Unit 5 - Ch. 18 | Eating + Feeding Disorders

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.

A (For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the triggers are anxiety-producing situations. Identification of 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 highest priority.)

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

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 often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. 25% underweight.

A (Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and not usually seen in bulimia.)

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. Im grossly underweight, but thats what I want. d. Im a few pounds overweight, but I can live with it.

A (Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness and will persist in trying to lose more weight.)

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.

A (Weight gain of more than 2 to 5 pounds weekly may overwhelm the hearts 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 referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugo

ACDF (Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia. See relationship to audience response question.)

Pharmacological Interventions for Bulimia Nervosa

Anti-depressants along with CBT brings improvement in symptoms - fluoxetine has FDA approval for acute and maintenance therapy

Outcomes Identification for Anorexia Nervosa

Attainment of a safe weight is number one

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.

B (One goal of health teaching is 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 eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-day bingeing. Journal entries are private.)

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 patients feelings. d. Help the patient balance energy expenditures with caloric intake.

B (The nursing intervention of observing for adverse effects of refeeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety, as well as communicating empathy, relate to coping. Helping the patient achieve balance between energy expenditure and caloric intake is an inappropriate intervention.)

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.

C (Hypokalemia results from potassium loss associated with vomiting. Physiological 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 dangers associated with hypokalemia.)

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

C (Overly controlled eating behaviors, extreme weight loss, 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. The patient with eating disorder not otherwise specified may be obese. See relationship to audience response question.)

As a patient admitted to the eating disorders unit undresses, a nurse observes that the patients 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

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.)

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expression

CDE (Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patients eating and prevention of exercise, purging, and other activities. There is strict adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.)

Rumination Disorder

Characterized by undigested food being returned to the mouth that is then re-chewed, re-swallowed, or spit out - can occur at any age - symptoms frequently remit spontaneously, but may become habitual and result in severe malnutrition or death Interventions: repositioning infants and small children during feeding, make mealtimes pleasant experience, distract child when behavior starts

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

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 is a subjective consideration. The other indicators are more objective but less related to the nursing diagnosis.)

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.

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 would not be 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 refeeding. Which system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Integumentary d. Cardiovascular

D (Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment is a necessity to ensure the patients physiological integrity. The other body systems are not initially involved in the refeeding syndrome.)

Which assessment finding for a patient diagnosed with an eating disorder meets criteria 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

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 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.

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 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

D (The patients history and lab result support the nursing diagnosis Imbalanced nutrition: less than body requirements. Data are not present 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 over the trunk. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient says, I wont 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

D (The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patients self-starvation is the priority.)

Nursing Diagnoses for Bulimia Nervosa

Decreased cardiac output, disturbed body image, ineffective coping, powerlessness, chronic low self-esteem, social isolation

Outcomes in Bulimia Nervosa

Electrolytes in balance, adequate cardiac output, satisfaction with body image, effective coping, makes informed life decisions, verbalizes confidence, expresses independent decision making

Assessment in Anorexia Nervosa

General Assessment: growth of lanugo on face and back, amenorrhea, electrolyte imbalance, decreased BP and pulse Perception of problem, eating habits, history of dieting, methods used to achieve weight control, value attached to a specific shape and weight, interpersonal and social functioning, mental status, physiological parameters

Assessment in Binge-Eating Disorder

History of quantity of food consumed in discrete binge-eating episodes, how often episodes occur, perception of problem, psychosocial history, nutritional pattern, history of weight cycling, binge-eating triggers and foods

Nursing Diagnoses for Anorexia Nervosa

Imbalanced nutrition, decreased cardiac output, risk for injury, risk for imbalanced fluid volume

Nursing Diagnoses for Binge-Eating Disorder

Imbalanced nutrition: more than body requirements, disturbed body image, ineffective coping, anxiety, chronic low self-esteem, powerlessness, social isolation

Binge-Eating Disorder

Individuals engage in repeated episodes of binge eating after which they experience significant distress - causes obesity

Bulimia Nervosa

Individuals engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced committing, misuse of laxatives or diuretics, fasting, excessive exercise

Anorexia Nervosa

Individuals refuse to maintain a minimally normal weight for height and express intense fear of gaining weight

Pharmacological Interventions for Anorexia Nervosa

No FDA-approved drugs - fluoxetine is helpful in reducing obsessive compulsive behaviors after patient has reached maintenance weight

Assessment in Bulimia Nervosa

Patients usually appear well, at or near ideal weight Physical Signs: enlarged parotid glands, dental erosion, caries if pt has been inducing vomiting Emotional + Relationship Signs: impulsivity and compulsivity, chaotic, non-nurturing family relationships, familial or social instability, difficult interpersonal relationships

Pica

Persistent eating of substances such as dirt or paint that have no nutritional value - usually begins in early childhood and lasts for a few months - may interfere with eating nutritional items and can be dangerous Interventions: monitor eating behavior, reward appropriate eating

Interventions in Binge-Eating Disorder

Pharmacological interventions, surgical interventions, health teaching and promotion, teamwork and safety

Pharmacological Interventions for Binge-Eating Disorder

SSRIs (pts regain weight after stopping), Vyvanse (CNS stimulant) is only FDA-approved medication; other medications to treat overweight and obesity may be used off-label

Avoidant/Restrictive Food Intake Disorder

Starts in childhood - mealtime difficulties that resolve spontaneously with or without caregiver support and education - may result in weight loss, growth retardation, and nutritional deficiency Interventions: behavioral modification, support and education, treating anxiety and depressive symptoms

Interventions for Anorexia Nervosa

Suicidal ideation, psychosocial interventions, pharmacological interventions, integrative medicine, health teaching and promotion, safety and teamwork

Interventions for Bulimia Nervosa

Teamwork and safety, pharmacological interventions, counseling, health teaching and health promotion