Eating Disorders

What are the physical symptoms of Anorexia Nervosa?

Physical symptoms include extreme weight loss (less than 75% of expected weight), starvation leading to malnutrition, fluid and electrolyte imbalances (specifically hypokalemia < 3.5), lanugo (fine, thin hair), amenorrhea, cold intolerance, low vital signs (bradycardia < 60 bpm, hypotension, hypothermia), loss of muscle mass, and osteoporosis.

What are the physical symptoms of Bulimia Nervosa?

Clients usually maintain a normal body weight or may be slightly overweight. Physical symptoms include tooth and gum deterioration (dental enamel erosion from stomach acid), salivary gland inflammation, esophageal erosion, scaly skin, and fluid/electrolyte imbalances like hypokalemia.

What are the physical characteristics of Binge Eating Disorder?

Clients are more likely to be overweight or obese. This disorder frequently affects people over age 35 and occurs more often in men than other eating disorders.

What are the psychological symptoms of Anorexia Nervosa?

Psychological symptoms include a distorted body image, an unrealistic and intense fear of gaining weight or becoming obese, depression, emotional lability, and an inability or refusal to acknowledge the severity of the problem.

What are the psychological symptoms of Bulimia Nervosa?

These include a distorted view of body image and an obsessive desire to lose weight, which are accompanied by feelings of intense guilt, remorse, shame, and self-contempt following binge episodes.

What are the psychological symptoms of Binge Eating Disorder?

Clients experience marked psychological distress, including intense guilt, shame, and disgust regarding their eating behaviors.

What are the behavioral symptoms of Anorexia Nervosa?

Behaviors involve severe restriction of nutritional intake, vigorous and excessive exercise, ritualistic food behaviors (such as cutting food into minute pieces or refusing to eat around others), and social isolation.

What are the behavioral symptoms of Bulimia Nervosa?

Behaviors include recurrent episodes of uncontrolled binge eating in secret (consuming large amounts of food in a short period), followed by compensatory behaviors such as self-induced vomiting, fasting, or misuse of laxatives, diuretics, and enemas.

What are the behavioral symptoms of Binge Eating Disorder?

Behaviors consist of recurrent episodes of binge eating over an extended period (often more than 2 hours) without the regular use of inappropriate compensatory behaviors like purging or fasting.

What are the biological theories behind the etiology of eating disorders?

Eating disorders tend to run in families, indicating a genetic predisposition, and there is often a family history of mood or anxiety disorders. Other theories involve neurochemical changes (disturbances in serotonin and norepinephrine) and hypothalamus dysfunction, where the lateral hypothalamus regulates decreased eating and the ventromedial regulates excessive eating.

What psychological and developmental factors contribute to eating disorders?

Adolescents struggling with autonomy and identity development are at risk. Contributing factors include body image disturbance, emotional eating, low self-esteem, stress, depression, a discrepancy between self-perception and how others view them, and a need for control that drives restrictive eating.

What sociocultural theories explain the development of eating disorders?

The media propagates a cultural idealization of thinness, linking beauty, desirability, and happiness to being thin. Pressure from parents, coaches, and peers, along with bullying and cyberbullying about weight, are significant contributing factors.

How do family influences contribute to the etiology of eating disorders?

Eating disorders can be a response to family discord, abuse, or a lack of emotional support. Known risk factors include enmeshed families where boundaries are unclear and dependency is fostered, as well as childhood adversity such as physical neglect, sexual abuse, or parental maltreatment.

What is the most effective psychotherapy for Bulimia Nervosa and Binge Eating Disorder?

Cognitive-Behavioral Therapy (CBT) is the most effective treatment, as it interrupts the cycle of binging and purging while altering dysfunctional thoughts about weight and self-concept.

What therapy is highly recommended for clients under 18 with Anorexia?

Family therapy is highly recommended to resolve family enmeshment and improve communication.

What is the primary focus of medical management for severe anorexia?

The primary focus is weight restoration, rehydration, and the correction of electrolyte imbalances. Hospital admission is indicated for life-threatening complications, severe weight loss, and cardiovascular issues, which may require total parenteral nutrition (TPN) or tube feedings if the client is severely malnourished.

