MENTAL HEALTH: CHAPTER 20: EATING DISORDERS:

Eating Disorder: Assessment: Thought Process & Content:

- Clients with eating disorders spend most of the time thinking about dieting, food, and food-related behavior. - They are preoccupied with their attempts to avoid eating or eating "bad" or "wrong" foods. - Clients cannot think about themselves without thinking about weight and food. - The body image disturbance can be almost delusional; even if clients are severely underweight, they can point to areas on their buttocks or thighs that are "still fat," thereby fueling their need to continue dieting. - Clients with anorexia who are severely underweight may have paranoid ideas about their family and health care professionals, believing they are their "enemies" who are trying to make them fat by forcing them to eat.

Eating Disorders: Low Serotonin Levels:

- Control satiety and hunger

Eating Disorder: Assessment: Roles & Relationships:

- Eating disorders interfere with the ability to fulfill roles and to have satisfying relationships. - Clients with anorexia may begin to fail at school, which is in sharp contrast to previously successful academic performance. - They withdraw from peers and pay little attention to friendships. - They believe that others will not understand, or fear that they will begin out-of-control eating with others. - Clients with bulimia feel great shame about their binge eating and purging behaviors. As a result, they tend to lead secret lives that include sneaking behind the backs of friends and family to binge and purge in privacy. - The time spent buying and eating food and then purging can interfere with role performance both at home and at work.

Pica & Rumination:

- Eating or feeding disorders in childhood include pica, which is persistent ingestion of nonfood substances, and rumination, or repeated regurgitation of food that is then rechewed, reswallowed, or spit out. - Both of these disorders are more common in persons with intellectual disability.

Self-Harm:

- Especially with anorexia b/c they don't have insight to the disorder, one priority is to have them recognize what they are doing to themselves (one goal of therapy) - If they want to hurt themselves, you must place them on 1-1 to maintain safety - Monitor them and make sure they stay safe

Eating Disorder: Assessment: History:

- Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence who are achievement-oriented, dependable, eager to please, and seeking approval before onset of the condition. - Parents describe clients as being "good, causing us no trouble" until the onset of anorexia. - Likewise, clients with bulimia are often focused on pleasing others and avoiding conflict. - Clients with bulimia, however, often have a history of impulsive behavior such as substance abuse and shoplifting as well as anxiety, depression, and personality disorders

A nurse is seeing a patient in an outpatient client for treatment of anorexia nervosa: Which is the most appropriate short term outcome for this patient: A) Patient will use stress reducing techniques to avoid purging B) Patient will discuss chaos in personal life and link to purging C) Patient will gain 2 lbs before next weekly appointment D) Patient will remain of symptoms of malnutrition and dehydration

C) Patient will gain 2 lbs before next weekly appointment - Anorexia does NOT involve purging at all - We want short term outcome goals and to be able to assess next week - 2 lbs. is a better written goal and is measurable and specific

Patient diagnosed with anorexia stops eating 5 months ago has lost 25% of total body weight, which subjective patient response would nurse assess to support diagnosis A) " I don't use laxatives or diuretics to lose weight" B) "I'm losing lots of hair and it comes out in handfuls" C) "I know I'm thin but I refuse to be fat" D) "I don't know why people are worried I need to lose weight"

D) "I don't know why people are worried I need to lose weight" - Because they don't see anything wrong w/ what they're doing. They only see themselves as fat, that's more priority to them than being healthy, they will themselves

Contributing Factors:

Developmental factors: - Self perception of body in adolescence Family influences: - Family dysfunction - Abuse - Lack of emotional support Sociocultural Factors: - "ideal woman" image - Sports

Eating Disorder: Intervention: Identifying Emotions and Developing Coping Strategies: Self-Monitoring:

- Is a cognitive-behavioral technique designed to help clients with bulimia. - It may help clients identify behavior patterns and then implement techniques to avoid or replace them - Self-monitoring techniques raise client awareness about behavior and help them regain a sense of control. - The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes. - In this way, clients begin to see connections between emotions and situations and eating behaviors. - The nurse can then help clients develop ways to manage emotions, such as anxiety, using relaxation techniques or distraction with music or another activity. - This is an important step toward helping clients find ways to cope with people, emotions, or situations that do not involve food.

Bulimia Nervosa:

- Often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. - The amount of food consumed during a binge episode is much larger than a person would normally eat. - The client often engages in binge eating secretly. - Between binges, the client may eat low-calorie foods or fast. - Binging or purging episodes are often precipitated by strong emotions and followed by guilt, remorse, shame, or self-contempt. - The weight of clients with bulimia is usually in the normal range, though some clients are overweight or underweight. - Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients. - Dentists are often the first health care professionals to identify clients with bulimia.

Eating Disorders: Community-Based Care:

- Treatment for clients with eating disorders usually occurs in community settings. - Hospital admission is indicated only for medical necessity, such as for clients with dangerously low weight, electrolyte imbalances, or renal, cardiac, or hepatic complications. - Clients who cannot control the cycle of binge eating and purging may be treated briefly in an inpatient setting. - Other treatment settings include partial hospitalization or day treatment programs, individual or group outpatient therapy, and self-help groups.

1. Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which problem? a.Clients object to the side effect of weight gain. b.Fluoxetine can cause appetite suppression and weight loss. c.Fluoxetine can cause clients to become giddy and silly. d.Clients with anorexia get no benefit from fluoxetine.

b.Fluoxetine can cause appetite suppression and weight loss.

