should the nurse plan to include during the orientation phase of group development? A. Determine the rules that the group will follow B. Address disagreements among group members C. Help clients work through the grief response D. Transition from the role of leader to facilitator

A. Determine the rules that the group will follow WHY? During the orientation phase of group development, the nurse should determine the rules that apply to the group and ensure that all members understand these rules. Examples of rules to be discussed include confidentiality and meeting times.

A nurse is caring for a client with anorexia nervosa who has light skin. Which of the following findings should the nurse expect? A. Presence of lanugo B. Flushed skin tone C. Hyperactive bowel sounds D. Clubbing of the fingernails

A. Presence of lanugo WHY? The nurse should expect a client who has anorexia nervosa to have lanugo (fine, neonatal-like hair growth) on the body as a result of malnutrition and starvation.

A nurse is providing teaching to the guardian of a female adolescent client who has bulimia nervosa. Which of the following statements by the guardian indicates an understanding of the teaching? A. "My daughter is at risk for developing high blood pressure." B. "It is important for my daughter to have regular dental checkups." C. "I should weigh my daughter daily for several weeks." D. "Bleeding during my daughter's periods will increase."

B. "It is important for my daughter to have regular dental checkups." For a client who has bulimia nervosa, repeated vomiting erodes tooth enamel and predisposes the teeth to caries. Therefore, frequent dental checkups are essential.

A nurse in a health clinic is providing teaching to a client about binge eating disorder. Which of the following client statements indicates an understanding of the teaching? A. "This problem is caused by a slow metabolism." B. "The abdominal pain I often have is due to the amount of food that I eat." C. "Most of my weight gain is water weight." D. "At least I do not need to worry about being physically ill."

B. "The abdominal pain I often have is due to the amount of food that I eat." WHY? Gastrointestinal complications can arise for clients who have binge eating disorder due to the larger than normal amount of food they consume. Other manifestations include constipation, diarrhea, urgency, and a feeling of anal blockage.

A nurse is assessing a client who has binge-eating disorder. Which of the following findings should the nurse expect? A. Amenorrhea B. Abdominal pain C. Restricted caloric intake D. Frequent use of laxatives

B. Abdominal pain WHY? The nurse should expect the client who has binge-eating disorder to report problems with abdominal pain due to the gastrointestinal dilation that results from eating excessive volumes of food.

A nurse is assessing a client who has anorexia nervosa. The nurse should expect the client to display which of the following characteristics? A. Refusal to participate in physical exercise activities B. Feelings of decreased self-worth C. Preoccupied with concerns about personal health D. Avoidance of discussions of food

B. Feelings of decreased self-worth WHY? The nurse should expect a client who has anorexia nervosa to have an altered sense of self-image and self-identity. The client often bases feelings of self-worth on body weight; therefore, feelings of self-worth are often decreased because of a view of self as overweight.

A nurse is assessing an adolescent who has a new diagnosis of anorexia nervosa. Which of the following findings should the nurse expect? A. Increased blood pressure B. Lanugo over the back C. Oily skin with acne D. Elevated body temperature

B. Lanugo over the back WHY? The nurse should expect an adolescent who has anorexia nervosa to have lanugo present on the skin as a result of impaired metabolic activity. Other manifestations of anorexia nervosa include hypothermia, hypotension, and dry skin.