Card Set Information
DSM-IV-TR definition of anorexia?
Refusal to maintain body weight for height
Weight 15% under ideal body wt. Or 85% of what is should be
Fear of gaining weight & becoming fat
Denial of seriousness of low body weight
Females- amenorrhea**(Absence of 3 consecutive cycles)
Eating habits of anorexia?
Consume 500 to 700 calories/day & often as few as 200 cal/day
Compulsive about eating habits
May eliminate all meat
May have bizarre food preferences
May cook for family to mask not eating
After eats, may go to bathroom to purge
May smoke to keep down appetite
Theories of anorexia?
: conflict over one’s sexual role.
Lose control over eating/do not accurately experience hunger/satiety
Distorted body image
Life out of control and controls self by not eating
: Values thinness
Ways anorexics hide weight?
Drinks water before weighing
Specific gravity measurements for water loading
Tapes quarters or objects under armpits
Puts things in underwear
Weigh in hospital gowns to prevent pt from weighing down clothing or hiding stuff in it.
Watch slouching especially during height measurement. Get accurate height.
What are some medical complications related to anorexia?
CNS-decreased REM sleep
Thermoregulation- they feel cold
Renal- Hematuria, proteinuria
Hemotologic- Leucopoenia, anemia, decreased platelets
Metabolic- dehydration, acidosis,
Decrease in K+, Cl-, Ca++, phosphates., Mg,*** (Both anorexia & bulimia can lead to electrolyte imbalance)
Endocrine- decrease in luteinizing hormone & FSH, decrease in thyroid stimulating hormones
Muscle wasting, leads to sudden death as dysrhythmias
Falling off the growth curve for 2 years-underweight- are in greater danger of death ***
Treatments for eating disorders
Current body weight
Height and growth curve analysis
Assess eating pattern
Attitudes about food and weight
Assess distorted thoughts about food
Food preferences (may be vegetarian-easier to disguise
Evaluate social & emotional functioning with peers & family
Emotional/social ssessments for anorexia?
Distorted body image
Fear of being fat
States is fat despite malnourished state
Does severe exercise
Enmeshed family patterns
Physical assessments for anorexia?
Lanugo over body
Mottled cold skin
Low blood pressure, pulse, temperature
Dry mucous membranes
Absence of 3 or more menstrual cycles
Has hollow face, sunken eyes
Wears baggy clothing
Exhibits delayed psychosexual development
Fluid & electrolyte imbalance
Interventions for anorexia?
Stabilize physical status first; then psychological
Hospitalization at BMI less than 17 or Weight under 75%
Monitor food intake & exercise
Offer food preferences when possible
Monitor 2 hours after eating
Design an eating and exercise program
Administer medication & monitor side effects
--SSRI’s (to help treat underlying anxiety/depression)
--Antipsychotics for agitation & aggression
: compares perceived body size by drawing imagined outline of body on paper, and then tracing the outline of their actual body in order to compare perception to reality.
Discuss starvation as self-destructive
Avoid coercing to eat
Provide careful praise for weight gain
Use liquid diets if needed (Boost)
Hyperalimentation to restore electrolyte, fluid & nutritional balance
Encourage pt to view replacement therapy as medication
What would you use cognitive restructuring for with an anorexic?
Preoccupation with food
Fear of getting fat
Need to be perfect
Fears of development
What are the outcomes you want from anorexics?
Establish healthy eating plan
Demonstrate adequate weight for height/age
Provide for .5 to 3 pounds weight gain/week
Fluid and electrolyte balance
Good skin turgor, moist mucous membranes
Resumes normal menstrual cycles
Resumes normal sleep cycle
Maintains healthy exercise
Has a realistic body image
Verbalizes feels good about self
States no longer fearful of weight gain
Resolves control issues
Resumes sexual interest
Is no longer preoccupied with food
Resolves family enmeshment
What is the challenge of treating multiple anorexic pts together?
They may learn strategies to maintain anorexia from each other.
What is the DSM-IV-TR criteria for bulemia?
Within 2 hours:
Eats large amount of food
Lacks control over eating
Binge/purging 2 times weekly for 3 months
Recurrent inappropriate compensatory behavior:
Misusing diuretics, enemas or medications
What is some general process information about bulimia?
Don’t have the severe identity problem anorexics do***
They know they have a problem
Binge on high fat, high carbohydrates easy to purge
Deceased protein intake
Around age 40 if not dealt with may not purge and can gain weight
Maintains relatively same weight
What are some medical complications related to bulimia?
Callous on finger
Esophagitis & tears
Chronic sore throat
Delayed gastric emptying
Muscle aching & cramping
Puffy eyes and broken blood vessels
Diarrhea, skin breakdown
Constipation without laxatives
Laxative abuse & laxative habit
What are you assessing in bulimia?
Binging & purging episodes
Use of laxatives, enemas, diuretics
Engagement in strict dieting/fasting to prevent weight gain
Weight stays relatively stable
Attempts to conceal binging/purging
Fluid & electrolyte imbalance
What outcomes do you want to see with bulimia?
Ceases binging/purging episodes
Maintains normal weight
Establishes an exercise plan
States is comfortable with body weight
Eats nutritionally balance meals
States is in control of life
interventions for bulimia?
Monitor for binging and purging
Eat foods harder to purge
Observe for 2 hours after eating
Limit sweet, soft or sugary foods easily purged
Discuss binge/purging as self-destructive
Develop coping strategies
Eat packaged food to count calories
Teach to cut food in small pieces & chew a lot
Establish healthy dietary & exercise plan
--Prozac and others (SSRIs)
Use cognitive therapy
Restructure negative thinking
Deal with guilt
Develop realistic beliefs about food & weight
Rispredal & Zyprexa are sometimes used for impulsivity
Use hospitalization & nutritional therapy as needed