Lecture Notes: Eating Disorders

Overview

• Presenter: Kathy from Level Up RN
• Topics Covered: Bulimia Nervosa, Anorexia Nervosa, Binge Eating Disorder
• Includes a quiz with five questions at the end.

Bulimia Nervosa

Key Characteristics

• Binge eating followed by compensatory measures (vomiting, laxatives, extreme exercise).
• Individuals likely have weight fluctuations but are not usually underweight.

Signs and Symptoms

• Parotid Gland Swelling: Due to excessive vomiting, leading to excess saliva production.
• Dental Erosion: Stomach acid erodes dental enamel through frequent vomiting.
• Russell's Sign: Callusing on the knuckles from repeated self-induced vomiting.
• Weight Fluctuations
• Dehydration & Electrolyte Imbalances: Hypokalemia, hyponatremia, metabolic alkalosis.

Hospitalization Criteria

• Syncope (fainting)
• Hypothermia
• Chloride level <88, Potassium level <3.2
• Intractable vomiting, arrhythmias, esophageal tears
• Hematemeis (blood in vomit)
• Suicide risk or inadequate response to outpatient therapy

Anorexia Nervosa

Key Characteristics

• Restriction of caloric intake leading to dangerously low body weight.
• Different from simple anorexia (loss of appetite).

Signs and Symptoms

• Extreme Thinness
• Amenorrhea: Lack of menstruation.
• Lanugo: Downy hair growth on the body.
• Cold Intolerance, Brittle Hair and Nails
• Severe Constipation, Lethargy
• Decreased Heart Rate, Respiratory Rate, and Blood Pressure

Hospitalization Criteria

• Electrolyte Imbalances
• Daytime Heart Rate <50 bpm
• Systolic BP <90
• Presence of Arrhythmias
• Body Temperature <96°F
• Body Weight <75% of Ideal
• Body Fat <10%
• Refusal to Eat or Inadequate Response to Outpatient Therapy

Treatment for Bulimia and Anorexia Nervosa

• Therapies: Individual, group, cognitive behavioral, nutritional counseling.
• Medications: For psychiatric comorbidities (e.g., antidepressants for depression).

Nursing Care

• Monitor I’s and O’s.
• Daily Weigh-ins: Same scale, morning.
• Observe during and post-meals (1 hour).
• Restrict Strenuous Activity.
• Provide Privileges for Treatment Compliance and Weight Gain.
• Watch for Refeeding Syndrome: Severe electrolyte imbalances, arrhythmias, seizures.

Binge Eating Disorder

Key Characteristics

• Recurrent episodes of eating large amounts of food despite lack of hunger.
• Feelings of guilt and shame following episodes.

Common Characteristics

• Low Self-Esteem, Social Withdrawal
• Frequent Dieting, Weight Fluctuations
• Gastrointestinal Symptoms: Reflux, abdominal cramping.

Treatment

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT): Emotion regulation, reducing self-destructive behavior.
• Medications: SSRIs.

Nursing Care

• Encourage Food Diary Keeping.
• Establish Realistic Weight Goals.
• Refer to Support Groups.

Quiz Questions

1. Signs of parotid gland swelling and dental erosion are related to which disorder? Bulimia Nervosa
2. Individuals with bulimia nervosa are typically underweight. True or False? False
3. Amenorrhea and lanugo are signs of which disorder? Anorexia Nervosa
4. Hospitalization criteria for anorexia nervosa includes a body temperature under what degree? 96°F
5. What is a complication from rapid nutritional introduction after starvation? Refeeding Syndrome

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