How are medications primarily utilized in the treatment of eating disorders?

Medications have limited clinical success alone but are primarily used to treat comorbid mood and anxiety disorders.

Which Tricyclic Antidepressants are used for eating disorders, and what are their indications?

Amitriptyline, Imipramine, Desipramine, and Nortriptyline are used to improve mood and reduce preoccupation with shape and weight. Amitriptyline in high doses can be used to promote weight gain in anorexia.

What is the primary indication for Fluoxetine (Prozac) in treating eating disorders?

Fluoxetine is an SSRI that is the most effective medication for treating bulimia and is also used for binge eating disorder. SSRIs must be monitored closely in anorexia because weight loss can be a side effect.

What is the indication for the MAOI Phenelzine (Nardil) in eating disorders?

Phenelzine is used for short-term positive results in treating bulimia.

Why is the antipsychotic Olanzapine (Zyprexa) used for anorexia?

It is used for anorexia to target bizarre body image distortions through its antipsychotic effect and to promote weight gain.

What is the indication for the antihistamine Cyproheptadine (Periactin) in eating disorders?

It is given in high doses to promote weight gain.

Which stimulant is used as a pharmacotherapy option specifically for Binge Eating Disorder?

Lisdexamfetamine (Vyvanse).

What medication is a critical contraindication for clients who purge, and why?

Bupropion (Wellbutrin) is not recommended due to an increased risk of seizures.

What should be included in the nursing assessment of a client with an eating disorder?

The nurse should utilize specialized assessment tools, gather a thorough client history, and observe the client's general appearance, motor behavior, mood, affect, and thought processes.

What are the primary nursing goals and planning objectives for a client with an eating disorder?

Goals include establishing nutritional eating patterns, identifying emotions, developing non-food-related coping strategies, and maintaining body weight within 5% to 10% of normal limits.

What are the key nursing interventions for promoting safe nutrition and monitoring food intake?

The nurse should increase caloric intake gradually for safe weight gain, maintain strict records of protein and caloric intake, and provide one-on-one supervision during meals and for 1 to 2 hours following meals and snacks to prevent purging or hiding of food.

How and when should a client with an eating disorder be weighed?

The client should be weighed daily in uniform clothing prior to oral intake.

What should the nurse monitor in the client's environment?

The environment should be checked for hidden or trashed food wrappers and laxative boxes.

How should a nurse therapeutically communicate and interact with a client regarding eating behaviors?

Provide positive support and honest praise while avoiding power struggles, and focus on the client's strengths rather than expressing approval or disapproval solely over eating behaviors.

In what setting does the majority of eating disorder treatment take place?

Treatment mostly takes place in the community setting, such as outpatient therapy, self-help groups, and partial hospitalization, unless medical necessity dictates inpatient care.

What are the key points for health promotion and teaching regarding eating disorders?

Educate parents, children, and peers to resist peer pressure to diet, to develop realistic ideas about body shape and size, and to recognize that media-portrayed ideals are unrealistic.

What strategies are used for relapse prevention in clients with eating disorders?

Relapse prevention focuses heavily on improving self-esteem and developing non-food-related coping strategies to deal with stress, emotions, and life issues.

What crucial education must be provided to the families of clients with eating disorders?

Families should avoid labeling foods as 'good' or 'bad,' avoid talking only about weight or calories, and avoid criticizing their own bodies in front of their children while modeling a healthy relationship with food. They must also understand they cannot simply 'force' the client to eat and that professional psychiatric help is required.

What is the 'Fix-It' Trap, and why must psychiatric nurses avoid it?

The 'Fix-It' trap is the overwhelming need to nurse the client back to health; because clients must be willing participants, trying to force recovery will lead to the nurse experiencing feelings of failure.

How should a nurse manage frustrations when working with clients who have eating disorders?

The nurse should recognize that feeling anger and frustration is normal when clients refuse help, but must be careful to never view the client's behavior as a personal attack against them.

How can a nurse maintain a neutral and objective stance in therapeutic communication?

The nurse should be empathetic, strictly nonjudgmental, present information factually without chiding or scolding, and avoid labeling behaviors or food as 'good' or 'bad'.