NUR 114
EXAM 2 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 2 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 2 Study Guide
1. Exemplar: Eating Disorders and Feeding
People with eating disorders experience severe disruptions in normal eating patterns and a significant
disturbance in the perception of body shape and weight. Individuals with eating disorders may display a
mixture of anorectic and bulimic behaviors.
Anorexia nervosa: intense irrational beliefs about their shape, weight, and they engage in self-starvation,
express intense fear of gaining weight, and have disturbance in self-evaluation of weight and its
importance. There are two subtypes of anorexia:
The individual restricts his/her intake of food
The individual engages in binge eating and/or purging
Bulimia nervosa: individuals engage in repeated episodes of binge eating followed by inappropriate
compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other
medications, fasting, or excessive exercise.
Binge eating disorder: diagnosed with individuals engage in repeated episodes of binge eating,
consuming large amounts of calories, after which they experience significant distress. These individuals
do not use the compensatory measures that you see in people with bulimia nervosa.
Prevalence and Co-morbidity:
Anorexia and bulimia are typically more common in women
Anorexia has the highest mortality rates of all psychiatric disorders
All eating disorders can contribute to “significant compromise in every organ system of the body,
including the cardiovascular, gastrointestinal, endocrine, dermatological, hematological, skeletal,
and CNS”
Female as well as male athletes demonstrate increased incidence of eating disorders
Anorexia has an average onset in early or middle adolescence
Eating disorders are almost always comorbid (usually associated with depression, social phobias,
OCD, bipolar, etc.)
Most binge eaters are obese
Theory:
Neurobiological and neuroendocrine models: brain imagine studies have shown unusual activity
in various regions of the brain including the frontal, cingulate, temporal, and parietal areas. In
both bulimia and anorexia, the serotonin pathways are abnormal. Brain scans reveal altered
serotonin receptors and transporters. This may be the basis for mood problems, reduced impulse
control, and the motivation for eating and enjoying food.
Genetic models: twin studies, family, and adoption studies have shown a genetic link. Female
relatives or people with eating disorders are 12 times more likely to develop an eating disorder.
Genetic vulnerability might stem from an underlying neurotransmitter dysfunction, or perhaps the
vulnerability is on of inherited temperament, cognitive style, mood regulating tendencies, and
unique weight set point.
Psychological models: while biology may create a predisposition for eating disorders,
psychological determinants may play a role in activating them. Anorexia nervosa often results in
amenorrhea in females and physiological changes that interfere with the development of an age-
appropriate sexual role. “Core psychopathology” is both anorexia and bulimia are thought to be
low self-esteem and self-doubts about personal worth. People with anorexia their families have
been seen as controlling, emphasizing perfection, achievement, and compliance. Bulimic
, families are seen as chaotic and emotionally expressive, particularly in terms of conflict and
negativity. The Academy of Eating Disorders strongly opposes any theoretical model that states
family dynamics are the primary cause of anorexia/bulimia nervosa, but they do emphasize the
importance that family/allies treatment can play in the eating disorders.
Cultural Considerations:
Western cultural typically embraces that being thin is considered beautiful. Non-western cultures
are now starting to develop that mind-set as well
Food refusal in some non-western societies may not be motivated by fat phobia but rather dieting
may reflect personal meaning based on religious or ascetic values
DSM-5 the anorexia nervosa criterion of fear of weight gain has been expanded to include
persistent behavior that interferes with weight gain to capture this subgroup of patients who do
not endorse fear of gaining weight as motivation
Anorexia Nervosa
Assessment: all of these findings are consistent with malnourishment and dehydration
Cachectic: severely underweight with muscle wasting
Lanugo: growth of fine, downy hair on the face and back
Mottled skin
Cool skin on the extremities
Low BP, pulse, and temperature
The cardinal symptom of anorexia nervosa is dangerously low body weight in relation to age and gender.
The ideal BMI for a healthy person is between 19-25
Mild: BMI greater than or equal to 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI <15
Individuals with binge/purge type of anorexia nervosa may also have:
Prominent parotid glands – the largest salivary glands, located in each cheek in front of the ears.
The become swollen due to heightened stimulation from repeated vomiting.
