Eating Disorders - Cormier

BMIs for anorexia

***under 17 = marker for anorexia - mild: BMI greater than or equal to 17 - moderate: 16-16.99 - severe: 15-15.99 - extreme: less than 15

individual therapy

- Helpful when underlying psychological problems are contributing to the maladaptive behaviors

self-ideal/self-expectancy

- Individuals perception of what he wants to be or do or become. - Arises out of perceptions one has of expectations of others. - Disturbances in self-concept can occur when they are unable to meet their ideals and expectations.

family therapy

- Involves educating the family about the disorder - Assesses the family's impact on maintaining the disorder - Assists in methods to promote adaptive functioning by the patient

patient/family education on the management of the illness

- Principles of nutrition - Ways patient may feel in control of life - Importance of expressing fears and feelings, rather than holding them inside - Alternative coping strategies - Correct administration of prescribed medications - Indication for and side effects of prescribed medications - Relaxation techniques - Problem-solving skills

self-consistency

- Strives to maintain a stable self-image...even if the image is negative, because of the need for stability and self-consistency.

body image

- Subjective perception of one's physical appearance based on self-evaluation and reactions and feedback from others.

patient/family education on the nature of the illness

- Symptoms of anorexia nervosa and bulimia nervosa - What constitutes obesity - Causes of eating disorders - Effects of the illness or condition on the body

the moral-ethical self

- That aspect that evaluates who the person says he is. It observes, compares, sets standards, and makes judgments that influence one's self evaluation.

self-esteem

- The degree of regard or respect the person has for themselves; a measure of worth they place on their abilities and judgments.

goals for clients with an eating d/o

- The patient has achieved and maintained at least 80% of expected body weight; less than 20% over expected - Has vital signs, blood pressure, and laboratory serum studies within normal limits - Verbalizes importance of adequate nutrition***

self-concept

- Thinking component of the self; the totality of a complex, organized and dynamic system of learned beliefs, attitudes and opinions that each person holds to be true about himself.

neuropeptide Y

- a NT that stimulates appetite and eating - especially during the consumption of carbs - when you haven't eaten for awhile, the brain releases additional amounts of this chemical

bing/purge type of anorexia

- binging or purging behaviors - amenorrhea - eat, but get rid of food afterwards with the intention of weight loss - self-induced vomiting, misuse of laxatives/diuretics

predisposing factors to eating d/o's

- biological influences: possible genetics, possible hypothalamic dysfunction - neurochemical influences: serotonin + norepinephrine = bulimia; anorexia may be r/t high levels of endogenous opioids - psychodynamic influences: suggests that eating d/o's result from very early and profound disturbances in mother-infant interactions resulting in retarded ego development + unfulfilled sense of separation-individuation (Freud) - family influences: conflict avoidance = child becomes the problem and the focus on the conflict is diverted such as spousal conflict

predisposing factors to obesity

- biological: genetics - lifestyle: increased intake, sedentary - psychsocial: unresolved dependency needs, fixation in the oral stage - physiological: hypothyroidism, decreased insulin production, increased cortisone production, polycystic ovarian syndrome, lesions in the appetite and satiety centers of the hypothalamus *transactional model of stress/adaptation: ---- The etiology of obesity is most likely influenced by multiple factors.

binge eating d/o

- compulsive overeating - large quantities of food in a short period of time, two or more times/week - eat until uncomfortably full, large amounts when not hungry, alone - feeling disgusted with one's self - sense of lack of control over eating during the episode - similar to bulimia nervosa w/o the compensatory behaviors - no purging, but there may be fasts or repetitive diets + feelings of shame/self-hatred after a binge - behavior may be a way to relieve stress from: anxiety, depression, loneliness - body weight: can be normal or mild-severe obesity

hypothalamus

- contains the appetite regulation center within the brain - regulates the body's ability to recognize when it's hungry, not hungry, and when it's fulll

leptin

- curbs appetite by reducing the production of neuropeptide Y

ventromedial hypothalamus

- destroyed = you overeat and become severely obese *turns off eating*

bulimia nervosa assessment

- episodic, uncontrolled, compulsive, rapid ingestion of LARGE quantities of food over a short period of time (purging) - followed by an inappropriate compensatory behaviors to rid the body of the excess calories - mostly normal weight range, some slight over/under weight - harder to detect b/c of lack of major weight loss like the anorexics - depression, anxiety, and substance abuse aren't uncommon - destroyed electrolyte balance/dehydration

