3320 eating disorders

predisposing factors

genetics, neurochemical (bulimia nervosa- 5HT, NE), psychodynamic influences, family influences, culture

anorexia nervosa DSM-5 criteria

restricting energy intake to below requirements, significant loss of weight or malnourishment, intense fear of weight gain or persistent interference with weight gain, disturbance of body image, self-evaluation linked to body shape or weight

anorexia nervosa symptoms

hypothermia, bradycardia, hypotension, edema, lanugo, metabolic changes, anxiety, depression, perfectionism

refeeding syndrome

catastrophic cardiopulmonary collapse in early stages of nutritional replacement, insulin surge causes electrolyte shift into cells→hypokalemia, hypophosphatemia, hypomagnesemia

refeeding syndrome nursing priorities

start nutrition slowly, monitor electrolytes, replace phosphorus, administer thiamine, cardiac monitoring

refeeding syndrome symptoms

muscle weakness, cardiac arrhythmias, respiratory distress, peripheral edema, confusion

bulimia nervosa

onset in late adolescence/early adulthood, occurs primarily in societies that place emphasis on thinness as a model of attractiveness for women

bulimia nervosa DSM-5 criteria

recurrent episodes of binge eating and inappropriate compensatory behavior to rid body of excess calories at least once a week for 3 months, self-evaluation influenced by body shape and weight

binge eating

uncontrolled rapid ingestion of large quantities of food over short period of time

inappropriate compensatory behavior to rid body of calories

self-induced vomiting, laxatives, diuretics, enemas

bulimia nervosa symptoms

normal weight range, depression, anxiety, substance abuse, Russell’s sign, parotid swelling, excessive vomiting/laxative/diuretic abuse→dehydration, hypokalemia

binge eating disorder

eating used as coping mechanism, 50% of people also have history of depression

binge eating disorder DSM-5 criteria

eating within any 2hr period an amount of food that is larger than what most people would eat in a similar time frame under similar circumstances, sense of lack of control over eating during episode, marked distress over binging, occurs at least once a week for 3 months and not associated with another disorder

nursing actions- imbalanced nutrition/deficit fluid volume

don’t focus on eating food specifically, assess for bradycardia, behavior modification plan, meal/snacks structured, sit with client after meal to ensure no purging, discuss triggers and coping methods

nursing actions- denial

establish trusting relationship, structure and consistency are important, assist to understanding correlation between emotional issues and eating behaviors

nursing actions- disturbed body image/low self esteem

help client develop realistic perception of body image, promote feelings of control, allow opportunities of independent decisions to enhance self esteem

nursing actions- hospitalization

malnutrition, dehydration, electrolyte imbalances (phosphate, potassium, magnesium), cardiac arrhythmia or bradycardia, hypothermia, hypotension, suicidal ideation

behavior modification

issues of control are central to etiology of eating disorders, client must perceive that they are in control of treatment, staff and client agree about goals and system of rewards

individual therapy

helpful when underlying psychological problems are contributing to maladaptive behaviors

family therapy

maudsley approach, educate family about disorder, assess family’s impact on maintaining the disorder, assists in methods to promote adaptive functioning by the client

psychopharmacology

meds in combination with CBT are most effective, prescribed for associated symptoms (anxiety, depression)

meds for anorexia nervosa and bulimia nervosa

SSRIs

meds for binge eating disorder with obesity

topiramate and lisdexamfetamine