Severe electrolyte imbalance from purging, which may be from vomiting, abusing
laxatives/diuretics, or enemas
Biophysical evaluation includes:
Perception of their problem
Eating habits
History of dieting
Methods used to achieve weight control (restricting, purging, exercising)
Value attached to a specific weight and shape
Interpersonal and social functioning
Mental status and physiological parameters
Possible signs and symptoms of anorexia nervosa:
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
, Peculiar handling of food
Possible development of rigorous exercise plan
Possible self-induced vomiting, use of laxatives, diuretics
Judges self-worth based off of weight
Controls what they eat in order to feel powerful and overcome feelings of hopelessness
Many women will begin to experience amenorrhea
Assessment Guidelines:
Determine if medical/psychiatric condition warrants hospitalization
Assess family’s level of understanding
Assess acceptance of therapeutic modalities
Perform thorough physical exam
Check for other medical conditions
Determine family and patient need for teaching regarding treatment plan
Assess patient and families desire to participate in support groups
DSM-5 uses BMI ranges derived from the WHO to gauge the level of severity, the degree of
functional disability, and need for supervision
Diagnosis:
Imbalanced nutrition: less than body requirements
Decreased cardiac output
Risk for injury
Risk for electrolyte imbalance or fluid volume
Disturbed body image
Anxiety
Chronic low self-esteem
Ineffective coping
Outcomes:
Outcomes need to be measurable and include a time estimate for attainment. Common outcomes include:
Patient will refrain from self-harm
Normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks
Achieve 85-90% of ideal body weight
Be free of physical conditions
Etc.
Planning:
Planning is based on the patient’s acuity of their present situation. If patient is less than 75% of ideal body
weight the plan is to provide immediate stabilization. Inpatient hospitalization is usually brief in order to
address immediate concerns such as electrolyte imbalances, dysrhythmias, and significant depression.
Some hospitalized patients will require refeeding syndrome, which is a potentially catastrophic treatment
complication in which the demands of the replenished circulatory system overwhelm the capacity of the
nutritionally depleted cardiac muscle, which results in cardiovascular collapse.
Once the patient becomes medically stable, then the plan will begin to address the underlying eating
disorder. These issues are typically treated outpatient. Treatment includes:
Group therapy
EXAM 2 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 2 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 2 Study Guide
1. Exemplar: Eating Disorders and Feeding
People with eating disorders experience severe disruptions in normal eating patterns and a significant
disturbance in the perception of body shape and weight. Individuals with eating disorders may display a
mixture of anorectic and bulimic behaviors.
Anorexia nervosa: intense irrational beliefs about their shape, weight, and they engage in self-starvation,
express intense fear of gaining weight, and have disturbance in self-evaluation of weight and its
importance. There are two subtypes of anorexia:
The individual restricts his/her intake of food
The individual engages in binge eating and/or purging
Bulimia nervosa: individuals engage in repeated episodes of binge eating followed by inappropriate
compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other
medications, fasting, or excessive exercise.
Binge eating disorder: diagnosed with individuals engage in repeated episodes of binge eating,
consuming large amounts of calories, after which they experience significant distress. These individuals
do not use the compensatory measures that you see in people with bulimia nervosa.
Prevalence and Co-morbidity:
Anorexia and bulimia are typically more common in women
Anorexia has the highest mortality rates of all psychiatric disorders
All eating disorders can contribute to “significant compromise in every organ system of the body,
including the cardiovascular, gastrointestinal, endocrine, dermatological, hematological, skeletal,
and CNS”
Female as well as male athletes demonstrate increased incidence of eating disorders
Anorexia has an average onset in early or middle adolescence
Eating disorders are almost always comorbid (usually associated with depression, social phobias,
OCD, bipolar, etc.)
Most binge eaters are obese
Theory:
Neurobiological and neuroendocrine models: brain imagine studies have shown unusual activity
in various regions of the brain including the frontal, cingulate, temporal, and parietal areas. In
both bulimia and anorexia, the serotonin pathways are abnormal. Brain scans reveal altered
serotonin receptors and transporters. This may be the basis for mood problems, reduced impulse
control, and the motivation for eating and enjoying food.
Genetic models: twin studies, family, and adoption studies have shown a genetic link. Female
relatives or people with eating disorders are 12 times more likely to develop an eating disorder.