Eating Disorders: Developmental Factors: Enmeshment:

- Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. - Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. - These family environments may have an orientation toward control, system maintenance, or conflict - Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. - These teens begin to control their eating through severe dieting and thus gain control over their weight. - Losing weight becomes reinforcing; by continuing to lose, these clients exert control over one aspect of their lives

Eating Disorder: Intervention: Establishing Nutritional Eating Patterns:

- Typically, inpatient treatment is for clients with anorexia nervosa who are severely malnourished and for clients with bulimia whose binge eating and purging behaviors are out of control. - Primary nursing roles are to implement and supervise the regimen for nutritional rehabilitation. - Total parenteral nutrition or enteral feedings may be prescribed initially when a client's health status is severely compromised. - When clients can eat, a diet of 1,200 to 1,500 calories/day is ordered, with gradual increases in calories until clients are ingesting adequate amounts for height, activity level, and growth needs. - Typically, allotted calories are divided into three meals and three snacks. - A liquid protein supplement is given to replace any food not eaten to ensure consumption of the total number of prescribed calories. - The nurse is responsible for monitoring meals and snacks and often initially will sit with a client during eating at a table away from other clients. - Depending on the treatment program, diet beverages and food substitutions may be prohibited, and a specified time may be set for consuming each meal or snack. - Clients may also be discouraged from performing food rituals such as cutting food into tiny pieces or mixing food in unusual combinations. - The nurse must be alert for any attempts by clients to hide or to discard food. - After each meal or snack, clients may be required to remain in view of staff for 1 to 2 hours to ensure they do not empty the stomach by vomiting. - Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. - As clients begin to gain weight and become more independent in eating behavior, these restrictions are reduced gradually. - In most treatment programs, clients are weighed only once daily, usually upon awakening and after they have emptied the bladder. - Clients should wear minimal clothing, such as a hospital gown, each time they are weighed. -They may attempt to place objects in their clothing to give the appearance of weight gain. - Clients with bulimia are often treated on an outpatient basis. - The nurse must work closely with clients to establish normal eating patterns and to interrupt the binge-and-purge cycle. - He or she encourages clients to eat meals with their families or if they live alone, with friends. - Clients should always sit at a table in a designated eating area, such as a kitchen or dining room. - It is easier for clients to follow a nutritious eating plan if it is written in advance and groceries are purchased for the planned menus. - Clients must avoid buying foods frequently consumed during binges, such as cookies, candy bars, and potato chips. - They should discard or move to the kitchen food that was kept at work, in the car, or in the bedroom.

Eating Disorders: Developmental Factors: Body Image:

- Advertisements, magazines, television, and movies that feature thin models reinforce the cultural belief that slimness is attractive. - Excessive dieting and weight loss may be the way an adolescent chooses to achieve this ideal. - Body image is how a person perceives his or her body, that is, a mental self-image. - For most people, body image is consistent with how others view them. - For people with anorexia nervosa, however, body image differs greatly from the perception of others. - They perceive themselves as fat, unattractive, and undesirable even when they are severely underweight and malnourished.

All Eating Disorders:

- All eating disorders have fear of gaining weight

Eating Disorders: Self-Awareness Issues:

- An emaciated, starving client with anorexia can be a shocking sight, and the nurse may want to "take care of this child" and nurse her back to health. - When the client rejects this help and resists the nurse's caring actions, the nurse can become angry and frustrated and feel incompetent in handling the situation. - The client initially may view the nurse, who is responsible for making the client eat, as the enemy. - The client may hide or throw away food or become overtly hostile as anxiety about eating increases. - The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. - Taking the client's behavior personally may cause the nurse to feel angry and behave in a rejecting manner. - Because eating is such a basic part of everyday life, the nurse may wonder why the client cannot just eat "like everyone else." - The nurse may also find it difficult to understand how a 75-lb client sees herself as fat when she looks in the mirror. - Likewise, when working with a client who binges and purges, the nurse may wonder why the client cannot exert the willpower to stop. - The nurse must remember that the client's eating behavior has gotten out of control. - Eating disorders are mental illnesses, just like schizophrenia and bipolar affective disorder.

Main eating disorders:

- Anorexia - Bulimia

Most Common Eating Disorders:

- Anorexia - Bulimia

Anorexia: Onset & Clinical Course:

- Anorexia nervosa typically begins between the ages of 14 and 18 years. - In the early stages, clients often deny having a negative body image or anxiety regarding their appearance. - They are pleased with their ability to control their weight and may express this. -When they initially come for treatment, they may be unable to identify or to explain their emotions about life events such as school or relationships with family or friends. - A profound sense of emptiness is common. - As the illness progresses, depression and lability in mood become more apparent. - As dieting and compulsive behaviors increase, clients isolate themselves. - This social isolation can lead to a basic mistrust of others and even paranoia. - Clients may believe their peers are jealous of their weight loss and may believe that family and health care professionals are trying to make them "fat and ugly." - For clients with anorexia, about 30% to 50% achieve full recovery, while 10% to 20% remain chronically ill. = - Compared to the general population, clients with anorexia are six times more likely to die from medical complications or suicide. - Clients with the lowest body weights and longest durations of illness tended to relapse most often and have the poorest outcomes. - Clients who abuse laxatives are at a higher risk for medical complications.

Eating Disorder: Intervention: Identifying Emotions and Developing Coping Strategies:

- Because clients with anorexia have problems with self-awareness, they often have difficulty identifying and expressing feelings (alexithymia). - Therefore, they often express these feelings in terms of somatic complaints, such as feeling fat or bloated. - The nurse can help clients begin to recognize emotions such as anxiety or guilt by asking them to describe how they are feeling and allowing adequate time for response. - The nurse should not ask, "Are you sad?" or "Are you anxious?" because a client may quickly agree rather than struggle for an answer. - The nurse encourages the client to describe his or her feelings. - This approach can eventually help clients recognize their emotions and connect them to their eating behaviors.

Eating Disorder: Cultural Considerations:

- Both anorexia nervosa and bulimia nervosa are far more prevalent in industrialized societies, where food is abundant and beauty is linked with thinness. - In the United States, anorexia nervosa is less frequent among African Americans. - On the island of Fiji, when there was little television, eating disorders were almost nonexistent and being "plump" was considered the ideal shape for girls and women. - In the 5 years following the widespread introduction of television, the number of eating disorders in Fiji increased significantly - Eating disorders are most common in the United States, Canada, Europe, Australia, Japan, New Zealand, South Africa, and other developed industrialized countries. - As a society becomes more prosperous with increased availability of foods high in fat and carbohydrates and increased emphasis on the thinness equals beauty concept, the incidence of eating disorders increases. - In addition, immigrants from cultures in which eating disorders are rare may develop eating disorders as they assimilate the thin-body ideal - Schulte (2016) found that both male and female youths in the United Arab Emirates experienced binge eating. - Obesity was a prevalent problem, as was emotional eating and body-related guilt. - Eating disorders appear to be equally common among Hispanic and Caucasian women and less common among African American and Asian women. - Minority women who are younger, better educated, and more closely identified with middle-class values are at increased risk for developing an eating disorder - During the past several years, eating disorders have increased among all U.S. social classes and ethnic groups. - With today's technology, the entire world is exposed to the Western ideal. - As this ideal spreads to non-Western cultures, anorexia and bulimia will likely increase there as well.

