NR320 - Exam 3 Study Guide, NR320 Mental Health, Chamberlain College of Nursing.

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 Withdrawn socially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