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lccc nursing psy
lccc nursing psy final
What is healthy eating?
: know the difference between physical and emotional cues and needs. Eat when you are hungry; stop when you are full/meet your body needs
: eat pleasurable foods without guilt or anxiety
: 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
What are some statistics about anorexia and bulimia? BED?
: 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
: occurs in 1-5% of high school girls
as high as 19% in college women
: occurs more commonly in women; can vary from 3-30% of women
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
What is the etiology?
no consensus on precise cause
Combination of psychological, biological, family, gene ti, environmental and social factors
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
What is the female athlete's triad? Whose at risk? What should you look for?
: eating disorders, stress fractures, amenorrhea
: 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
What are the associated psychiatric conditions?
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)
What are the fears?***
Anorexia nervosa is not a disorder of appetite
Clients may report decreased appetite
Others Fear appetite
What is the assessment, diagnosis and plan for anorexia nervosa
: general assessment, self assessment
: refeeding syndrome
What are the signs and symptoms of anorexia nervosa?
Dry skin, blue hands and feet
delayed puberty, primary or secondary amenorrhea
scalp hair loss
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????)
What lab assessment is necessary?
Mg, PO4, Calcium
Albumin, serum protein
: Specific gravity
thyroid function tests
What diseases should you rule out first?
New onset DM
Primary depression with anorexia
Inflam. bowel disease
Central nervous system lesions
What interventions are done for AN in acute care?
Health teaching and promotion
Safety and teamwork
Why is cognitive behavioral therapy used for AN? Who is part of the interdisciplinary team?
: emphasizes the relationship of thoughts and feelings to behavior; limited efficacy
: medical provider, dietitian with experience in ED, mental health professional
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
What kind of complications cause hospitalization in AN?
Severe malnutrition (<75% IBW)
Arrested growth and development
Failure of outpatient treatment
Acute psychiatric emergencies
Comorbid conditions that interfere with the treatment of the ED
What is the goal for nutrition in AN?
: 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
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
What kind of cardiac changes do you see with AN?
: occurs in 32-60% of clients with anorexia
: 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)
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
What are the signs and symptoms of BN?
Impulsivity (stealing, alcohol abuse, drugs/tobacco)
bleeding or easy bruising
swollen parotid glands
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
What are the complications of BN?
inability to concentrate urine
What is one of the most severe complications of BN?
Difficult to reverse
: weight gain, 1200-1500mg/day of elemental calcium
multivitamin wit 400 IU vitamin D
Consider estrogen/progesterone replacement
What are the interventions for BN in acute care?
Teamwork and safety
Health teaching and health promotion
Advanced practice interventions
What type of therapy is effective for BN? What about pharmtherapy?
: cognitive behavioral therapy is effective
: high success rate; fluoxetine-studies reveal up to 67% reduction in vomiting
Topiramate-reduced binge eating by 94% and average wt loss of 6.2kg
What is refeeding syndrome?
: cardiovascular collapse, rhabdomyolysis, seizures, delirium, starte refeeding at 20kcals/kg and increase by 100-200kcals/day
: Daily MVI with thiamine
What is the most common eating disorder in the US?
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
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
What are some statistics for BED?
occurs more commonly in women
depending on population surveyed, can vary from 3-30%
What is the treatment for BED?
What are the common feeding and elimination disorders?
: Pica (craving food with no nutritious value) Rumination ( throwing food then re-chewing it), Avoidant/restrictive food intake disorder
: enuresis, encopresis
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