bulimia nervosa CATIs

- fatigue - dry skin - irregular heartbeat - Russell's sign: sores, scars or calluses on the knuckles or hands from hitting teeth - amenorrhea or irregularities - abnormal bowel functioning - damaged teeth and gums - stolen salivary glands in the cheeks - sores in the throat and mouth - bloating - dehydration

meds used for bulimia nervosa

- fluoxetine (Prozac) - imipramine (Tofranil) - desipramine (Norpramine) - amitriptyline (Elavil) - nortriptyline (Aventyl) - phenelzine (Nardil)** be careful b/c of amount of food restrictions

meds used for anorexia nervosa

- fluoxetine (Prozac): doesn't cause weight gain - clomipramine (Anafranil) - cyproheptadine (Periactin): helps to start stimulate hunger signals - chlorpromazine (Thorazine): anxiety and cognitive distortions; be careful with weight gain & EPS - olanzapine (Zyprexa) - Remeron: sub-therapeutic dose to avoid big weight gain, stimulates appetite

meds used for obesity

- fluoxetine (Prozac): suppresses some anxiety/antidepressant effect - Various anorexiants (CNS stimulants) = phentermine/ topiramate (Qsymia): appetite suppressor, weight loss - New agents: naltrexone/bupropion (Contrave) -9/14 lorcaserin (Belviq) orlistat (Xenical) liraglutide/ (Saxendra)

bariatric surgery

- for extreme cases of obesity, BMI > 40 or BMI 35 - 39.9 with serious weight-related health issues - limits the amount of food the individual is able to eat or decrease the absorption of food and calories or both - requires lifestyle changes for sx. to work - gastric bypass, LAGB, gastric sleeve, bioliopancreatic diversion with duodenal switch

epidemiological factors

- girls/women, 12 - 30 years old - bulimia > anorexia - onset: late teens or early adulthood - correlation between eating d/o's & depression; strong correlation between personality d/o's and eating d/o's in clusters B & C = dependent and avoidant personality d/o's w/ anorexia & borderline w/ binging

common binge foods

- high carbs - high fat - convenient foods - cakes, cookies, ice creams - soft, easier to purge (bulimia) - high food bills

patient/family education for the obese pt.

- how to: plan a reduced-calorie/nutritious diet, read food labels, establish realistic weight loss plan, establish a planned program of exercise

assessment of a patient with an eating d/o

- hx. - physical exam - labs - EKG alterations - psychosocial assessment

obesity health risks

- hyperlipidemia - DM - OA - angina - respiratory insufficiency

s+s of anorexia

- hypothermia - bradycardia - hypotension r/t dehydration - edema b/c body is trying to hold on to whatever water it can - lanugo grows in an attempt to conserve heat - variety of metabolic changes - bruise easily d/t the lack of calcium which aides in clotting ***body is trying to conserve = over-compensation

behavior modification

- issues of control are central to the etiology, therefore the pt. must perceive that he or she is in control of the tx. - "buy-in" of the pt. is essential - The patient has control over: eating, amount of exercise pursued, and whether to induce vomiting - Staff and patient agree about: goals and system of rewards

effects of not eating for a while

- low blood sugar - fat is released from cells - hypothalamus detects these changes and creates a cascading series of events which lead to feelings of hunger that motivate us to eat - eating brings BS levels back into balance and replenishes fat cells

power and control

- may become the overriding elements within the family - parental criticism promotes and increase in obsessive and perfectionistic behavior on the part of the child, who continues to seek love, approval, and recognition - distorted eating patterns may represent rebellion against the parents once ambivalence develops - eating d/o is seen as a way to gain - who holds the power and control in the family?

anorexia assessment

- morbid fear of obesity - gross distortion of body image - preoccupied with food - refusal to eat - extreme weight loss, usually more than 15% of expected weight - anxiety and depression are common - amenorrhea, which leads to brittle bones d/t lack of estrogen - anxiety r/t not meeting goals/weight loss, fearful that someone's going to make them eat, parental approval, etc.

