Mental Health Exam 2
what are the standardized screening tools for eating disorders *** - Eating Disorders Inventory
- Body Attitude Test
- Diagnostic Survey for Eating Disorders
- Eating Attitudes Test- SCOFF Questionnaire
PROS: increases self-awareness and they're pretty accurate
CONS: patients can lie (secrecy)
anorexia *** - Fewer calories taken in than required
- significantly lowered body weight (UNDERWEIGHT)
- Developed rigid rules around food
- Intense fear of gaining weight or refusal to maintain healthy weight
- Obsessed with food & dieting
- Weighing several times a day (before AND after meals)
- Extreme perfectionism
- Minimal amounts of food consumption w/ excessive exercise, diuretics, laxatives, caffeine
- Lack of recognition of the seriousness of body weight (deny having a weight problem)
- levels of severity are based on BMI and determine the treatment plan
- HIGHEST DEATH RATE (suicide/starvation)
anorexia risk factors *** - family history (genetic or environmental)
- developed countries (societal norms, access to food)
- history of child/adolescent abuse
- commonly begins in teen years
,- high achieving
- athletes/dancers
- high expectations to perform, goal-oriented families or personalities
- need to control
- most common in females: white, highly educated and high academic achievement (SWAG: SKINNY
WHITE AFFLUENT GIRLS)
what are signs of anorexia *** - cut food into tiny pieces to appear to be eating reheating food multiple
times
- self induced vomiting after minimal consumption
- refusing to eat in the presence of others
- wearing baggy clothes, feeling cold
- use of diuretics, enemas, and diet pills
- malnourishment (brittle hair, nails, dry yellow skin, laungo)
anorexia assessment *** brain: change in LOC, decreased concentration, agitation
kidneys: fluid and electrolyte imbalances
heart: pulse and bp drop with arrhythmias bones become brittle
sunken eyes, skeletal appearance
lanugo growth
delayed gastric motility (abdominal pain and distension)
hypothyroid state- cold extremities
peripheral edema with advanced starvation
nursing concerns for anorexia *** - frequently deny weight problem
- may resist treatment
,- do not recognize eating behavior as abnormal
- have low self esteem
- see weight loss as a victory
- are preoccupied with food
anorexia treatment *** - cognitive behavioral therapy
- stress management
Maudsley approach- parent take responsibility for feed the child for every meal and snack
anorexia medications *** antidepressants- SSRIs
there is no fda approved drug available to help the client gain weight
refeeding syndrome *** the potentially fatal complication (enteral--> NG tube or parenteral--> IV fluid)
that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client
(pancreas not used to releasing insulin)
- body is in SHOCK!
- hallmark is HYPOPHOSPHATEMIA
- fluid balance, electrolyte, and glucose metabolism abnormalities
- very frequent vital signs, place on cardiac monitor, initiation of thiamine
anorexia nutritional care *** work with a VERY SPECIALIZED dietician to:
- consider the client's preferences and their ability to consume food
- provide a structured and INFLEXIBLE eating schedule initially (no RR breaks for at least an HOUR after
eating)
- 1 on 1 observation for all meals and bathroom breaks + suicide watch
- provide small, frequent meals
- provide a diet high in fiber and low in sodium
, - limit high-fat, gassy foods
- administer a multivitamin and mineral supplement
- instruct the client to avoid caffeine and herbal supplements
- anticipate manipulative behavior (crisis mode)
- Goals for weight gain? 1-2 lb
bulimia *** - binge eating then purging once per week for 3 months
- female adolescent-early adulthood
- use diuretics, laxatives, self induced vomiting, enemas to lose weight
- coincides with mood disorder anxiety, substance use, or self injurious behavior
- feeling of guilt for loss of control
- more common than anorexia
what is the DSM-5 criteria for bulimia *** -recurrent episodes of binge eating (either eating an amount
of food larger than most people in an amount of time or lack on control of over eating during the
episode)
- recurrent inappropriate compensatory behavior to prevent weight gain such as self induced vomiting,
misuse of laxatives, diuretics, or other medications, fasting, excessive exercise
- binge and inappropriate compensatory behaviors both occur at least once a week for 3 months
- self evaluation is unduly influenced by body shape and weight
- disturbance does not occur exclusively during episodes of anorexia
bulimia assessment *** - normal or overweight
- hoarseness/sore throat
- esophagitis/gerd
- bone loss
- dental enamel erosion, pitting, carries (often first sign)