Anorexia Vs. Bulimia:

- Bulimia is normal weight BMI above 18.5, but less than 25 - Anorexia is super underweight less than 18.5, less than the minimum for their age and height (for adults that's less than 18.5)

Eating Disorder: Assessment: Mood & Affect:

- Clients with eating disorders have labile moods that usually correspond to their eating or dieting behaviors. - Avoiding "bad" or fattening foods gives them a sense of power and control over their bodies, while eating, binging, or purging leads to anxiety, depression, and feeling out of control. - Clients with eating disorders often seem sad, anxious, and worried. - Those with anorexia seldom smile, laugh, or enjoy any attempts at humor; they are somber and serious most of the time. - In contrast, clients with bulimia are initially pleasant and cheerful as though nothing is wrong. - The pleasant façade usually disappears when they begin describing binge eating and purging; they may express intense guilt, shame, and embarrassment. - It is important to ask clients with eating disorders about thoughts of self-harm or suicide. - It is not uncommon for these clients to engage in self-mutilating behaviors, such as cutting. - Concern about self-harm and suicidal behavior should increase when clients have a history of sexual abuse

6. The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? a.The client can identify calorie content for each meal. b.The client identifies healthy ways of coping with anxiety. c.The client spends time resting in her room after meals. d.The client verbalizes knowledge of former eating patterns as unhealthy.

b.The client identifies healthy ways of coping with anxiety.

Bulimia Nervosa: Onset & Clinical Course:

- Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or 19 years is the typical age of onset. - Binge eating frequently begins during or after dieting. - Between binging and purging episodes, clients may eat restrictively, choosing salads and other low-calorie foods. - This restrictive eating effectively sets them up for the next episode of binging and purging, and the cycle continues. - Clients with bulimia are aware that their eating behavior is pathologic, and they go to great lengths to hide it from others. - They may store food in their cars, desks, or secret locations around the house. - They may drive from one fast-food restaurant to another, ordering a normal amount of food at each but stopping at six places in 1 or 2 hours. - Such patterns may exist for years until family or friends discover the client's behavior or until medical complications develop for which the client seeks treatment. - Follow-up studies of clients with bulimia show that as many as 25% or more are untreated. - Clients with bulimia had 45% full recovery, while 23% remained chronically ill - One-third of fully recovered clients relapse. - Clients with a comorbid personality disorder tend to have poorer outcomes than those without. - The death rate from bulimia is estimated at 3% or less. - Most clients with bulimia are treated on an outpatient basis. - Hospital admission is indicated if binging and purging behaviors are out of control and the client's medical status is compromised. - Most clients with bulimia have near-normal weight, which reduces the concern about severe malnutrition, a factor in clients with anorexia nervosa.

Bulimia: Treatment: Cognitive-Behavior Therapy:

- CBT has been found to be the most effective treatment for bulimia. - This outpatient approach often requires a detailed manual to guide treatment. - Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept. - Web-based CBT, including face time with a therapist, has been effective as well as traditionally delivered CBT. - Smartphone applications (apps) for eating disorder self-management are also promising and highly acceptable to user groups

Eating Disorders:

- Can be viewed on a continuum, with clients with anorexia eating too little or starving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much. - There is much overlap among the eating disorders; 30% to 35% of normal-weight people with bulimia have a history of anorexia nervosa and low body weight, and about 50% of people with anorexia nervosa exhibit the compensatory behaviors seen in bulimic behavior, such as purging and excessive exercise. - The distinguishing features of anorexia include an earlier age at onset and below-normal body weight; the person fails to recognize the eating behavior as a problem. - Clients with bulimia have a later age at onset and near-normal body weight. - They are usually ashamed and embarrassed by the eating behavior - More than 90% of cases of anorexia nervosa and bulimia occur in women. - Although fewer men than women suffer from eating disorders, the number of men with anorexia or bulimia may be much higher than previously believed, many of whom are athletes. - Men, however, are less likely to seek treatment. - The prevalence of both eating disorders is estimated to be 2% to 4% of the general population in the United States. - In addition, a majority of the general population is dissatisfied with body image and preoccupied with weight and dieting at some point in their lives

Eating Disorder: Assessment: General Appearance & Motor Behavior:

- Clients with anorexia appear slow, lethargic, and fatigued; they may be emaciated, depending on the amount of weight loss. - They may be slow to respond to questions and have difficulty deciding what to say. - They are often reluctant to answer questions fully because they do not want to acknowledge any problem. - They often wear loose-fitting clothes in layers, regardless of the weather, both to hide weight loss and to keep warm (clients with anorexia are generally cold). - Eye contact may be limited. Clients may turn away from the nurse, indicating their unwillingness to discuss problems or to enter treatment. - Clients with bulimia may be underweight or overweight but are generally close to expected body weight for age and size. - General appearance is not unusual, and they appear open and willing to talk.

Eating Disorder: Assessment: Judgement & Insight:

- Clients with anorexia have limited insight and poor judgment about their health status. - They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. - Facts about failing health status are not enough to convince these clients of their true problems. - Clients with anorexia continue to restrict food intake or to engage in purging despite the negative effect on health. - In contrast, clients with bulimia are ashamed of the binge eating and purging. - They recognize these behaviors as abnormal and go to great lengths to hide them. - They feel out of control and unable to change, even though they recognize their behaviors as pathologic.