eating d/o's in males

- muscularity in the media - less likely to get help - sexuality - occupational hazards *weight loss in an attempt to improve athletic success differs from an eating disorder when the central psychopathology is absent

evaluation of tx. for the patient with an eating d/o

- requires reassessment of the behaviors for which the patient sought treatment. - Behavioral change will be required by patient and family members

restrictive anorexia

- simply refusing to eat as a way of preventing weight gain; may go for days without eating - perception is distorted, see themselves as fat

factors that influence eating d/o's

- society - culture: fashion/diet-fitness industry/women's movement - messages are being sent via the media that effect body image of men, women, and teens

lateral hypothalamus

- stimulation = eating, even if you're full - destroyed = starvation, eventual death *turns on eating*

meds used for bing-eating disorder

- topiramate (Topamax) suppresses desire to eat, weight loss

patient/family education about support services

- weight watchers - overeaters anonymous - National Association of Anorexia Nervosa and Associated Disorders - National Eating Disorders Association

Bariatric surgery may be an intervention indicated for the morbidly obese patient A: TRUE B: FALSE

A

Self-induced vomiting frequently follows a binge. A: TRUE B: FALSE

A

The nurse must assess clients suspected of having bulimia nervosa to learn about the client's eating patterns and which compensatory method the client uses for dealing with negative feelings associated with the binge eating. The nurse keeps in mind that the compensatory method used most often by individuals who have bulimia nervosa is which of the following methods? A. Self-induced vomiting B. Repeated use of laxatives C. Excessive exercise D. Periods of not eating

A

Which of the following objective data would the nurse expect to find in the client with anorexia nervosa? A. Osteoporosis B. Preoccupation with food C. Feeling isolated and lonely D. A score of 13 on the Mini-Mental State Exam

A Rationale: 1. Osteoporosis. Clients with anorexia have low estrogen levels and are a high risk for developing osteopenia and osteoporosis. This is an objective finding. 2. Preoccupation with food. A preoccupation with food is a subjective finding associated with anorexia nervosa. 3. A score of 13 on the Mini-Mental State Exam. A score of 13 is a low score on the MMSE and is an objective finding that is not associated with anorexia nervosa. 4. Feeling isolated and lonely. Feelings of loneliness and isolation are subjective.

An effective intervention to facilitate individual coping for clients with eating disorders is to: A. Provide flexibility in activities of daily living. B. Have the treatment team determine the client's plan of care. C. Provide the client with limited information on a need-to-know basis. D. Prohibit the client from making decisions regarding care.

A Rationale: 1. Provide flexibility in activities of daily living. Allowing the client the ability to determine daily activities encourages autonomy and increases the client's sense of responsibility. 2. Have the treatment team determine the client's plan of care. Encouraging the client to participate in the treatment planning process teaches the client coping, decision-making skills, and self-determination. When a client participates in the treatment planning, the client is more likely to adhere to the treatment regimen. 3. Prohibit the client from making decisions regarding care. Clients should be encouraged to participate in decision making. This encourages the client to take more self-responsibility and gives the message that the client is capable of making choices. 4. Provide the client with limited information on a need-to-know basis. Information should be presented matter-of-factly and honestly. This increases the client's adherence and fosters autonomy.

Which of the following is a treatment used with bulimia nervosa? A: Cognitive- behavioral therapy B: Antipsychotic medication C: Fasting D: Intravenous therapy

A Rationale: Cognitive-behavioral therapy is a type of therapy that has been successful with patient with bulimia nervosa (option A). Antipsychotic medication, fasting and intravenous therapy are not treatment modalities for bulimia nervosa (options, B, C, D).

In addition to having difficulties controlling their eating behavior, persons with bulimia nervosa also may exhibit which of these behaviors? A: Acting-out behaviors B: Dissociative behaviors C: Pressured speech D: Metonymic speech

A Rationale: Persons with bulimia nervosa may also exhibit impulsive acting out behaviors (option A). They are not likely to exhibit dissociative behaviors (option B), pressured speech (option C), or metonymic speech (option D). The latter two options refer to speech patterns used by persons who have schizophrenia.

