Psychiatric Mental Health, part 37: Disorders - Eating Disorders

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Cathy covers eating disorders, including: bulimia nervosa, anorexia nervosa, and binge eating disorder. She talks about key signs and symptoms of bulimia nervosa and anorexia nervosa, along with hospitalization criteria for each disorder. Cathy then covers treatment and nursing care of patients with bulimia nervosa and anorexia nervosa. She the discusses binge eating disorder, including a review of common signs and symptoms of this disorder, treatment of binge eating disorder, and nursing care of patients with binge eating disorder. At the end of the video, Cathy provides a quiz to test your knowledge of some of the key points she covered in the video.

  • 00:00 Introduction - Eating Disorders
  • 00:38 Bulimia Nervosa
  • 3:12 Anorexia Nervosa
  • 4:53 Bulimia Nervosa & Anorexia Nervosa
  • 6:05 Binge Eating Disorder
  • 7:32 Quiz Time!

Full Transcript: Psychiatric Mental Health, part 37: Disorders - Eating Disorders

Hi, I'm Cathy with Level Up RN. In this video, we are going to discuss eating disorders, including bulimia nervosa, anorexia nervosa, and binge-eating disorder. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN psychiatric mental health nursing flashcards, definitely pull those out and pay close attention to the bold red text on these cards. Because those represent the most important facts that you're likely to get tested on in nursing school.

Bulimia nervosa is an eating disorder, characterized by binge eating, followed by compensation measures to avoid gaining weight, such as vomiting, laxative use, or extreme exercise. Signs and symptoms of bulimia nervosa are super important to know for your nursing school exam. This includes parotid gland swelling. So your parotid glands produce saliva, and with bulimia nervosa, an individual is often vomiting a lot, which causes these glands to produce excess saliva. And this overstimulation of the glands causes them to grow in size. Another key symptom of bulimia nervosa is dental erosion. Because when an individual is vomiting a lot, the stomach acid in the vomit is coming into contact with the teeth, and it erodes the enamel on the teeth. Russell's sign is another important symptom to know. This is where we have callusing on the knuckles. So with repetitive self-induced vomiting, the skin on the knuckles comes in contact with the incisor teeth, and this causes abrasions and callusing on the knuckles. It's important to note that an individual with bulimia nervosa will have weight fluctuations, but they will likely not be underweight, which is very different than anorexia nervosa, where the individual will have a dangerously low body weight. Other signs and symptoms of bulimia nervosa include dehydration, electrolyte imbalances, as well as acid-base imbalances. So this can include hypokalemia, hyponatremia, as well as metabolic alkalosis. And then, finally, I would be familiar with the hospitalization criteria for an individual with bulimia nervosa. This criteria includes syncope - which means fainting - hypothermia, a chloride level under 88, a potassium level under 3.2, intractable vomiting, arrhythmias, esophageal tears, hematemesis - which means blood in the vomit - suicide risk, or inadequate response to outpatient therapy.

Moving on to anorexia nervosa now. Anorexia nervosa is an eating disorder characterized by restriction of calorie intake that results in a dangerously low body weight. This is different than anorexia, which is the loss of appetite. Signs and symptoms of anorexia nervosa include extreme thinness; amenorrhea or lack of menstruation; lanugo, which is downy hair growth on the body, particularly on the shoulders and back; cold intolerance; brittle hair and nails; severe constipation; as well as lethargy. Individuals with anorexia nervosa will also have a decrease in heart rate, respiratory rate, as well as blood pressure.

I would definitely be familiar with the hospitalization criteria for an individual with anorexia nervosa, as this lends itself very well to a select-all-that-applies type question. So this criteria includes electrolyte imbalances, a daytime heart rate under 50 beats per minute, a systolic blood pressure under 90, the presence of arrhythmias, a body temperature under 96 degrees Fahrenheit, a body weight that is less than 75% of the ideal body weight, a body fat percentage under 10%, refusal to eat, or inadequate response to outpatient therapy. Treatment of bulimia nervosa and anorexia nervosa includes individual and group therapy, cognitive behavioral therapy, nutrition counseling, as well as medications to treat psychiatric comorbidities, for example, antidepressants to treat depression. In terms of nursing care, we need to maintain strict eyes and nose. We should weigh the patient every morning using the same scale. And then we need to stay with the patient during meals and for at least one hour after meals. We should also restrict strenuous activity, and we can provide privileges based on treatment compliance as well as weight gain. If a patient has inadequate oral intake, then two feedings may be ordered by the provider. As the nurse, you need to monitor the patient for something called refeeding syndrome. Refeeding syndrome can occur if nutrition is introduced too rapidly after prolonged starvation. Signs and symptoms of this disorder include severe electrolyte imbalances, arrhythmias, and seizures.

The last eating disorder that we're going to talk about is binge-eating disorder, which is the most common eating disorder in the United States. This disorder is characterized by recurrent episodes of eating large amounts of food. So an individual with binge-eating disorder will eat large amounts of food even though they are not physically hungry, and afterwards, they will feel guilt and shame. So common characteristics of people who have binge-eating disorder include low self-esteem, social withdrawal, frequent dieting, weight fluctuations, as well as gastrointestinal symptoms such as reflux and abdominal cramping. Treatment of binge-eating disorder includes cognitive behavioral therapy, or CBT, as well as dialectical behavioral therapy, or DBT. So DBT is a specific form of CBT that helps the patient to regulate their emotions and helps to reduce self-destructive behavior. Medications such as SSRIs can also be helpful. In terms of nursing care, we want to encourage the patient to keep a food diary, and we can work with the patient to establish realistic weight goals. And then we can also provide referrals to support groups.

All right, it's quiz time, and I've got five questions for you this time because we covered a lot of important information. Are you guys ready?

Question number one, parotid gland swelling and dental erosion are signs of what eating disorder? The answer is bulimia nervosa.

Question number two, individuals with bulimia nervosa often have a dangerously low body weight, true or false? The answer is false. So individuals with bulimia nervosa are typically not underweight.

Question number three, amenorrhea and lanugo are signs of what eating disorder? The answer is anorexia nervosa.

Question number four, hospitalization criteria for anorexia nervosa includes a body temperature under blank degrees Fahrenheit. The answer is 96.

And last question, blank is a complication that can occur when nutrition is introduced too rapidly after prolonged starvation. The answer is refeeding syndrome.

All right. I hope you did great with that quiz, and I hope you learned a lot with this video. Super appreciate you watching. Take care, and good luck with studying.

For an innovative [inaudible]-- five questions for you this time because.

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