Anorexia Nervosa: Binge Eating:

- Clients with anorexia nervosa can be classified into two subgroups depending on how they control their weight. - Clients with the restricting subtype lose weight primarily through dieting, fasting, or excessive exercising. - Those with the binge eating and purging subtype engage regularly in binge eating followed by purging. - Binge eating means consuming a large amount of food (far greater than most people eat at one time) in a discrete period of usually 2 hours or less. & Purge Eating

Anorexia: Treatment:

- Clients with anorexia nervosa can be difficult to treat because they are often resistant, appear uninterested, and deny their problems. - Treatment settings include inpatient specialty eating disorder units, partial hospitalization or day treatment programs, and outpatient therapy. - The choice of setting depends on the severity of the illness, such as weight loss, physical symptoms, duration of binging and purging, drive for thinness, body dissatisfaction, and comorbid psychiatric conditions. - Major life-threatening complications that indicate the need for hospital admission include severe fluid, electrolyte, and metabolic imbalances; cardiovascular complications; severe weight loss and its consequences; and risk for suicide. - Short hospital stays are most effective for clients who are amenable to weight gain and who gain weight rapidly while hospitalized. - Longer inpatient stays are required for those who gain weight more slowly and are more resistant to gaining additional weight. - Outpatient therapy has the best success with clients who have been ill for fewer than 6 months, are not binging and purging, and have parents likely to participate effectively in family therapy. - Cognitive-behavioral therapy (CBT) can also be effective in preventing relapse and improving overall outcomes

Anorexia: Treatment: Psychotherapy:

- Family therapy may be beneficial for families of clients younger than 18 years. - Families who demonstrate enmeshment, unclear boundaries among members, and difficulty handling emotions and conflict can begin to resolve these issues and improve communication. - Family therapy is also useful to help members be effective participants in the client's treatment. - Family-based early intervention can prevent future exacerbation of anorexia when families are able to participate in an effective manner. - However, in a dysfunctional family, significant improvements in family functioning may take 2 years or more. - Individual therapy for clients with anorexia nervosa may be indicated in some circumstances; for example, if the family cannot participate in family therapy, if the client is older or separated from the nuclear family, or if the client has individual issues requiring psychotherapy. - Therapy that focuses on the client's particular issues and circumstances, such as coping skills, self-esteem, self-acceptance, interpersonal relationships, and assertiveness, can improve overall functioning and life satisfaction. - CBT, long used with clients with bulimia, has been adapted for adolescents with anorexia nervosa and used successfully for initial treatment as well as relapse prevention. - Enhanced cognitive-behavioral therapy (CBT-E) has been even more successful than CBT. - In addition to addressing the body image disturbance and dissatisfaction, CBT-E addresses perfectionism, mood intolerance, low self-esteem, and interpersonal difficulties

Eating Disorder: Outcome Identification:

- For severely malnourished clients, their medical condition must be stabilized before psychiatric treatment can begin. - Medical stabilization may include parenteral fluids, total parenteral nutrition, and cardiac monitoring. Examples of expected outcomes for clients with eating disorders include: •The client will establish adequate nutritional eating patterns. •The client will eliminate use of compensatory behaviors such as excessive exercise and use of laxatives and diuretics. •The client will demonstrate coping mechanisms not related to food. •The client will verbalize feelings of guilt, anger, anxiety, or an excessive need for control. •The client will verbalize acceptance of body image with stable body weight.

Eating Disorder: Assessment: Sensorium & Intellectual Processes:

- Generally, clients with eating disorders are alert and oriented; their intellectual functions are intact. - The exception is clients with anorexia who are severely malnourished and showing signs of starvation, such as mild confusion, slowed mental processes, and difficulty with concentration and attention.

Eating Disorders: Family Influences:

- Girls growing up amid family problems and abuse are at higher risk for both anorexia and bulimia. - Disordered eating is a common response to family discord. - Girls growing up in families without emotional support may try to escape their negative emotions. - They may place an intense focus outward on something concrete—physical appearance. - Disordered eating becomes a distraction from emotions. - Childhood adversity has been identified as a significant risk factor in the development of problems with eating or weight in adolescence or early adulthood. - Adversity is defined as physical neglect, sexual abuse, or parental maltreatment that includes little care, affection, and empathy as well as excessive paternal control, unfriendliness, or overprotectiveness.

Eating Disorders: Mental Health Promotions: Healthy People 2020:

- Healthy People 2020 includes an objective to increase comprehensive school education for a variety of topics, including unhealthy dietary patterns and inadequate physical injury. - This is in response to the increasing epidemic of obesity in the United States, including young children and adolescents.

Anorexia: Hospitalized For Nutrition:

- IVS or TPA - Dehydration, refeeding so they can gain weight - They can also go due to electrolyte imbalance and cardiac issue, otherwise they'll go to an outpatient facility or special places for eating disorders and therapy (some can be in for self-harming or for needing hydration therapy and b/c they are refusing to eat sometimes they need NG tube) b/c so frail and thin they can be wasting away - MAKE SURE WITH DAILY WEIGHTS YOU DON'T LET THEM SEE IT! They want to maintain the image of being really small: Once they're so small they see their hips and bones as fat and want to start getting rid of it

Eating Disorders: Sociocultural Influences:

- In the United States and other Western countries, the media fuels the image of the "ideal woman" as thin. - This culture equates beauty, desirability, and, ultimately, happiness with being thin, toned, and physically fit. - Adolescents often idealize actresses and models as having the perfect "look" or body, even though many of these celebrities are underweight or use ways to appear thinner than they are. - Books, magazines, dietary supplements, exercise equipment, plastic surgery advertisements, and weight loss programs abound; the dieting industry is a billion-dollar business. - Western culture considers being overweight a sign of laziness, lack of self-control, or indifference; it equates pursuit of the "perfect" body with beauty, desirability, success, and willpower. - Thus, many women speak of being "good" when they stick to a diet and "bad" when they eat desserts or snacks - Pressure from others may also contribute to eating disorders. - Pressure from coaches, parents, and peers and the emphasis placed on body form in sports such as gymnastics, ballet, and wrestling can promote eating disorders in athletes - Parental concern over a girl's weight and teasing from parents or peers reinforces a girl's body dissatisfaction and her need to diet or control eating in some way. - `Studies indicate that bullying and peer harassment are also related to an increase in disordered eating habits for both bullies and victims.

