eating disorders

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eating disorders
2015-04-28 16:44:56
lccc nursing psy

lccc nursing psy final
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  1. What is healthy eating?
    • Mindful: know the difference between physical and emotional cues and needs. Eat when you are hungry; stop when you are full/meet your body needs
    • Enjoyable: eat pleasurable foods without guilt or anxiety
    • Flexible: be able to eat needed amount in available time. No calorie counting. Eat a variety of foods. Don't avoid any food group. Try new things without knowing all ingredients
  2. What are some statistics about anorexia and bulimia? BED?
    • anorexia: incidence rates have increased over past 25 years, affects 1% of adolescent females, rates for men on 10% of those for women; seen in clients as young as 6
    • Bulimia: occurs in 1-5% of high school girls
    • as high as 19% in college women
    • BED: occurs more commonly in women; can vary from 3-30% of women
  3. When is onset most likely?
    • eating disorders ave onset most commonly in teen and young adult years, but may occur at other ages ( BN slightly later onset then AN) 
    • <10% have onset prior to puberty
  4. What is the etiology?
    • no consensus on precise cause
    • Combination of psychological, biological, family, gene ti, environmental and social factors
  5. What are the associated factors?
    • hx of dieting in adolescent children
    • Childhood preoccupation with a thin body and social pressure about weight
    • Sports and artistic endeavors in which leanness is emphasized
    • Women whose first degree relatives have eating disorders-6 to 10 fold increased risk for developing an eating disorder
  6. What is the female athlete's triad? Whose at risk? What should you look for?
    • The triad: eating disorders, stress fractures, amenorrhea
    • At risk: appearance related sports, high performance sports
    • What to look for: Weight, HR 40-50, hypotension, hypothermia, parotid swelling, poor dentition, overuse injuries especially stress fractures
  7. What are the associated psychiatric conditions?
    • affective disorders 
    • anxiety disorders
    • OCD
    • Personality disorders
    • substance abuse
  8. What is the DSM-5 criteria for anorexia nervosa?
    • refusal to maintain weight within a normal ramge for height and age (more tan 15% below ideal body weight)
    • Fear of weight gain*
    • Severe body image disturbance in which body image is the predominant measure of self-worth with denial of the seriousness of the illness
    • In post-menarchal females, absence of the menstrual cycle, or amenorrhea (greater than three cycles)
  9. What are the fears?***
    • Anorexia nervosa is not a disorder of appetite
    • Clients may report decreased appetite
    • Others Fear appetite
  10. What is the assessment, diagnosis and plan for anorexia nervosa
    • Assessment: general assessment, self assessment 
    • Plan: refeeding syndrome
  11. What are the signs and symptoms of anorexia nervosa?
    • Dry skin, blue hands and feet
    • cold intolerance
    • constipation, bloating 
    • delayed puberty, primary or secondary amenorrhea
    • nerve compression
    • fainting 
    • ortho hypo 
    • lanugo 
    • scalp hair loss
    • early satiety 
    • weakness, fatigue
    • short stature 
    • osteopenia
    • breast atrophy
    • atrophic vaginitis 
    • pitting edema 
    • cardiac murmurs
    • sinus brady 
    • hypothermia
  12. What questions should you ask as a screening tool? (Esp)
    • Are you satisfied with your eating patterns?: no is abnormal
    • Do you ever in secret?: yes is abnormal
    • Does your weight affect the you feel about yourself?: yes is abnormal
    • Have any members of your family suffered with an eating disorder?: Yes is abnormal
    • Do you currently suffer with or have you suffered in the past with an eating disorder?  
    • (2 or more abnormal is bad????)
  13. What lab assessment is necessary?
    • CBC: anemia 
    • Electrolytes, BUN/Cr
    • Mg, PO4, Calcium 
    • Albumin, serum protein
    • B-HCG
    • UA: Specific gravity 
    • thyroid function tests
    • Serum prolactin 
    • FSH 
    • Bone density
  14. What diseases should you rule out first?
    • New onset DM
    • Adrenal insufficiency
    • Primary depression with anorexia
    • Inflam. bowel disease
    • Abdominal masses
    • Central nervous system lesions
  15. What interventions are done for AN in acute care?
    • psychosocial interventions 
    • Pharm interventions 
    • integrative medicine
    • Health teaching and promotion 
    • Safety and teamwork
  16. Why is cognitive behavioral therapy used for AN? Who is part of the interdisciplinary team?
    • Cognitive behavioral: emphasizes the relationship of thoughts and feelings to behavior; limited efficacy 
    • Care team: medical provider, dietitian with experience in ED, mental health professional
  17. What medications are used for AN?
    • disappointing results, effective only for comorbid conditions of depression and ocd
    • Anxiolytics may be helpful before meals to supress the anxiety associated with eating