A nurse observes a female patient for signs and symptoms of anorexia nervosa, which include A: amenorrhea B: tachycardia C: decreased activity D: elevated temperature

A Rationale: Signs and symptoms of anorexia nervosa include amenorrhea (option A); bradycardia, rather than tachycardia (option B); increased activity (often excessive), rather than decreased activity (option C); and hypothermia, rather than elevated temperature (option D).

According to the family systems theory, family behavior characteristics associated with anorexia include (select all that apply): A. Unclear boundaries between family members. B. Family members' preoccupation with food and eating. C. Individual autonomy. D. Isolation between family members. E. Successful conflict resolution

A & B Rationale: 1. Unclear boundaries between family members. The family systems theory believes that in families that become enmeshed, there are no clear boundaries between family members. This family environment contributes to the development of an eating disorder. 2. Isolation between family members. Family members of anorexics tend to be overly involved and highly dependent on one other. Isolation between family members is more common in families with a bulimic family member. 3. Family members' preoccupation with food and eating. The entire family of an individual with anorexia is overly involved and preoccupied with eating, foods, and rituals associated with meals. This atmosphere makes food and relevant activities the main focus of life. 4. Individual autonomy. There is minimal autonomy for all family members of an individual with anorexia. Family systems theory states that all members of the family are involved in the anorexia and related behaviors. 5. Successful conflict resolution. Families of individuals with an eating disorder avoid conflict and deny problems to maintain harmony within the family.

A patient diagnosed with anorexia nervosa restricting type engages in binge eating and purging A: TRUE B: FALSE

B

Bulimic patients are emaciated A: TRUE B: FALSE

B

Persons diagnosed with binge eating disorder may be underweight and frequently diet A: TRUE B: FALSE

B

Which is characteristic of the diagnosis of anorexia nervosa? A) Obsession with weight gain B) Body image disturbance C) Disregard for the feelings of others D) Healthy family relationships

B - The distortion in body image by a patient diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated.

The most common coexisting mental health issue associated with anorexia and bulimia is: A. Agoraphobia. B. Depression. C. Panic attacks. D. Anxiety.

B Rationale: 1. Anxiety. Clients with eating disorders do suffer from anxiety, which can be exacerbated when the client is not able to sustain the eating disorder. However, anxiety is not the most common coexisting mental health issue associated with anorexia and bulimia. 2. Panic attacks. Clients with anorexia may experience panic attacks when they are unable to maintain their usual ritualistic behaviors, but this is not the most common comorbidity. 3. Agoraphobia. Clients with eating disorders may experience agoraphobia due to the physical changes associated with the eating disorder. Clients may also develop agoraphobia as a result of not being able to interrupt their ritualistic behaviors. It is not altogether uncommon for eating-disordered individuals to be agoraphobic. 4. Depression. Depression is the most common disorder associated with anorexia and bulimia. It is unclear if the eating disorder is the primary disorder resulting in depression (a secondary depression) or if depression is primary and the eating disorder is a coping method.

A nurse is teaching a group of adolescents about the risk factors and complications of anorexia nervosa. Which of the following complications should the nurse stress as the most serious? A. Ineffective coping skills B. Increased risk of mortality C. Ineffective family relationships D. Depression

B Rationale: 1. Ineffective coping skills. The individual with anorexia nervosa does have ineffective coping skills and this should be addressed at the appropriate time. The most serious complication of anorexia nervosa is the risk of death due to the severe physiological changes and the risk of suicide. 2. Depression. Clients with anorexia nervosa may experience a coexisting depression. However, the immediate risk is death. 3. Increased risk of mortality. The most serious complication of anorexia nervosa is the risk of death due to the severe physiological changes and the risk of suicide. 4. Ineffective family relationships. Family relationships may be an underlying cause of anorexia nervosa and can be addressed once the client has been medically stabilized. Cognitive Level: Application Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: Distinguish among the various eating disorders.

Educational guidelines for family members of clients with eating disorders include: A. Expecting a full recovery within 6 months of starting treatment. B. Expressing love and affection both verbally and physically. C. Scheduling family activities that include food. D. Recognizing the client's need to have his or her behaviors controlled by family members.