Anorexia: Treatment:

- In-patient setting based on severity condition Treatment is difficult due to resistance: - Deny problem - Uninterested Hospitalization due to: - Fluid, electrolyte and metabolic imbalances - Cardiovascular complications - Risk for suicide (Self harm behaviors) - Focus on receiving balanced meals and snacks to gradually increase weight Medications are used to promote weight gain: - Amitriptyline - Antihistamine Help with self image: - Zyprexa Psychotherapy - Family therapy - Individual therapy - Learn coping skills, self-esteem, self acceptance Enhanced cognitive behavioral therapy: - Perfectionism, mood intolerance - Interpersonal difficulties

Purge Eating:

- Involves compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. - Some clients with anorexia do not binge but still engage in purging behaviors after ingesting small amounts of food.

2. Which is an example of a cognitive-behavioral technique? a.Distraction b.Relaxation c.Self-monitoring d.Verbalization of emotions

c.Self-monitoring

Anorexia Nervosa:

- Is a life-threatening eating disorder characterized by the client's restriction of nutritional intake necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. - Clients with anorexia have a body weight that is less than the minimum expected weight considering age, height, and overall physical health. -In addition, clients have a preoccupation with food and food-related activities and can have a variety of physical manifestations - Clients with anorexia become totally absorbed in their quest for weight loss and thinness. - The term "anorexia" is actually a misnomer; these clients do not lose their appetites. - They still experience hunger but ignore it and also ignore the signs of physical weakness and fatigue; they often believe that if they eat anything, they will not be able to stop eating and will become fat. - Clients with anorexia are often preoccupied with food-related activities, such as grocery shopping, collecting recipes or cookbooks, counting calories, creating fat-free meals, and cooking family meals. - They may also engage in unusual or ritualistic food behaviors such as refusing to eat around others, cutting food into minute pieces, or not allowing the food they eat to touch their lips. - These behaviors increase their sense of control. - Excessive exercise is common; it may occupy several hours a day.

Night Eating Syndrome:

- Is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. - It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss - Most people with night eating syndrome are obese. - Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants has shown limited, yet positive effects

Binge Eating Disorder:

- Is characterized by recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress. - Binge eating disorder frequently affects people over age 35, and it occurs more often in men than does any other eating disorder. - Individuals are more likely to be overweight or obese, overweight as children, and teased about their weight at an early age

Identify Potential Risk Factors Of Eating Disorders:

- It is important to identify potential risk factors for developing eating disorders so that prevention programs can target those at highest risk. - Adolescent girls who express body dissatisfaction are most likely to experience adverse outcomes, such as emotional eating, binge eating, abnormal attitudes about eating and weight, low self-esteem, stress, and depression. - Characteristics of those who developed an eating disorder included disturbed eating habits; disturbed attitudes toward food; eating in secret; preoccupation with food, eating, shape, or weight; fear of losing control over eating; and wanting to have a completely empty stomach

Anorexia:

- Key characteristics is the weight - What are they doing? They still feel hunger but don't respond - They're restricting themselves - If they're hungry and restrict themselves from eating (feel hunger/thirst but don't respond to cues of their body b/c the body says they want nutrients but they don't respond) b/c body weight is so low this is why they wear lays of clothing: to hide and mask weight and they don't have body fat to keep warm - Can be hospitalized for low weight and will have cardiac issues, and electrolyte imbalance due to excessive exercising and dehydration - They have falls and can hurt themselves - If they continue they can die and have heart problems

Eating Disorder: Assessment: Self-Concept:

- Low self-esteem is prominent in clients with eating disorders. - They see themselves only in terms of their ability to control their food intake and weight. - They tend to judge themselves harshly and see themselves as "bad" if they eat certain foods or fail to lose weight. - They overlook or ignore other personal characteristics or achievements as less important than thinness. - Clients often perceive themselves as helpless, powerless, and ineffective. - This feeling of lack of control over themselves and their environment only strengthens their desire to control their weight.

Does Medication Help With Anorexia?

- Mainly cognitive behavioral therapy - No medication is proven to help (some can increase their appetite and help them gain weight) - Primary purpose of CBT is: help them change their perspective on their body image b/c it's distorted - Those who have severe body distortion: medication for delusions and cognitive disorders: antipsychotics give to them and they also help increase weight gain as well but mainly antipsychotics for body image distortion

Anorexia: Treatment: Medical Management:

- Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances. - Clients receive nutritionally balanced meals and snacks that gradually increase caloric intake to a normal level for size, age, and activity. - Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. - Generally, access to a bathroom is supervised to prevent purging as clients begin to eat more food. - Weight gain and adequate food intake are most often the criteria for determining the effectiveness of treatment.

Eating Disorders: Mental Health Promotions: Education:

- Nurses can educate parents, children, and young people about strategies to prevent eating disorders. Important aspects include realizing that the "ideal" figures portrayed in advertisements and magazines are unrealistic, developing realistic ideas about body size and shape, resisting peer pressure to diet, improving self-esteem, and learning coping strategies for dealing with emotions and life issues.

Nursing Care & CBT For Anorexia & Bulimia:

- Nursing care centers around weight gain and monitor eating, make sure they don't purge, daily weights: b/c they want to gain 1-2 lbs a week while there - Do CBT with therapist who will help them reframe thinking and gain self-esteem b/c most eating disorders they have low self-esteem and feel like the only thing they can control is what they eat

Eating Disorders: Developmental Factors: Body Image Disturbance (BID):

- Occurs when there is an extreme discrepancy between one's body image and the perceptions of others and extreme dissatisfaction with one's body image

Eating Disorder: Intervention: Providing Client & Family Education:

- One primary nursing role in caring for clients with eating disorders is providing education to help them take control of nutritional requirements independently. - This teaching can be done in the inpatient setting during discharge planning or in the outpatient setting. - The nurse provides extensive teaching about basic nutritional needs and the effects of restrictive eating, dieting, and the binge-and-purge cycle. - Clients need encouragement to set realistic goals for eating throughout the day. - Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. - For clients who purge, the most important goal is to stop. - Teaching should include information about the harmful effects of purging by vomiting and laxative abuse. - The nurse explains that purging is an ineffective means of weight control and only disrupts the neuroendocrine system. - In addition, purging promotes binge eating by decreasing the anxiety that follows the binge. - The nurse explains that if clients can avoid purging, they may be less likely to engage in binge eating. - The nurse also teaches the techniques of distraction and delay because they are useful against both binging and purging. - The longer clients can delay either binging or purging, the less likely they are to carry out the behavior. - The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. - They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight.