    • Case reports in the literature supporting the use of olanzapine
  18. What kind of complications cause hospitalization in AN?
    • Severe malnutrition (<75% IBW) 
    • Dehydration 
    • Electrolyte disturbance 
    • cardiac dysrhythmia
    • Arrested growth and development 
    • physiologic instability 
    • Failure of outpatient treatment 
    • Acute psychiatric emergencies 
    • Comorbid conditions that interfere with the treatment of the ED
  19. What is the goal for nutrition in AN?
    • Goal: regain to goal of 90-92% if IBW; inpatient treatment varies by facility 
    • this is done by: 
    • Oral liquid nutrition 
    • Nasogastric tube feedings 
    • gradual caloric increase wit regular food 
    • parenteral nutrition rarely indicated
  20. How does amenorrhea relate to AN?
    • Scondary amenorrhea affects more than 90% of clients with anorexia
    • Caused by low levels of FSH and LH 
    • Menses resumes with 6 months of achieving 90% IBW
  21. What kind of cardiac changes do you see with AN?
    • MVP: occurs in 32-60% of clients with anorexia
    • Long QT: as many as 33% of patients ( independent marker for arrhythmia, immediate attention if client is bradycardic and underweight as well 
    • Risk of heart failre is greates in the first 2 weeks of refeeding: reduced cardiac contractility and refeeding edema ( slow refeeding, repletion of PO4, avoidance of sodium intake)
  22. What is the DSM-5 criteria for bulimia
    • episodes of binge eating with a sense of loss of control
    • binge eating is followed by compensatory behavior of the purging type (self induced vomiting, lax abuse, diuretic abuse) or non-purging ( excessive exercise, fasting, or stric diets) 
    • Binges and the resulting compensatory behavior must occur a minimum of two times per week for 3 months
    • Dissatisfaction with body shape and weight
  23. What are the signs and symptoms of BN?
    • Mouth sores
    • Pharyngeal trauma
    • Dental caries
    • Esophageal rupture
    • Impulsivity (stealing, alcohol abuse, drugs/tobacco) 
    • Muscle cramps 
    • weakness 
    • bloody diarrhea
    • bleeding or easy bruising
    • irregular periods
    • fainting 
    • swollen parotid glands 
    • hypotension
  24. What will you find with BN on Physical exam?
    • all elements of anorexia plus 
    • parotid gland swelling and erosion of the teeth enamel; calluses on hands 
    • *Weight may be normal
  25. What are the complications of BN?
    • Hypokalemia
    • hyponatremia
    • elevated BUN 
    • inability to concentrate urine
    • Decreased GFR 
    • ketonuria
  26. What is one of the most severe complications of BN?
    • Osteopenia
    • Difficult to reverse
    • Treatment: weight gain, 1200-1500mg/day of elemental calcium 
    • multivitamin wit 400 IU vitamin D 
    • Consider estrogen/progesterone replacement
  27. What are the interventions for BN in acute care?
    • Teamwork and safety 
    • Pharmacological interventions 
    • Counseling 
    • Health teaching and health promotion 
    • Advanced practice interventions: psychotherapy
  28. What type of therapy is effective for BN? What about pharmtherapy?
    • Therapy: cognitive behavioral therapy is effective 
    • Pharm: high success rate; fluoxetine-studies reveal up to 67% reduction in vomiting
    • TCAs
    • Topiramate-reduced binge eating by 94% and average wt loss of 6.2kg
  29. What is refeeding syndrome?
    • Severe hypophosphatemia: cardiovascular collapse, rhabdomyolysis, seizures, delirium, starte refeeding at 20kcals/kg and increase by 100-200kcals/day 
    • Wernicke's encephalopathy: Daily MVI with thiamine
    • Constipation: metoclopromide
  30. What is the most common eating disorder in the US?
  31. What is the criteria for binge eating disorder?
    • eating in a discrete period of time an amount of food that is larger than most people would eat in a similar period 
    • Occurs 2 days per week for six month duration
    • Associated with a lack of control and with distress over the binge eating
  32. BED must have 3 of which 5 criteria?
    • eating much more rapidly than normal 
    • eating until uncomfortably fool 
    • eating large amounts of food when not feeling physically hungry 
    • eating alone because of the embarrassment
    • feeling very disgusted, depressed or very guilty over overeating
  33. What are some statistics for BED?
    • occurs more commonly in women 
    • depending on population surveyed, can vary from 3-30%
  34. What is the treatment for BED?
    • Cognitive therapy 
    • group/family therapy 
    • nutrition counseling 
    • pharmacotherapy-SSRI
  35. What are the common feeding and elimination disorders?
    • feeding: Pica (craving food with no nutritious value) Rumination ( throwing food then re-chewing it), Avoidant/restrictive food intake disorder 
    • Elimination: enuresis, encopresis
  36. What is voluntary encopresis?
    • person has control over where and when bowel movements occur
    • Once a month for at least 3 months 
    • developmentally at least 4 years old 
    • power struggle, oppositional deviant disorder, conduct disorder, sexual abuse