B Rationale: 1. Scheduling family activities that include food. Family activities should not involve food. This enables the client to learn other ways of experiencing pleasure, socializing, and opportunities to develop new coping skills. 2. Expecting a full recovery within 6 months of starting treatment. Full recovery from eating disorders can take years. Attitudes and behaviors need to change, and clients experience relapses as they progress through treatment. 3. Recognizing the client's need to have his or her behaviors controlled by family members. Clients with eating disorders often have control issues, and the dysfunctional eating is their way of controlling their world and self. Avoiding power struggles will promote the recovery process. 4. Expressing love and affection both verbally and physically. Clients in treatment are learning how to feel good about themselves without the use of food. Underlying issues related to family relationships can contribute to an eating disorder. Clients need to feel accepted and loved for who they are.

The nurse observes a client admitted with anorexia nervosa doing repeated, vigorous sit-ups. The most appropriate action from the nurse is to: A. Allow the client to complete the exercise routine. B. Interrupt the behavior and offer to walk with the client. C. Take away the client's visitor privileges. D. Tell the client she cannot do exercises.

B Rationale: 1. Tell the client she cannot do exercises. The client in treatment for anorexia nervosa is learning effective coping methods to deal with anxiety and other psychosocial issues. The client should not engage in such vigorous activity, but a power struggle with an adolescent will not promote an alternative to dealing with anxious feelings. 2. Allow the client to complete the exercise routine. Allowing the client to complete the exercise reinforces the client's misperception of body image. The client needs to learn an acceptable coping method to deal with anxiety and emotions. 3. Interrupt the behavior and offer to walk with the client. The nurse should interrupt behavior and offer to walk with the client. This allows the nurse to set the pace of the walk and offer the client an opportunity to discuss feelings. 4. Take away the client's visitor privileges. Clients with anorexia have a negative self-image. Revoking visitor privileges reinforces the message of negative self-worth and image.

The nurse needs to teach patients who had bariatric surgery the following A: Eat only soft foods for a year B: Life style changes to maintain weight loss C: Refrain from drinking water D: The surgery will be the cure

B Rationale: Cognitive-behavioral therapy is a type of therapy that has been successful with patient with bulimia nervosa (option A). Antipsychotic medication, fasting and intravenous therapy are not treatment modalities for bulimia nervosa (options, B, C, D).

A nurse is treating an emaciated patient who was just admitted to the unit diagnosed with anorexia nervosa. What is the treatment priority at this time? A: Discussing her feelings regarding her illness B: Maintaining electrolyte balance C: Weigh patient D: Force feed

B Rationale: Persons with anorexia nervosa admitted to the hospital in an emaciated condition are in need of immediate electrolyte stabilization (option B). Discussing feelings regarding the illness is not pertinent at this time. Furthermore, clients with anorexia are in denial of any illness (option A), Providing food as an intervention (option C), is not a priority at the present time and force feeding is not presently indicated (option D).

Treatment of anorexia nervosa tends to be very difficult because the client usually A: Exhibits sociopathic behavior. B: Strongly denies the illness. C: Lacks the intellectual ability to understand the illness. D: Feels physically well.

B Rationale: Treatment of anorexia nervosa tends to be difficult because of the client's strong denial (option B). Clients with anorexia nervosa are not sociopathic (option A) and may be very bright intellectually (option C). The client usually has disturbing bodily changes related to the illness, and may be very physically ill (option D).

When working with families of clients with anorexia nervosa, as well as the clients themselves, the nurse will most often find which of the following types of behavior? A. Uncaring B. Negativistic C. Perfectionistic D. Disorganized

C

You are caring for a female client who is 17 years old, 5 foot 6 inches tall, weighs 95 pounds, and who has been admitted with a diagnosis of Anorexia Nervosa. The client's mother says to the nurse: "I am very worried that my daughter has not menstruated." The most appropriate immediate question by the nurse would be which of the following questions? A. "Are you aware that some girls begin menstruation as late as 18?" B. "Would you like me to get an order for a pregnancy test?" C. "Has she ever had a menstrual period and if so when?" D. "Do you know if your daughter is sexually active?"

