1. What is the difference between anorexia nervosa, bulimia nervosa and binge eating? Describe the defining characteristics of each disorder. Anorexia Nervosa is characterized by preoccupied with food and the rituals for eating, voluntary refusal to eat, endocrine dysfunction and a distorted psychopathic attitude towards weight and eating. Body weight is less than 85% of expected normal body weight. This disease occurs mostly in females. The patient may have a fear of gaining weight and view self as fat even when emaciated. Patients may have a peculiar way of handiling food (pushing it around the plate, cut into tiny pieces), possible rigorous exercise regimen and may judge self worth by weight. Patient may also abuse laxatives as well.
begins at childhood or teens.
Clinical Manifestations:
-amenorrhea for at least 3 consecutive cycles.
-lanugo
-low weight
-yellow skin
-peripheral edema
-muscle weakening
-abnormal lab values (hypokalemia, anemia, impaired liver and kidney function, abnormal thyroid function tests, elevated carotene levels)
-cardiovascular abnormalities (bradycardia, hypotension)
-continuous diet
-hair loss
-sensitivity to cold
-dry skin
- constipation.
lethargy
feelings of anxiety
low glucose
laxative abuse
russel's sign - calloused knuckles.
Bulimia Nervosa is characterized by recurrent episodes of eating large quantities of food ( can be 5,000-6,000 calories at one time)over a short period of time (binging) that may be followed by inappropriate compensatory behaviors to rid the body of these excessive calories such as purging. Most patients maintain normal weight or may weight slightly higher. There are two types of Bulimia; Binging and Non Purging. The purging type self induce vomiting. They could have erosion or scars on the teeth, fingernails, and knuckles (Russell’s signs). The non purging type could compensate for bringing through other means, such as excessive exercise and the misuse of laxatives, diuretics and diet drugs of enemas.
Clinical Manifestations:
-normal to slightly high weight
-dental caries, tooth erosion
-parotid swelling
-gastric dilation or rupture
-calluses or scars on hands from self induced vomiting
-peripheral edema
-muscle weakening
-abnormal lab values (electrolytes (hypokalemia ,hyponatremia, hypochloremia,)
-CV abnormalities
-Cardiac failure
-swollen parotid glands
-broken blood vessels in the eyes from vomiting
depression, anxiety, substance abuse, low self esteem, anxiety ( r/t not being discovered) Bing Eating is associated with obesity. This is when a patient engages in repeated episodes of being eating, after which they experience significant distress. The patient will consume large amounts of food or “over eat”. They usually do not engage in compensatory behaviors like in bulimia
Clinical Manifestations:
-eating large amounts of food
-eating even when full
-eating rapidly during binge episodes
-feeling that their eating behavior is out of control
-depression
-anxiety
-frequent dieting without weight loss
-frequently eating alone
-hoarding food
-hiding empty food containers
-feeling depressed, disgusted or upset about your eating
2. Identify 3 priority nursing diagnoses for the disorders listed in question # 1 above. Anorexia: Risk for Injury r/t electrolyte disturbances, muscle weakening and decreased bone density, Decreased cardiac output r/t starvation, dehydration and electrolyte disturbances, Imbalanced nutrition: less than body requirements r/t decreased caloric intake and exercise, Disturbed body image Bulimia: Decreased cardiac output r/t cardiac arrhythmias/electrolyte disturbances, Ineffective coping r/t bingeing as manifested by depression and or/stress, Anxiety r/t disturbed self concept. Binge: Imbalanced Nutrition: more than body requirements related to compulsive overeating, Ineffective individual coping r/t disturbed impulse control related to compulsive overeating, anxiety r/t feelings of compulsiveness.
3. Identify at least 3 nursing interventions specific to the eating disorders.
restore balance,
understand nutrition,
gain control,
don't comment on weight loss/gain,
set time limits,
focus on pt not food for anorexic patient,
stay after meals.
4. Identify assessment findings you would expect to find for patients with the following substance abuse issues:
a. Stimulants
b. Nicotine
c. Cocaine - heart probs, HIV/AID's for IV drug users, phlebitis, bacterial endocartitis ( infection of the heart) sunken nose.
d. Alcohol ( risk for grand mal seizures)
e. Amphetamines - depressed, lethargic, increased appetitie, craving for drug.
assessment for no outward s/s - hypertention, weight loss, tremors, poor school/career, urine test. crank bugs - visual and tactile hallucination of bugs under skin. dental problems. can cause acute renal failure and seizures.
f. Sedative-Hypnotics
g. Cannabis
Inhalants - brain damage ( encephalothapy) cognition problems. assess for chemical odor, disorientation, depression, chemical stains, nausea, bad coordination, increased VS.
5. Write 3 priority nursing diagnoses for each substance listed.
ineffective coping
risk for injury
6. Identify symptoms of withdrawal for the substances listed in #4.
alcohol - irritated, anxious, insomnia, anorexia, startle easily, confusion, nightmares, high BP, hyperalert, jerky, nausea, vomiting, hallucinations, increased HR, autonomic hyperactivity, psychomotor agitation, tremors, slurred speech, incoordination, unsteady gait, impaired memory, stupor/coma.. ( peaks at 24-48 hrs)
alchohol withdrawal delerium can result in death, peaks 2-3 days. s/s - changes in conciousness and delusions. anorexic, tremors, hypertension, and confusion.
7. Identify priority nursing interventions for patients who use/abuse the substance listed in # 4.
symptom assessment - phrase a question that assumes behavior has already taken place ( eg. what drugs do you do when your drinking?)
direct questions ( drug of preference, ect)
meth - don't overstimulate, explain procedures.
alcohol - symptom management, keep close to ns. station. orient pt frequently.