Anorexia As A Nurse:

- Priority is nutrition - You want them to gain weight b/c they are less than body requirements - Normally with nursing knowledge: normal weight gain is 1-2 lbs a week is expectation - In order to ensure patient is gaining weight: the intervention is: stay with them while they eat, stay with them 1-2 hours after they eat, daily weights, if they want to go to the bathroom monitor them closely (you have to be with them when they go, even if they ask for privacy the answer is NO , especially within 1-2 hours after eating. 4 hours later, maybe yes)

Bulimia:

- Regular weight and binging then purging!!! - Both restrict, but anorexia restricts food and doesn't eat, bulimia restricts food but they'll binge later (fast during the day and binge at night, or eat snacks throughout the day to curve the cravings and binge at night) - They do restrict, but not like anorexia - Restricts so they can eat a whole lot later, but anorexia restricts to maintain smaller weight

Rumination:

- Regurgitating food, then rechewed, re-swallowed or spit out

Eating Disorders: Low Epinephrine Levels:

- Related to decrease heart rate and blood pressure

Anorexia:

- Restriction of nutritional intake Characterized by: - Intense fear of gaining weight or being fat - Impaired perception of shape or size of body - Inability to acknowledge seriousness of the problem - Body weight is less than minimum expected for age, height, and overall physical health - Still have ability to feel hunger just ignores the signs of hunger Classified by how they control their weight (Subgroups): •Binge eating •Purging Individuals are preoccupied with food activities: - Grocery shopping, cooking, collecting cookbooks, counting calories Ritualistic food behaviors: - Cutting food into small pieces - Refuse to eat around other people - Excessive exercise is common

Eating Disorders: Developmental Factors: Self-Perception Of The Body:

- Self-perceptions of the body can influence the development of identity in adolescence greatly and often persist into adulthood. - Self-perceptions that include being overweight lead to the belief that dieting is necessary before one can be happy or satisfied. - Clients with bulimia nervosa report dissatisfaction with their bodies as well as the belief that they are fat, unattractive, and undesirable. - The binging and purging cycle of bulimia can begin at any time—after dieting has been unsuccessful, before the severe dieting begins, or at the same time as part of a "weight loss plan."

Anorexia: Treatment: Psychopharmacology:

- Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in inpatients with anorexia nervosa. - Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. - Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored; however, close monitoring is needed because weight loss can be a side effect.

Eating Disorder: Assessment:

- Several specialized tests have been developed for eating disorders. - An assessment tool such as the Eating Attitudes Test is often used in studies of anorexia and bulimia. - This test can also be used at the end of treatment to evaluate outcomes because it is sensitive to clinical changes.

Bulimia: Treatment: Psychopharmacology:

- Since the 1980s, many studies have been conducted to evaluate the effectiveness of medications, primarily antidepressants, to treat bulimia. - Drugs, such as desipramine (Norpramin), imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), phenelzine (Nardil), and fluoxetine (Prozac), were prescribed in the same dosages used to treat depression - In all the studies, the antidepressants were more effective than were the placebos in reducing binge eating. - They also improved mood and reduced preoccupation with shape and weight; however, most of the positive results were short term. - It may be that the primary contribution of medications is treating the comorbid disorders frequently seen with bulimia.

7. A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? a.Guilt and shame about eating patterns b.Lack of knowledge about food and nutrition c.Refusal to talk about food-related topics d.Unrealistic perception of body size

d.Unrealistic perception of body size

Orthorexia Nervosa:

- Sometimes called orthorexia, is an obsession with proper or healthful eating. - It is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, but some believe it is on the rise and may constitute a separate diagnosis. - Others believe it is a type of anorexia or a form of obsessive-compulsive disorder. Behaviors include compulsive checking of ingredients; cutting out increasing number of food groups; inability to eat only "healthy" or "pure" foods; unusual interest in what others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs - Comorbid psychiatric disorders are common in clients with anorexia nervosa and bulimia nervosa. - Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. - Of those, depression and obsessive-compulsive disorder are most common. - Both anorexia and bulimia are characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. - In addition, clients with bulimia may also exhibit high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder. - Eating disorders are often linked to a history of sexual abuse, especially if the abuse occurred before puberty. - Such a history may be a factor contributing to problems with intimacy, body satisfaction, sexual attractiveness, and low interest in sexual activity - Clients with eating disorders and a history of sexual abuse also have higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. - Childhood neglect, both physical and emotional, is also associated with eating disorders - Whether sexual abuse has a cause-and-effect relationship with the development of eating disorders, however, remains unclear.

Eating Disorder: Etiology: Biological Factors:

- Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families. - Genetic vulnerability might also result from a particular personality type or a general susceptibility to psychiatric disorders - Or, it may directly involve a dysfunction of the hypothalamus. - A family history of mood or anxiety disorders (e.g., obsessive-compulsive disorder) places a person at risk for an eating disorder. - Disruptions of the nuclei of the hypothalamus may produce many of the symptoms of eating disorders. - Two sets of nuclei are particularly important in many aspects of hunger and satiety (satisfaction of appetite)—the lateral hypothalamus and the ventromedial hypothalamus - Deficits in the lateral hypothalamus result in decreased eating and decreased responses to sensory stimuli that are important to eating. - Disruption of the ventromedial hypothalamus leads to excessive eating, weight gain, and decreased responsiveness to the satiety effects of glucose, which are behaviors seen in bulimia. - Many neurochemical changes accompany eating disorders, but it is difficult to tell whether they cause or result from eating disorders and the characteristic symptoms of starvation, binging, and purging. For example, norepinephrine levels rise normally in response to eating, allowing the body to metabolize and use nutrients. - Norepinephrine levels do not rise during starvation, however, because few nutrients are available to metabolize. - Therefore, low norepinephrine levels are seen in clients during periods of restricted food intake. - Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia. - Increased levels of the neurotransmitter serotonin and its precursor tryptophan have been linked with increased satiety. - Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa; this may explain binging behavior. - The positive response of some clients with bulimia to the treatment with SSRI antidepressants supports the idea that serotonin levels at the synapse may be low in these clients.