what are the standardized screening tools for eating disorders *** - Eating Disorders Inventory
- Body Attitude Test
- Diagnostic Survey for Eating Disorders
- Eating Attitudes Test- SCOFF Questionnaire
PROS: increases self-awareness and they're pretty accurate
CONS: patients can lie (secrecy)
anorexia *** - Fewer calories taken in than required
- significantly lowered body weight (UNDERWEIGHT)
- Developed rigid rules around food
- Intense fear of gaining weight or refusal to maintain healthy weight
- Obsessed with food & dieting
- Weighing several times a day (before AND after meals)
- Extreme perfectionism
- Minimal amounts of food consumption w/ excessive exercise, diuretics, laxatives, caffeine
- Lack of recognition of the seriousness of body weight (deny having a weight problem)
- levels of severity are based on BMI and determine the treatment plan
- HIGHEST DEATH RATE (suicide/starvation)
anorexia risk factors *** - family history (genetic or environmental)
- developed countries (societal norms, access to food)
- history of child/adolescent abuse
- commonly begins in teen years
,- high achieving
- athletes/dancers
- high expectations to perform, goal-oriented families or personalities
- need to control
- most common in females: white, highly educated and high academic achievement (SWAG: SKINNY
WHITE AFFLUENT GIRLS)
what are signs of anorexia *** - cut food into tiny pieces to appear to be eating reheating food multiple
times
- self induced vomiting after minimal consumption
- refusing to eat in the presence of others
- wearing baggy clothes, feeling cold
- use of diuretics, enemas, and diet pills
- malnourishment (brittle hair, nails, dry yellow skin, laungo)
anorexia assessment *** brain: change in LOC, decreased concentration, agitation
kidneys: fluid and electrolyte imbalances
heart: pulse and bp drop with arrhythmias bones become brittle
sunken eyes, skeletal appearance
lanugo growth
delayed gastric motility (abdominal pain and distension)
hypothyroid state- cold extremities
peripheral edema with advanced starvation
nursing concerns for anorexia *** - frequently deny weight problem
- may resist treatment
,- do not recognize eating behavior as abnormal
- have low self esteem
- see weight loss as a victory
- are preoccupied with food
anorexia treatment *** - cognitive behavioral therapy
- stress management
Maudsley approach- parent take responsibility for feed the child for every meal and snack
anorexia medications *** antidepressants- SSRIs
there is no fda approved drug available to help the client gain weight
refeeding syndrome *** the potentially fatal complication (enteral--> NG tube or parenteral--> IV fluid)
that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client
(pancreas not used to releasing insulin)
- body is in SHOCK!
- hallmark is HYPOPHOSPHATEMIA
- fluid balance, electrolyte, and glucose metabolism abnormalities
- very frequent vital signs, place on cardiac monitor, initiation of thiamine
anorexia nutritional care *** work with a VERY SPECIALIZED dietician to:
- consider the client's preferences and their ability to consume food
- provide a structured and INFLEXIBLE eating schedule initially (no RR breaks for at least an HOUR after
eating)
- 1 on 1 observation for all meals and bathroom breaks + suicide watch
- provide small, frequent meals
- provide a diet high in fiber and low in sodium
, - limit high-fat, gassy foods
- administer a multivitamin and mineral supplement
- instruct the client to avoid caffeine and herbal supplements
- anticipate manipulative behavior (crisis mode)
- Goals for weight gain? 1-2 lb
bulimia *** - binge eating then purging once per week for 3 months
- female adolescent-early adulthood
- use diuretics, laxatives, self induced vomiting, enemas to lose weight
- coincides with mood disorder anxiety, substance use, or self injurious behavior
- feeling of guilt for loss of control
- more common than anorexia
what is the DSM-5 criteria for bulimia *** -recurrent episodes of binge eating (either eating an amount
of food larger than most people in an amount of time or lack on control of over eating during the
episode)
- recurrent inappropriate compensatory behavior to prevent weight gain such as self induced vomiting,
misuse of laxatives, diuretics, or other medications, fasting, excessive exercise
- binge and inappropriate compensatory behaviors both occur at least once a week for 3 months
- self evaluation is unduly influenced by body shape and weight
- disturbance does not occur exclusively during episodes of anorexia
bulimia assessment *** - normal or overweight
- hoarseness/sore throat
- esophagitis/gerd
- bone loss
- dental enamel erosion, pitting, carries (often first sign)