8. Review the material from Case Study #3 (Dementia, etc.)
1. What is the difference between anorexia nervosa, bulimia nervosa and binge eating? Describe the defining characteristics of each disorder.
Anorexia Nervosa is characterized by preoccupied with food and the rituals for eating, voluntary refusal to eat, endocrine dysfunction and a distorted psychopathic attitude towards weight and eating. Body weight is less than 85% of expected normal body weight. This disease occurs mostly in females. The patient may have a fear of gaining weight and view self as fat even when emaciated. Patients may have a peculiar way of handiling food (pushing it around the plate, cut into tiny pieces), possible rigorous exercise regimen and may judge self worth by weight. Patient may also abuse laxatives as well.
begins at childhood or teens.
Clinical Manifestations:
-amenorrhea for at least 3 consecutive cycles.
-lanugo
-low weight
-yellow skin
-peripheral edema
-muscle weakening
-abnormal lab values (hypokalemia, anemia, impaired liver and kidney function, abnormal thyroid function tests, elevated carotene levels)
-cardiovascular abnormalities (bradycardia, hypotension)
-continuous diet
-hair loss
-sensitivity to cold
-dry skin
- constipation.
lethargy
feelings of anxiety
low glucose
laxative abuse
russel's sign - calloused knuckles.
Bulimia Nervosa is characterized by recurrent episodes of eating large quantities of food ( can be 5,000-6,000 calories at one time)over a short period of time (binging) that may be followed by inappropriate compensatory behaviors to rid the body of these excessive calories such as purging. Most patients maintain normal weight or may weight slightly higher. There are two types of Bulimia; Binging and Non Purging. The purging type self induce vomiting. They could have erosion or scars on the teeth, fingernails, and knuckles (Russell’s signs). The non purging type could compensate for bringing through other means, such as excessive exercise and the misuse of laxatives, diuretics and diet drugs of enemas.
Clinical Manifestations:
-normal to slightly high weight
-dental caries, tooth erosion
-parotid swelling
-gastric dilation or rupture
-calluses or scars on hands from self induced vomiting
-peripheral edema
-muscle weakening
-abnormal lab values (electrolytes (hypokalemia ,hyponatremia, hypochloremia,)
-CV abnormalities
-Cardiac failure
-swollen parotid glands
-broken blood vessels in the eyes from vomiting
depression, anxiety, substance abuse, low self esteem, anxiety ( r/t not being discovered)
Bing Eating is associated with obesity. This is when a patient engages in repeated episodes of being eating, after which they experience significant distress. The patient will consume large amounts of food or “over eat”. They usually do not engage in compensatory behaviors like in bulimia
Clinical Manifestations:
-eating large amounts of food
-eating even when full
-eating rapidly during binge episodes
-feeling that their eating behavior is out of control
-depression
-anxiety
-frequent dieting without weight loss
-frequently eating alone
-hoarding food
-hiding empty food containers
-feeling depressed, disgusted or upset about your eating
2. Identify 3 priority nursing diagnoses for the disorders listed in question # 1 above.
Anorexia: Risk for Injury r/t electrolyte disturbances, muscle weakening and decreased bone density, Decreased cardiac output r/t starvation, dehydration and electrolyte disturbances, Imbalanced nutrition: less than body requirements r/t decreased caloric intake and exercise, Disturbed body image
Bulimia: Decreased cardiac output r/t cardiac arrhythmias/electrolyte disturbances, Ineffective coping r/t bingeing as manifested by depression and or/stress, Anxiety r/t disturbed self concept.
Binge: Imbalanced Nutrition: more than body requirements related to compulsive overeating, Ineffective individual coping r/t disturbed impulse control related to compulsive overeating, anxiety r/t feelings of compulsiveness.
3. Identify at least 3 nursing interventions specific to the eating disorders.
restore balance,
understand nutrition,
gain control,
don't comment on weight loss/gain,
set time limits,
focus on pt not food for anorexic patient,
stay after meals.
4. Identify assessment findings you would expect to find for patients with the following substance abuse issues:
a. Stimulants
b. Nicotine
c. Cocaine - heart probs, HIV/AID's for IV drug users, phlebitis, bacterial endocartitis ( infection of the heart) sunken nose.
d. Alcohol ( risk for grand mal seizures)
e. Amphetamines - depressed, lethargic, increased appetitie, craving for drug.
assessment for no outward s/s - hypertention, weight loss, tremors, poor school/career, urine test. crank bugs - visual and tactile hallucination of bugs under skin. dental problems. can cause acute renal failure and seizures.
f. Sedative-Hypnotics
g. Cannabis
Inhalants - brain damage ( encephalothapy) cognition problems. assess for chemical odor, disorientation, depression, chemical stains, nausea, bad coordination, increased VS.
5. Write 3 priority nursing diagnoses for each substance listed.
ineffective coping
risk for injury
6. Identify symptoms of withdrawal for the substances listed in #4.
alcohol - irritated, anxious, insomnia, anorexia, startle easily, confusion, nightmares, high BP, hyperalert, jerky, nausea, vomiting, hallucinations, increased HR, autonomic hyperactivity, psychomotor agitation, tremors, slurred speech, incoordination, unsteady gait, impaired memory, stupor/coma.. ( peaks at 24-48 hrs)
alchohol withdrawal delerium can result in death, peaks 2-3 days. s/s - changes in conciousness and delusions. anorexic, tremors, hypertension, and confusion.
7. Identify priority nursing interventions for patients who use/abuse the substance listed in # 4.
symptom assessment - phrase a question that assumes behavior has already taken place ( eg. what drugs do you do when your drinking?)
direct questions ( drug of preference, ect)
meth - don't overstimulate, explain procedures.
alcohol - symptom management, keep close to ns. station. orient pt frequently.
8. Review the material from Case Study #3 (Dementia, etc.)