Eating Disorders: Mental Health Promotions: National Eating Disorder Association:

- The National Eating Disorders Association (2018) provides the following suggestions to promote positive body image: •Get rid of the notion that a particular diet, weight, or body size will automatically lead to happiness and fulfillment. •Learn everything you can about anorexia nervosa, bulimia nervosa, binge eating disorder, and other types of eating disorders. •Make the choice to challenge the false idea that thinness and weight loss are great and that body fat and weight gain are horrible or indicate laziness, worthlessness, or immorality. •Avoid categorizing foods as "good/safe" versus "bad/dangerous." Remember that we all need to eat a balanced variety of foods. •Stop judging yourself and others based on body weight or shape. Turn off the voices in your head that tell you that a person's body weight is an indicator of their character, personality, or value as a person. •Limit time on social media. Don't read or listen to others' negative comments. Surround yourself with positive, supportive, real people. •Become a critical viewer of the media and its messages about self-esteem and body image. Don't accept that the images that you see are the ideals you should try to attain. Choose to value yourself based on your goals, accomplishments, talents, and character. Avoid letting the way you feel about your body weight and shape determine the course of your day. - School nurses, student health nurses at colleges and universities, and nurses in clinics and doctors' offices may encounter clients in various settings who are at risk for developing or who already have an eating disorder. - In these settings, early identification and appropriate referral are primary responsibilities of the nurse. - Routine screening of all young women in these settings would help identify those at risk for an eating disorder. - Such early identification could result in early intervention and prevention of a full-blown eating disorder.

Eating Disorder: Assessment: Physiological & Self-Care Considerations:

- The health status of clients with eating disorders relates directly to the severity of self-starvation or purging behaviors or both - In addition, clients may exercise excessively, almost to the point of exhaustion, in an effort to control weight. - Many clients have sleep disturbances, such as insomnia, reduced sleep time, and early-morning wakening. - Those who frequently vomit have many dental problems, such as loss of tooth enamel, chipped and ragged teeth, and dental caries. - Frequent vomiting may also result in mouth sores. - Complete medical and dental examinations are essential.

Eating Disorders: Developmental Factors: Need To Develop Unique Identity:

- The need to develop a unique identity, or a sense of who one is as a person, is another essential task of adolescence - It coincides with the onset of puberty, which initiates many emotional and physiological changes. - Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be.

Eating Disorder: Intervention: Dealing With Body Image Issues:

- The nurse can help clients accept a more normal body image. - This may involve clients agreeing to weigh more than they would like, to be healthy, and to stay out of the hospital. - When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. - The nurse can also help clients view themselves in terms other than weight, size, shape, and satisfaction with body image. - Helping clients to identify areas of personal strength that are not food-related broadens clients' perceptions of themselves. - This includes identifying talents, interests, and positive aspects of character unrelated to body shape or size.

Eating Disorder: Evaluation:

- The nurse can use assessment tools such as the Eating Attitudes Test to detect improvement for clients with eating disorders. - Both anorexia and bulimia are chronic for many clients. - Residual symptoms such as dieting, compulsive exercising, and experiencing discomfort when eating in a social setting are common. - Treatment is considered successful if the client maintains a body weight within 5% to 10% of normal with no medical complications from starvation or purging.

Purge:

- To maintain weight with bulimia they may purge - Purge: eat a whole lot then purge - Afterwards they feel embarrassment, shame, guilt - They have normal weight - Some medication they can take: antidepressants and they help them improve their moods b/c usually they depressed or have anxiety and it also helps them stop focusing on their weight - They also benefit from cognitive behavioral therapy - CBT for bulimia is more towards self-management and teaching behaviors, IDing behaviors associated w/ binging, and teach how to ID feelings and replace the behavior with something else. - Want to stop them from binging and purging

Nurse working with a patient with bulimia asks them to recall a time in life when food could be consumed without purging. Which is the purpose of the intervention? A) To gain additional information about progression of disease B) Emphasis on patient's ability of consuming food without purging C) To incorporate specific foods into meal plan to reflect pleasant memories D) Assist patient to become more compliant with treatment plan

B) Emphasis on patient's ability of consuming food without purging - Want them to learn skills to replace purging - B/c "emphasis" they can do it before, helps to develop coping skills for patient - Ask questions: If say I was 25 and didn't purge, want to know more about it, how did they prevent from purging then, and that helps to ID ways to cope

Which of the following is the typical age of onset for anorexia? A. 10 to 14 years B. 14 to 18 years C. 18 to 22 years D. 22 years and older

B. 14 to 18 years - Rationale: Most commonly, anorexia begins between the ages of 14 and 18 years.

Binge Eating & Purge Eating:

Binge Eating: •Consume larger than normal amount of eating within a 2-hour period Purging: •Self-induced vomiting or misuse of laxative and diuretics •How they compensate for overeating

Risk Factors: Bulimia Nervosa:

Biological Risk Factors: - Obesity; early dieting; possible serotonin and norepinephrine disturbances; chromosome 1 susceptibility Developmental Risk Factors: - Self-perceptions of being overweight, fat, unattractive, and undesirable; dissatisfaction with body image Family Risk Factors: - Chaotic family with loose boundaries; parental maltreatment including possible physical or sexual abuse Sociocultural Risk Factors: - Same as above; weight-related teasing

Risk Factors: Anorexia Nervosa:

Biological Risk Factors: - Obesity; dieting at an early age Developmental Risk Factors: - Issues of developing autonomy and having control over self and environment; developing a unique identity; dissatisfaction with body image Family Risk Factors: - Family lacks emotional support; parental maltreatment; cannot deal with conflict Sociocultural Risk Factors: - Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation with achieving the ideal body

Bulimia: Treatment:

CBT: - Change thinking and actions Pharmacology: - Treat depression - Improves mood and reduce preoccupations with shape and weight Self-monitoring: - Help identify behaviors and implement techniques to avoid or replace them - Increase self awareness - Regain a sense of control

Client & Family Education For Eating Disorders:

Client •Basic nutritional needs •Harmful effects of restrictive eating, dieting, and purging •Realistic goals for eating •Acceptance of healthy body image Family and Friends •Provide emotional support. •Express concern about the client's health. •Encourage the client to seek professional help. •Avoid talking only about weight, food intake, and calories. •Become informed about eating disorders. •It is not possible for family and friends to force the client to eat. The client needs professional help from a therapist or psychiatrist.