C

The nurse is teaching a class on obesity prevention. Which statement by a student indicates that learning about obesity has occurred? A) "Obesity is classified as a psychiatric disorder in the DSM-IV-TR." B) "Obesity is defined as a body mass index (BMI) of 25.0 to 29.9." C) "Eighty percent of offspring of two obese parents are obese." D) "Lesions in the appetite center in the thalamus may contribute to obesity.

C - Genetics have been implicated in the development of obesity. - Research indicates that 80% of the offspring of two obese parents are obese.

The nursing diagnosis for a client with bulimia is Fluid Volume Deficit. Nursing interventions specific to the fluid volume deficit include: A. Ensuring daily consumption of 1000 to 2000 mL of liquid. B. Weighing the client after each meal. C. Monitoring the client for at least 1 hour after meals. D. Monitoring body temperature every 4 hours.

C Rationale: 1. Daily consumption of 1000 to 2000 mL of liquid. The bulimic client with a fluid volume deficit will require 2000-3000 mL of liquids to promote rehydration. The rate of fluid intake will be determined by the client's overall cardiac and renal functioning. 2. Weighing the client after each meal. Clients with bulimia should be weighed daily, preferably in the morning upon awakening. Weighing the client after each meal reinforces the client's anxiety about weight and is not effective in the management of bulimia. 3. Monitoring the client for at least 1 hour after meals. Clients with bulimia need to be monitored for at least 1 hour after meals to prevent purging. 4. Monitoring body temperature every 4 hours. Vital signs that should be monitored more frequently are pulse and blood pressure. These two vital signs reflect cardiac function and perfusion and are more significant than body temperature, as cardiac difficulties are common in this group.

How do cultural stereotypes contribute to the development of eating disorders? A. The stereotypes identify the population at risk for developing eating disorders. B. Cultural stereotypes increase an individual's insight regarding his or her own personal weight issues. C. There is a strong emphasis on low body weight justifying high self-esteem. D. Eating disorders result from biological and genetic factors.

C Rationale: 1. Eating disorders result from biological and genetic factors. Cultural stereotypes focus on attractiveness and the relationship between weight and self-esteem. There are multiple underlying factors that contribute to eating disorders. 2. There is a strong emphasis on low body weight justifying high self-esteem. An individual's identity and self-esteem are linked to body weight. 3. The stereotypes identify the population at risk for developing eating disorders. Stereotypes do not identify individuals at risk for developing eating disorders. 4. Cultural stereotypes increase an individual's insight regarding his or her own personal weight issues. Individuals may be more sensitive to their weight because of the culture, but cultural stereotypes do not enhance their insight related to personal weight.

Experts in the field of obesity recommend weight loss for those persons with a A: BMI between 20 and 25 B: BMI less than 30 C: BMI greater than 30 D: Blood pressure greater than 150/90

C Rationale: Experts recommend weight loss for those persons with a BMI greater than 30 (option C). BMI between 20 and 25, (option A) less than 30, unless medical indications warrant weight loss (option B) and blood pressure greater than 150/90 (option D) are not an indications.

Which of these sociocultural factors is most likely to contribute to the development of anorexia nervosa? A: Availability of low-calorie and diet foods B: Emphasis on nutrition education for the general public C: Unrealistic cultural ideals regarding body shape D: Reward for high achievement in athletic events

C Rationale: The American society places much emphasis on unnatural thinness of women, which is likely to be a factor contributing to the development of anorexia nervosa (option C). The factors listed in options A, B, and D are less likely to be related to the development of anorexia nervosa.

A patient is 5'8'' tall and weighs 105 pounds. The patient has been taking laxatives daily, and self-induces vomiting after eating. Which is the PRIORITY nursing diagnosis for this patient? A) Ineffective denial B) Disturbed body image C) Low self-esteem D) Imbalanced nutrition, less than body requirements

D - This patient is malnourished and underweight due to self-induced vomiting and laxative abuse. Nutritional status is compromised and this problem must be prioritized to establish physiological integrity.

Which assessment finding would the nurse expect in patients diagnosed with bulimia? A) They are below normal weight. B) They binge when they experience hunger. C) They will be highly motivated to seek help. D) They are within their normal weight range.

D - patients diagnosed with bulimia nervosa are often able to maintain a normal weight by purging after binging.

