Comprehensive Nursing Study Guide for Eating Disorders, Dementia, and Geriatric Care

Vital Signs and Clinical Indicators in Eating Disorders

Vital signs assessment is critical for patients with anorexia or any eating disorders.
A heart rate ( $HR$ ) of less than $40$ beats per minute is a critical indicator.
When presented with a clinical scenario involving various vital signs for an eating disorder patient, remember that overall physiological functions decrease.
The most significant decrease occurs in the heart rate ( $HR$ ), which is the most urgent finding if all other vital signs appear normal.
In specific cases, the respiratory rate ( $RR$ ) may increase; patients' priority findings must be assessed carefully to determine the need for intervention.
Indicators for severe anorexia that require immediate attention include:
    - Severe hypothermia.
    - Systolic blood pressure ( $SBP$ ) less than $70\,mmHg$ .
    - Potassium levels ( $K^+$ ) less than $3\,mEq/L$ .
    - Abnormal EKG changes.

Comparative Analysis of Anorexia, Bulimia, and Binge Eating Disorder

Anorexia Nervosa:
    - Patients are often obsessed with food; they will research it, think about it, and cook it, but they will not eat it.
    - Patients do not perceive themselves as skinny; they believe they are overweight.
    - Behavioral indicators include wearing baggy clothes to hide their body.
    - While some display hyperactivity, many are actually lethargic due to a severe lack of nutrients.
    - Amenorrhea (the lack of menstruation in females) is a specific complication of this disorder.
Bulimia Nervosa:
- Characteristics include binge eating followed by compensatory behaviors such as throwing up food (purging) or using laxatives.
- These patients often look average or have a normal BMI, which is why those close to them may not realize they have the condition.
Binge Eating Disorder:
- Patients consume large amounts of food but do not throw it up.
- They often prefer digestible food so they do not feel the need to purge.
Nursing Interventions & Discipline:
    - Encourage small, frequent meals for patients with Bulimia and Binge Eating disorders.
    - Nurses must watch anorexia patients for $1-3$ hours after they eat to prevent purging or exercise.
    - In an inpatient facility, visitors' bags must be searched because they might bring the patient laxatives.

Complications: Refeeding Syndrome

Refeeding syndrome is a major concern for nurses treating anorexia patients.
It occurs after prolonged periods of starvation when the reintroduction of food results in severe fluid and electrolyte imbalances.
This syndrome can lead to possible seizures and death.

Cognitive Impairment: Alzheimer’s Disease and Dementia

Risk Factors:
- The highest and most common risk factors for getting Alzheimer’s disease are getting older and the natural process of aging.
- Certain professions are associated with a higher risk of eating disorders, including figure skaters, dancers, athletes, and models.
Agnosia:
    - This is a condition common in dementia and Alzheimer’s patients where they can hear, smell, and see but cannot distinguish or determine the identity of what they are sensing.
    - Examples: A patient may look at a face and not recognize who it is; they may smell perfume but not know it is perfume.
    - Safety risk: They might smell spoiled or bad food and not realize it is dangerous to eat.
    - Care plan: The nurse must ensure they are not eating spoiled or bad food due to their inability to recognize health hazards.
Terminal Symptoms of End-Stage Alzheimer’s:
    - Inability to smile.
    - Requirement of complete total care ( $1:1$ patient care).
    - Incontinence (uncontrolled bladder).
    - Progression to a fetal position.
    - Inability to sit up straight, which leads to further complications.
    - Inability to swallow (due to the inability to sit up straight).
    - Inability to hold up the trunk of the body.
    - Inability to chew.

Therapeutic Interventions: Group and Reminiscence Therapy

Group Therapy:
    - Elderly patients' families may be upset seeing a frail, confused family member and may not see the value in group therapy.
    - The nurse's duty is to educate the family on the benefits, which include:
        - Interaction with others.
        - Provision of sensory stimulation.
        - Help with reality orientation.
        - Reduction in depression levels.
Reminiscence Therapy:
    - This therapy focuses on helping older adults and those with dementia or Alzheimer’s recall memories from the past.
    - Structure: Can be conducted in a $1:1$ or group setting.
    - Importance:
        - Allows patients to reflect on both negative and positive life memories.
        - Promotes resolution to life mistakes.
        - Stimulates old memories.
        - Promotes self-esteem.
Patient Environment:
- Use pictures of family and familiar objects to help dementia and Alzheimer's patients.
- Use activities that the patients enjoy.

Physiological Changes in Aging and Memory

Memory Changes:
    - Long-term memory generally stays stable throughout a person's life.
    - Short-term memory is the type of memory that starts to decrease as we age.
    - Humans are able to learn throughout their entire lives, but the ability to solve day-to-day problems can become harder with age.
Nursing Priorities for Dementia Patients:
    - First Priority: Assisting with Activities of Daily Living (ADLs), specifically assisting them with toileting and showering.
    - Second Priority: Reality and orientation.
    - Routine schedules are essential for dementia patients.

Pharmacological Management of Alzheimer’s Disease

Medication List:
    - Donepezil.
    - Galantamine.
    - Rivastigmine.
Donepezil Side Effects:
    - Lightheadedness.
    - Dizziness.
    - Faintness.
Education:
- It is very important to educate patients on fall risks when they are taking these specific medications.

Delirium and Acute Behavioral Changes

Delirium:
    - Delirium is not normal; it is a medical emergency situation.
    - Potential causes include:
        - Alcohol withdrawal.
        - Medications.
        - Drug abuse.
        - Age.
        - Infection or illness.
        - Sleep disturbance or lack of sleep.
        - Pain.
        - Surgery.
        - Cognitive impairment.
        - Emotional or mental illness.
        - High number of co-occurring conditions.
Sundowning:
- This refers to a syndrome characterized by a set of symptoms including increased confusion, anxiety, and other behavioral changes.
- These symptoms typically occur in some people with dementia during the late afternoon and evening.
Safety and Crisis Intervention:
- If a patient is dealing with suicidal ideation and expresses a desire to kill themselves, the immediate action is to provide a sitter.
- Always remember to use the least to most invasive interventions.

Questions & Discussion

Q: What is the most urgent vital sign for an eating disorder patient?
A: Heart rate ( $HR < 40$ ) is the most urgent if other signs are normal, though respiratory rate may sometimes increase.
Q: What is the difference between Bulimia nervosa and Binge eating?
A: Bulimia involves purging food (throwing up) or laxative use to maintain an average BMI; Binge eating involves consuming large amounts of food without purging.
Q: Which syndrome should the nurse worry about for anorexia patients?
A: Refeeding syndrome, which can cause fluid and electrolyte imbalances leading to seizures or death.
Q: Which eating disorder causes lack of menstruation in females?
A: Anorexia Nervosa.
Q: What care plan is needed for patients with Agnosia regarding eating?
A: Nurses must ensure they do not eat spoiled or bad food because they cannot distinguish what they are smelling or looking at.
Q: Why search visitor bags in an inpatient facility for eating disorders?
A: To ensure visitors are not bringing in laxatives for the patient.
Q: Is delirium normal?
A: No, it is a medical emergency.
Q: What kind of memory stays stable through life versus what decreases?
A: Long-term memory stays stable; short-term memory decreases.