Is the following statement true or false? One current biologic theory about eating disorders is that it involves a disruption in the cerebellum portion of the brain.

False - Rationale: One of the biologic theories of eating disorders involves disruption of the nuclei in the hypothalamus that relate to hunger and satiety.

Is the following statement true or false? Self-monitoring is an effective technique that a client with anorexia can use.

False - Rationale: Self-monitoring is an effective technique that a client with bulimia can use.

Nursing Roles With Anorexia Bulimia:

Implement and supervise regimens: - Monitoring meals and snacks Patients are discouraged from ritual behaviors with food: - Must be alerted of attempts to hide food or discard of food Monitor patient after eating for 1 to 2 hours to stop attempts to void of food: - Access to bathroom is limited or supervised Weighed daily: - Don't let patient see weight - In the morning - After using restroom - With limited clothing

Eating Disorder: Data Analysis:

Nursing diagnoses for clients with eating disorders include: •Imbalanced nutrition: Less than/more than body requirements •Ineffective coping •Disturbed body image •Chronic low self-esteem Other nursing diagnoses may be pertinent, such as deficient fluid volume, constipation, fatigue, and activity intolerance.

Bulimia:

Recurrent episodes of being eating: - Followed by compensatory behaviors - Avoid weight gain - Fasting, exercise or purging or binging - Feel guilt, shame, remorse - Weight tend to be normal range Dentist usually are the first to discover: - Destroyed tooth enamel - Dental carries - Chipped teeth - Usually treated in outpatient settings

Medical Complications With Eating Disorders:

Related to Weight Loss Musculoskeletal Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures Metabolic Hypothyroidism (symptoms include lack of energy, weakness, intolerance to cold, and bradycardia), hypoglycemia, and decreased insulin sensitivity Cardiac Bradycardia, hypotension, loss of cardiac muscle, small heart, cardiac arrhythmias (including atrial and ventricular premature contractions, prolonged QT interval, ventricular tachycardia), and sudden death Gastrointestinal Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea Reproductive Amenorrhea and low levels of luteinizing and follicle-stimulating hormones Dermatologic Dry, cracking skin due to dehydration, lanugo (i.e., fine, baby-like hair over body), edema, and acrocyanosis (i.e., blue hands and feet) Hematologic Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, and hypercarotenemia Neuropsychiatric Abnormal taste sensation, apathetic depression, mild organic mental symptoms, and sleep disturbances Related to Purging (Vomiting and Laxative Abuse) Metabolic Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, hypomagnesemia, and elevated blood urea nitrogen Gastrointestinal Salivary gland and pancreas inflammation and enlargement with an increase in serum amylase, esophageal and gastric erosion or rupture, dysfunctional bowel, and superior mesenteric artery syndrome Dental Erosion of dental enamel (perimyolysis), particularly front teeth Neuropsychiatric Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies, fatigue, weakness, and mild organic mental symptoms

3. The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? a.Supervise the client closely for 2 hours after meals and snacks. b.Increase the daily caloric intake from 1,500 to 2,000 calories. c.Increase the client's fluid intake. d.Request an order from the physician for fluoxetine.

a.Supervise the client closely for 2 hours after meals and snacks.

4. Which statement is true? a.Anorexia nervosa was not recognized as an illness until the 1960s. b.Cultures in which beauty is linked to thinness have an increased risk for eating disorders. c.Eating disorders are a major health problem only in the United States and Europe. d.Individuals with anorexia nervosa are popular with their peers as a result of their thinness.

b.Cultures in which beauty is linked to thinness have an increased risk for eating disorders.

8. A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? a.Ask the client to write about all feelings and experiences related to food. b.Assist the client in making daily meal plans for 1 week. c.Encourage the client to ignore feelings and impulses related to food. d.Teach the client about nutrition content and calories of various foods.

a.Ask the client to write about all feelings and experiences related to food.

5. Which is not a goal for treating the severely malnourished client with anorexia nervosa? a.Correction of body image disturbance b.Correction of electrolyte imbalances c.Nutritional rehabilitation d.Weight restoration

a.Correction of body image disturbance

Physical Problems Of Anorexia Nervosa:

•Amenorrhea •Constipation •Overly sensitive to cold, lanugo hair on body •Loss of body fat •Muscle atrophy •Hair loss •Dry skin •Dental caries •Pedal edema •Bradycardia, arrhythmias •Orthostasis •Enlarged parotid glands and hypothermia •Electrolyte imbalance (i.e., hyponatremia, hypokalemia)

Points To Consider When Working With Clients With Eating Disorders:

•Be empathetic and nonjudgmental, though this is not easy. Remember the client's perspective and fears about weight and eating. •Avoid sounding parental when teaching about nutrition or why laxative use is harmful. Presenting information factually without chiding the client will obtain more positive results. •Do not label clients as "good" when they avoid purging or eat an entire meal. Otherwise, clients will believe they are "bad" on days when they purge or fail to eat enough food.

Binge Eating Disorder:

•Binging episodes with out use of compensatory behaviors •Guilt, shame, and disgust about eating behavior •Psychological distress •35 and over; more often in men

Pica:

•Eating non-food items

Eating Disorders: Comorbid Disorders:

•Mood disorders (depression) •Anxiety •Substance abuse

Night Eating Syndrome:

•Morning anorexia •Even hyperphagia •Eating 50% of daily calories after last meal •Night awakenings to eat •Associated with stress, low self esteem, depression •Most are obese •Treatment is SSRI

Orthorexia:

•Obsession with proper or healthy eating •Common behaviors •Checking ingredients •Cutting out increasing number of food groups •Hours spent thinking about food

Eating Disorders Characterized By:

•Perfectionism •Negative emotions •Low self directedness •Low cooperation •Avoidant type behaviors