Anorexia vs. Bulimia

Anorexia vs. Bulimia

• Anorexia nervosa: Self induced starvation due to a fear of fatness, often accompanied by body dysmorphic disorder, and significantly impacts quality of life
• Bulimia nervosa: Characterized by binge eating followed by purging behaviours like self induced vomiting or laxative use, and can result in death from starvation

Relevant Labs to Test

• The following lab tests can be performed for Anorexia:
• Cholesterol
• Hemoglobin
• Hematocrit
• Serum albumin
• Thyroxine-binding prealbumin (PAB)
• Transferrin

Clinical Manifestations of Anorexia

• Manifestations including:
• Hair: Alopecia, easy to remove, lackluster "corkscrew" hair, decreased pigmentation
• Eyes: Dryness of conjunctiva, corneal vascularization, keratomalacia, Bitot spots
• GI tract: Nausea and vomiting, diarrhea
• Mouth: Stomatitis, cheilosis, glossitis, magenta tongue, swollen/bleeding gums, fissured tongue
• Hepatomegaly
• Skin: Dry and scaling; Petechiae/ecchymoses, follicular hyperkeratosis, nasolabial seborrhea, bilateral dermatitis
• Musculoskeletal: Subcutaneous fat loss, muscle wastage, edema, osteomalacia
• Hematologic: Anemia, leukopenia, neutropenia; low prothrombin time, prolonged clotting time
• Neurologic: Disorientation, confabulation, neuropathy, paresthesia
• Cardiovascular: Heart failure, cardiomegaly, tachycardia, cardiomyopathy, cardiac dysrhythmias

Outcomes Indicative of Anorexia

• Protein-energy undernutrition (PEU) comes in two forms:
• Marasmus: Calorie malnutrition with wasted body fat and protein; serum proteins remain preserved
• Kwashiorkor: Lack of protein quantity/quality despite adequate calories; body weight is more normal, serum proteins are low
• Starvation: Complete nutrient lack, an acute and severe form of PEU, which can lead to death

Indicators of Poor Outcome with Anorexia

• Factors associated with a poorer prognosis include:
• A long initial illness
• Severe weight loss
• Older age at onset
• Bingeing and purging
• Personality difficulties
• Difficulties in relationships

Anorexia Complications

• Cardiovascular: Reduced cardiac output
• Endocrine: Cold intolerance
• Immunologic: Increased susceptibility to infectious disease
• Integumentary: Dry, flaky skin, various types of dermatitis, poor wound healing
• Musculoskeletal: Cachexia, decreased activity tolerance, decreased muscle mass, impaired functional ability
• Neurologic: Weakness
• Psychiatric: Substance misuse
• Respiratory: Reduced vital capacity
• Gastrointestinal: Anorexia, diarrhea, impaired protein synthesis, malabsorption, vomiting, weight loss

Anorexia Medications

• Antidepressants, particularly SSRIs like fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox), manage depression, anxiety, and obsessive thoughts

Psychological Impact of Anorexia

• Anorexia nervosa is self-induced starvation stemming from a fear of fatness, resulting in the patient being underweight, and accompanied by body dysmorphic disorder (BDD)
• Results in significant psychological effects such as distorted body image, fear of weight gain, anxiety, depression, obsessive thoughts
• Self-esteem and self-concept may be severely impacted
• Creates an immense mental toll for individuals due to the pursuit of thinness and calorie restriction
• This can result in mood disturbances, social withdrawal, difficulty concentrating, and a loss of interest in previously-enjoyed activities

Psychological Treatment for Anorexia

• Cognitive behavioral therapy (CBT) assists with identifying and altering distorted thinking patterns/behaviors related to body image, food, and weight
• Family-based therapy is effective for adolescents
• A comprehensive treatment incorporates interpersonal psychotherapy, dialectical behavior therapy, acceptance and commitment therapy
• This interdisciplinary treatment involves dietitians, therapists, and medical professionals

Dietary Interventions for Anorexia

• Oral intake through the GI tract is the preferred route:

• Primary HCPs and RDNs commonly recommend high-calorie and nutrient-rich foods, such as milkshakes, cheese and nutritional supplement drinks

• It may be better tolerated to have six smaller meals rather than three larger ones

• Those with chewing problems can have a soft or pureed diet

• Nutritional supplementation include Ensure, Sustacal, Carnation Instant Breakfast, etc

• They are available in powder, soup, coffee, and pudding forms

• Total Enteral Nutrition may be required if oral intake is inadequate

• Enteral tube feeding may be necessary to supplement intake, or provide overall nutrition

• Nasoenteric, nasogastric, nasoduodenal, and nasojejunal tubes can be used for less than 4 weeks

• Enterostomal feeding tubes may be needed for long term feeding, gastrostomy, percutaneous endoscopic gastrostomy, or dual-access gastrostomy-jejunostomy tubes

• Continuous feeding is similar to IV therapy, and cyclic feeding is the same as continuous feeding

• Parenteral Nutrition can be partial or total, and is required when the GI tract is ineffective

• The undernutrition patient should consume a high-calorie, high-protein diet, as well as take nutritional supplements