The nurse is assessing a client with severe anorexia nervosa. Which of the following physical findings should be immediately reported to the physician? A. Amenorrhea B. Pulse rate of 102 C. Urine output of 50cc/hour D. Blood pressure of 80/40

D Rationale: 1. Amenorrhea. Clients with anorexia nervosa often experience amenorrhea due to hormonal imbalances. It is likely the client has had amenorrhea for some time. 2. Blood pressure of 80/40mm Hg. A decreased blood pressure is indicative of impaired cardiac and tissue perfusion. The dropping blood pressure, if not corrected, will impair vital organs. The health care provider should be alerted to this finding. 3. Urine output of 50cc/hour. A minimum of 30cc/hour is needed to maintain renal function. Depending on the client's fluid status and fluid intake, 50cc/hour is adequate to maintain renal function. 4. Pulse rate of 102. The increased pulse rate may be the body's attempt to compensate for the drop in blood pressure. The client may also have a persistent history of tachycardia.

The binge eating/purging type of anorexia nervosa and the purging type of bulimia nervosa differ in which of these ways? A: Anorexia nervosa is more prevalent than bulimia nervosa. B: In anorexia nervosa, hypokalemia can occur, while in bulimia nervosa, hyperkalemia is more likely to occur. C: Anorexia nervosa occurs more frequently in women, while bulimia nervosa occurs more frequently in men. D: In anorexia nervosa, weight is much lower than normal body weight, while in bulimia nervosa, weight is maintained in the normal range.

D Rationale: In anorexia nervosa, weight loss is dramatic, while in bulimia nervosa, weight is maintained in the normal range (option D). Bulimia nervosa is more prevalent than anorexia nervosa (opposite of option A). Hypokalemia is the electrolyte imbalance most likely to occur in both anorexia nervosa and bulimia nervosa (option B). Both anorexia nervosa and bulimia nervosa occur more frequently in women than in men (option C).

Patients with binge eating disorder may also engage in? A: Self-induced vomiting B: Laxative use C: Purging behaviors D: Repeated dieting

D Rationale: Patients with binge eating disorder frequently engage in dieting (option D). Self-induced vomiting and laxative use are all purging behaviors (options, A,B,C) which the patient with binge eating disorder does not engage in.

anorexia CATIs

Refusal to eat Denial of hunger Excessive exercise Flat affect, or lack of emotion Difficulty concentrating (no blood sugar) Preoccupation with food Skipping meals Making excuses for not eating Eating only a few certain "safe" foods, usually those low in fat and calories Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing Weighing food Cooking elaborate meals for others but refusing to eat them themselves Repeated weighing of themselves Frequent checking in the mirror for perceived flaws Wearing baggy or layered clothing Complaining about being fat

nursing care of the patient with an eating d/o

aimed at: - restoring nutritional balance - helping the patient gain control over life situation in ways other than inappropriate eating behaviors - promoting self-esteem and positive self-image in ways that relate to aspects other than appearance - Encouraging Realistic Thinking Processes - Exploring Feelings of Powerlessness - Encouraging Effective Coping - Restoring Family Processes - Enmeshment and Over-protectiveness - Conflict Avoidance and Rigidity

outcomes for clients with an eating d/o

the pt.: - Verbalizes knowledge regarding consequences of fluid loss caused by self-induced vomiting (or laxative/diuretic abuse) and importance of adequate fluid intake - Verbalizes events that precipitate anxiety and demonstrates techniques for its reduction - Verbalizes ways in which he or she may gain more control of the environment and thereby reduce feelings of helplessness - Expresses interest in welfare of others and less preoccupation with own appearance - Verbalizes that image of body as "fat" was misperception and demonstrates ability to take control of own life without resorting to maladaptive eating behaviors (anorexia) - Has established a healthy pattern of eating for weight control, and weight loss toward a desired goal is progressing (obesity) - Verbalizes plans for future maintenance of weight control (obesity)

successful behavioral modification

when the pt.: - has input into the care plan - is allowed to contract for privileges based on weight gain/loss - clearly sees what the tx. choices are ***the pt. has a choice whether to: - abide by the contact - gain weight: usually albs/week - earn the desired privilege