NR320: Mental Health Exam 3 (CH 23, 25, 30-35, 39) Page 1 of 20
NR320: Mental Health: Exam 3 / NR 320 Exam 3 Study Guide
(Latest): Chamberlain College of Nursing
Chapter 32: Eating Disorders
Concept of Eating Disorders:patient experiences severe disruption in normal eating and disturbance in perception of
body shape/weight
o Co-Morbidities:
Depression
Social phobias
OCD
Mood and anxiety disorders
Substance abuse
Personality disorders
Most common is hx of sexual abuse
o Female relatives of individuals with eating disorders have 12 times more likely at risk
o Nursing Communication Guidelines for Patients with Eating Disorders:
Long-term tx with individual, group and family therapy
Avoid authoritarianism and assumptions of parental role
Build therapeutic alliance
Frequently acknowledge pts difficulty with goal of gaining weight
Address underlying emotions of anxiety, depression, low self-esteem, and feelings of lack of control
o Causes of Eating Disorders:
Family issues
Conflicts among parents
Divorce
Depression
Perfectionist
Low self-esteem: doubts about self-worth, harsh self-judgment based on issue of weight
Misunderstood
Sexual abuse: want to keep childlike body, afraid of sexual maturity
Neglect
Social anxiety
A tendency toward perfectionism
Inflexible thinking – all or nothing thinking
Fear of losing control
o Understanding Eating Disorders:
Do not concentrate on food – Eating disorders are EMOTIONAL PROBLEMS
Attempt to control, hide, avoid & forget pain, stress & self-hate
Most prevalent in industrialized societies where thinness is considered the attractive ideal
Anorexia Nervosa: begins around puberty and involves extreme weight loss
o Diagnosis is made from:
A refusal to maintain a normal body weight - Dropping below 15% ideal body weight
,NR320: Mental Health Exam 3 (CH 23, 25, 30-35, 39) Page 2 of 20
Absence of menstruation for at least 3 months
Distorted view of body size, shape and weight
Intense fear of gaining weight
Disturbed body image (believing one is fat despite emancipation)
o Anorexic Thinking:
Need for control
Food rituals
Preoccupied with weight& shape
Restrict eating
See themselves as fat
Withdrawn socially
o Signs & Symptoms: Anorexia Nervosa
Cachectic: muscle wasting
Lanugo: soft hair growth over body (r/t inadequate protein in diet)
Mottled cool skin
Dehydration
Thin, brittle hair
Dry broken out skin that is gray or yellowed
Dental problems and gum disease
Feeling cold much of the time
Depression, isolation, loneliness
Insomnia
o Physical Complications: Anorexia Nervosa
Vital sign abnormalities ( BP)
Electrolyte imbalances
Osteoporosis
Abnormal thyroid function
Cardiac abnormalities (irregular HR)
Fatty degeneration of liver, elevated cholesterol
Kidney infection & failure (Hematuria&Proteinuria)
o Nursing Process: Anorexia Assessment Guidelines
Determine if medial/psychiatric condition warrants hospitalization (appropriate testing important)
Severe hypothermia, bradycardia, hypotension, hypokalemia, cardiac abnormalities
Weight loss more than 30% over 6 months
Suicidal of self-mutilating behaviors
Severe depression or psychosis
Emotional problems
Chaotic family relationships
o Treatment: Anorexia Nervosa
RefeedingSyndrome: emergency status causing cardiac collapse and possible death
Generally treat on an outpatient basis unless a medical emergency occurs
Patient will usually fight the tx because they fear gaining weight and losing control
Can be manipulative and will lie to avoid exposure that they are not eating
Family MUST be a part of the recovery process for support
CBT, group therapy, family therapy and medication for depression
, NR320: Mental Health Exam 3 (CH 23, 25, 30-35, 39) Page 3 of 20
Bulimia Nervosa
o Diagnosis is made from:
Assessment and the history of behaviors
Recurrent episodes of binge eating followed by self-induced vomiting, misuse of laxatives or diuretics
Behaviors are designed to prevent weight gain – not necessarily to lose weight
Patient will often be at normal or near normal weight so diagnosis is usually made off of patient history and
behaviors
o Characteristics: Bulimia Nervosa
Being a “people pleaser”
Low self-esteem
Depression, isolation and loneliness
Preoccupation with food; hoarding, hiding or stealing food
o Physical Complications:
Upset stomach
Burning throat (acid reflux)
Worn tooth enamel
Purging removes electrolytes: low electrolytes cause cardiac arrhythmias
Muscle spasms
Dehydration
Parotid gland enlargement: largest salivary gland
Esophageal tears
Russell’s sign: callus on knuckles from self-induced vomiting
Dry skin and hair; hair loss
o Treatment for Bulimia:
Medical stabilization is a priority b/c of the altered fluid balance and cardiac functioning
Patient is usually a lot more cooperative with tx due to the shame and humiliation of binging and purging
Family support and education
CBT
Medications to treat depression
Binge Eating Disorder: repeatedly go on large binges, uncontrollably consuming large quantities of food in short
periods of time and eating until they are uncomfortably full
o Diagnosis is made from:
Eating large amounts of food at first to comfort emotions
Eating when not hungry
Fuels guilt for over eating
Uses guilt about eating to avoid other feelings
Repeated episodes of binge eating even after experiencing significant distress
Compulsive overeating
Usually depression motivated
o Treatment: Binge Eating Disorder
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