• Patient Teaching on Diet:

• Reinforce importance of adhering to the physician-ordered diet

• Review any medications taken by the patient

• Teach the importance of iron supplements before or during meals

• Caution iron tends to lead to constipation, and adequate fluids and fiber should be emphasized

• Restoring normal eating patterns and healthy weights can be made with structured meal intervention and patient teaching

• The meal plan is individualized and gradually developed

• Patients educated on emotional connections with food, development of eating routines, and calorie levels

Nursing Evaluation for Anorexia

• Undernutrition evaluated
• The patient consumes available nutrients to meet the metabolic demands for maintaining weight and total pro- tein and has adequate hydration

Additional Notes from the Text

• Binge-eating disorder involves eating binges with a feeling of loss of control over eating

• Bulimia nervosa: Eating disorder characterized by episodes of binge eating followed by purging, excessive use of laxatives, or self-induced vomiting

• Cachexia: Extreme body wasting and malnutrition which results from an imbalance between food intake and energy use

• Marasmus: Calorie malnutrition where body fat and protein are wasted; serum proteins are often preserved as part of the disease process

• Malnutrition: excesses, deficiencies, or imbalances related to energy and/or nutrient intake

• Adults need 1600-3200 calories per day

• Adult Malnutrition Screening and Nutrition Intervention Pathway steps:

• Screen patient: Malnutrition Screening Tool (MST) for (18+ years), Mini Nutritional Assessment (MNA®) for (65+ years), etc

• If at-risk, trigger Registered Dietitian Nutritionist (RDN) consult and determine nutrition risk within 24 hours of malnutrition screening

• Focused Physical Assessment and NRS 2002 or Modified NUTRIC used

• Malnutrition and/or High Nutrition Risk are identified. RDN documents diagnosis/risk and Physician then confirms it

• Nutrition Care Plan and Intervention is created

• Patient is awake, alert, and able to tolerate oral feedings

• Specialized Nutrition Support initiated only if oral is insufficient

• Contraindications of Enteral Nutrition:• Severe Malabsorptive Condition, Severe GI Bleed, Distal High Output GI Fistula, Paralytic Ileus, Intractable Vomiting and/or Diarrhea,Mechanical Obstruction, Inaccessible GI tract

• Consideration for Parenteral nutrition if unable to start oral or enteral feeding, other wise:

• Initiate Oral Nutritional Supplements (ONS) - 2 servings per day within 24 hours of screening

• Diet Orders:

• Higher protein via BOOST® High Protein Drink, Higher calorie via BOOST® Plus Drink, Fluid restriction via BOOST® Plus Drink,Diabetes-friendly via BOOST Glucose Control® Drink, Renal-friendly via NOVASOURCE® Renal Drink, Clear liquid via BOOST BREEZE Drink,Thickened liquids via BOOST® Nutritional Pudding, All other diets, BOOST® High Protein Drink

• Nutriton for older aldults is largely the same

• Preventing Constipation

• The USDA (2022) suggests plenty of water and fiber consumption to manage constipation

• Assessing the older adult for Undernutrition Ask about signs or symptoms, Physical concerns (Chronic conditions/illnesses,Constipation,Decreased appetite, Dentition, Drugsn Dry mouth, Failure to thrive", Impaired eyesight, Pain that is acute or persistent,Weight loss, Psychosocial concerns (Inability to prepare meals due to etc,Decrease in enjoyment of meals, Depression Income, Loneliness Proximity to sources of nutrient-dense foods, Transportation access to get to sources of nutrient-dense foods.)

• Other Considerations: Fluid and electrolyte imbalance affected by nutrition, Protein energy malnutrition the etiology of undernutrition is multifactorial and dependent on the specific type of undernutrition experienced. .Refeeding syndrome is a potentially life-threatening complication related to fluid and electrolyte shifts d PPN and TPN also may be considered

PPN- Is administered through a cannula or catheter in a large distal vein of the arm on a short-term basis. Nursing safter critical rescue: recgonzie that you must monitor patients receivinf hat emultions for sever trilycerides,clotting and multisystem organ failure

• TPN when a patient requires intensive nutrition support for an extended time the health care provider orders centrally administered total parenteral nutrition. Nursing Care: fllow infusions nurses socieity standrads- administer ,onotrserumm the rates and document all weight

Obesity Introduction

• Obesity:

• Body weight and BMI usually increase throughout adulthood until about 60 years of age as for interventions see other notes

• Defined as body mass index (BMI) of 30 or above

• Central obesity is related to CAD, brain attack, type 2 diabetes, some cancers, sleep apnea, and early death

• Assessment with acronrym RESPECT: Rapprochement, ensure safety, encourage goals settiing, provide compassion

Ozempic medication and weight

• Ozempic is an injectable glucagon-like peptide-1 medication and promotes weight loss
• Common side effects include nausea, vomiting, abdominal pain, diarrhea, decreased appetite
• Rare side effects include pancreatitis, gallbladder issues, kidney issues and vision changes

Different Surgical Treatments and Complications:

• Preoperative care is similar for any patient laparoscopic or have and increased surgical risks. Monitor sign and sx infection an increased care after Doctor removes first bandaide

• Bariatric postoperative care includes:

  • patient postioning (semi-fowler) • Monitor oxygen saturation; provide oxygen, bilevel, or continuous positive airway pressure (BiPAP or CPAP) ventilation per orders

Sequential stockings, abdonmia binder, small feedings, record all girth daily Remove catheter in 24 hors Observe skin areas Collab with physicial tehrapist,

Anastomtic leaks mos common complication, Recognize that you must monitor for symptoms: increases pain, restlessness , contact surgeon immediately

• Med used patient analgesia, morphine

Diet: introduce liquid slowly ,

• Teachin g topic: dietprogersion , wound care, activity level and what sx to report

• Action Alert NG TUBE, somehave ng tube palce, Never reposition or cut to avoid ruptures!, removed when passing flatus

• In addition, the above is related with abon and laproscopic patients who have undergone bariatric at risk , Anstosisis

Bariatric Complications

Action Alert patient have ng tube palce, avoid ruptures!. Removed when passing flatus

critical rescue Anstisis have, monitor for for symptoms: increases pain, restlessness , contact surgeon immediately ComplicationsPulmonary embolism,Infection, Astosis Leak,Dumping syndrome Collapsing /folding: do not, instructs don not do! , can cause pressure anid disrupt the site All paitenrs some degree of after. Acute pain descried,

Liqudes and food introduced small in clear fluids, Reminds to eat slooow, choose proei, avoid fat orr sugar"

Further teaching after

Opertiav nausea and omitinf the common preventativ ethrapy , Assess pain. listen for bowel sounds and not the the stioolo in colr,, and assess copmlications from ng-tube,

Potassium? SodiumHyper Calcium imbalances, particularly hypercalcemia are associated with TPN. Clasify obesity and WWhat number of prir for pain ? Class = bmi to "15, 20 to10 to4,, whata types of faet has a ghigher rk

What to do:

Explain instructuinn the intervenetions for , to imprve and what they mean for, Assessmen tpaorach with REWPCT

What to assess?

What will make the process what what is to avoid, obtain more accuret heigh, Examine the skinn or any oppenness or yeast, Obtain

Diet considerations

Limit , encurage and exlain, Health Promotion and Disease Prevention, Ensure that feeding tube placement is verified by x-ray before use for feeding or medication administration, C-R-C Ensure they see inter professional as to be what need

Malabsorption

Malabosropton: check this insfo, garstsric bpaps combine to loweer and make the lower then nornkal, refrers to immparired adsortp of the tract of the intestince,

Gasstroeophageal Relfux Disease (GERD)

• GER occurs flow of stomach and erision or imflomation, the lower ophogesphlter and imapaired mechanisms,

GERD cause and complications:

Wigh and inter abdoamla pressure Nasgrasti lowers saphinctoer,

eposodes of GEREd . Night causde prolong expsre,

. Medicationsfor GERD:

inhibir gastitric Tums: calcium carbonate antiacids - magesuhim and alumium , do not with , assess , obser

Protonix

reduse, PPI increase skelatel, mepranze, reggalsn

a protin inhi the grug, promtote heal but, reserach concted to what hepppen with time pp;

Dangers of Barrett?

cantroucells, refus incrses risk

Expalin ahciolgeric drigs

By innervae muscarib and relux or heatbirm

###. asthma, caredd, Aspirein

Explain hemo and spire

What happens withs severe and long with symptions , exlapn how

Define Odynophgia and Dispesia, dyspepsia , so knwon also main sympon

explain sigs of

Asm them , thenask, , aorse mess?

Severe pain whthe bent over what asess,

Explain comolcatiions from eartim?

pt often dismiss that

Pt may having ?

telltat ays

Assess. and see

###What if the oldser adults like more sewrere compr Exlpain thigns to know, show the, thwe , that must do

Non surge treament

Assess diet.

6 what

what if the, what to do

Explin to do

in order to adhe, for all, what hpepne, what stucture?

How ?

Inflamation scaer, internees.

key nuusring?

Educaite food like.

• These for , to for. To be -Tissue.

Gsatrites

Explain the withmeds?

Factors,

What d? H pylor , with bactriac?

Define

And, with how, the treat. Why , What can make more worse? Is tyes

In the end and

What to in If, that a?

Bowol -

• Obsti[ationno passge of ?

-Explain difference and

Copaption no ovement fo over, Boluobstctioanhyj to prevent,.

Smal o and

That, with or with the that? What o?

###-Paralyic IIeus ,What it SAS Patient care/eatution what lIssNonrlyy .

There.

what to do. To be -"" ###. The to? What as y with? 8 Borygmi,

That What And hwat can y

To?

• and

Diets for. what you ,

Urinary stone .

types ? how and effect

what? type Defines and how relate

What a?

How t the, what, why.

What a?

what what can bwe symphon with type to. What to b and d! S&?

The

What a? Coma to A y to and? Can to

what

whas

what caff.e and do to! and what? why

" " "[]""" ""[]" [] "