Genetic vulnerability might stem from an underlying neurotransmitter dysfunction, or perhaps the
vulnerability is on of inherited temperament, cognitive style, mood regulating tendencies, and
unique weight set point.
Psychological models: while biology may create a predisposition for eating disorders,
psychological determinants may play a role in activating them. Anorexia nervosa often results in
amenorrhea in females and physiological changes that interfere with the development of an age-
appropriate sexual role. “Core psychopathology” is both anorexia and bulimia are thought to be
low self-esteem and self-doubts about personal worth. People with anorexia their families have
been seen as controlling, emphasizing perfection, achievement, and compliance. Bulimic
, families are seen as chaotic and emotionally expressive, particularly in terms of conflict and
negativity. The Academy of Eating Disorders strongly opposes any theoretical model that states
family dynamics are the primary cause of anorexia/bulimia nervosa, but they do emphasize the
importance that family/allies treatment can play in the eating disorders.
Cultural Considerations:
Western cultural typically embraces that being thin is considered beautiful. Non-western cultures
are now starting to develop that mind-set as well
Food refusal in some non-western societies may not be motivated by fat phobia but rather dieting
may reflect personal meaning based on religious or ascetic values
DSM-5 the anorexia nervosa criterion of fear of weight gain has been expanded to include
persistent behavior that interferes with weight gain to capture this subgroup of patients who do
not endorse fear of gaining weight as motivation
Anorexia Nervosa
Assessment: all of these findings are consistent with malnourishment and dehydration
Cachectic: severely underweight with muscle wasting
Lanugo: growth of fine, downy hair on the face and back
Mottled skin
Cool skin on the extremities
Low BP, pulse, and temperature
The cardinal symptom of anorexia nervosa is dangerously low body weight in relation to age and gender.
The ideal BMI for a healthy person is between 19-25
Mild: BMI greater than or equal to 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI <15
Individuals with binge/purge type of anorexia nervosa may also have:
Prominent parotid glands – the largest salivary glands, located in each cheek in front of the ears.
The become swollen due to heightened stimulation from repeated vomiting.
Severe electrolyte imbalance from purging, which may be from vomiting, abusing
laxatives/diuretics, or enemas
Biophysical evaluation includes:
Perception of their problem
Eating habits
History of dieting
Methods used to achieve weight control (restricting, purging, exercising)
Value attached to a specific weight and shape
Interpersonal and social functioning
Mental status and physiological parameters
Possible signs and symptoms of anorexia nervosa:
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
, Peculiar handling of food
Possible development of rigorous exercise plan
Possible self-induced vomiting, use of laxatives, diuretics
Judges self-worth based off of weight
Controls what they eat in order to feel powerful and overcome feelings of hopelessness
Many women will begin to experience amenorrhea
Assessment Guidelines:
Determine if medical/psychiatric condition warrants hospitalization
Assess family’s level of understanding
Assess acceptance of therapeutic modalities
Perform thorough physical exam
Check for other medical conditions
Determine family and patient need for teaching regarding treatment plan
Assess patient and families desire to participate in support groups
DSM-5 uses BMI ranges derived from the WHO to gauge the level of severity, the degree of
functional disability, and need for supervision
Diagnosis:
Imbalanced nutrition: less than body requirements
Decreased cardiac output
Risk for injury
Risk for electrolyte imbalance or fluid volume
Disturbed body image
Anxiety
Chronic low self-esteem
Ineffective coping
Outcomes:
Outcomes need to be measurable and include a time estimate for attainment. Common outcomes include:
Patient will refrain from self-harm
Normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks
Achieve 85-90% of ideal body weight
Be free of physical conditions
Etc.
Planning:
Planning is based on the patient’s acuity of their present situation. If patient is less than 75% of ideal body
weight the plan is to provide immediate stabilization. Inpatient hospitalization is usually brief in order to
address immediate concerns such as electrolyte imbalances, dysrhythmias, and significant depression.
Some hospitalized patients will require refeeding syndrome, which is a potentially catastrophic treatment
complication in which the demands of the replenished circulatory system overwhelm the capacity of the
nutritionally depleted cardiac muscle, which results in cardiovascular collapse.
Once the patient becomes medically stable, then the plan will begin to address the underlying eating
disorder. These issues are typically treated outpatient. Treatment includes:
Group therapy
