Eating Disorders

All these findings are indicative of malnourished and dehydrated state.

BMI is used to calculate/determine if patient is dangerously low in body weight

Not just about starvation. There is also binge purge anorexia. Assess for signs of swelling in mouth
(parotid glands/salivary glands). May see sores/scabs/scars on knuckles from gagging to purge. May
have acid deterioration of teeth (from gastric acids). May have gastric smelling breath. Other forms of
purging are excessive exercise following eating or using laxatives so food is not digested as well.

Weight gain back to 90% of ideal body weight – this is the weight at which most women are able to
menstruate

Depending on how underweight or severe case is (electrolyte imbalances, dehydration) individual may
be treated inpatient or outpatient. CBT or other types of therapy that focus on changing idea’s which
then help in changing behaviors are used.

Medications

 Fluoxetine (Prozac) – SSRI antidepressant

 Olanzapine (Zyprexa) – 2nd generation antipsychotic

Both work on supporting cognition and weight gain

Weight not a good indicator – often appear at ideal body weight or above

An oral assessment may reveal poor dentition from acid wearing away teeth, swollen glands, redness in
throat/mouth, acid smelling breath

May also observe scabbing or scarring on knuckles of hands

Stomach or GI problems/complaints may be present

 Prozac is the gold standard in treating Bulimia.

ADHD

 Inattention – appears careless in schoolwork and activities at home, easily distracted by external
stimuli, forgetful in daily activities, avoids or dislikes engaging in tasks that require sustained
mental effort
 Hyperactivity – fidgety, squirms in seat, restless, has difficulty in playing quietly or engaging in
quiet-time games or activities, talks excessively
 Impulsivity – has poor impulse control, has difficulty waiting for a turn or waiting in line,
interrupts others’ conversations

Diagnosis is based on DSM V and evaluation

DISTRACTIBILITY – may come from internal or external stimuli.

History important – including birth history where a hypoxic event may have occurred (ask parents,
teachers) about medical and developmental history
Majority of patients are treated with Ritalin. Given small dose initially, then slowly increased over time.
May cause depression of central nervous system (CNS). Monitor carefully for development of tics.
Especially cautious if family history of Tourette syndrome or ADHD combined with Tourette's.

Ritalin works by increasing dopamine and NE levels, which work on the central nervous system

Potential for abuse of these medications exists, some meds more than others, need to vigilant in
assessments keeping this in mind. Most cannot be used in children under 6 years of age.

Dosing is based on reduction of symptoms (not weight like most child meds). Regular evaluation/re-
evaluation is essential!

Behavior therapy attempts to prevent undesired behavior using a reward system. Collaboration with
therapists gets parents and school teachers on same page so all sending same message/reinforcing
same behaviors with same reward system. Consistency is incredibly important!

Part of being an educator to patients/families is to also be a good listener. The most common complaint
parents have of healthcare professionals is that they do not listen (actually listen) to what the parents
have to say. Focus on strengths of child/family when giving feedback.

Side effects include weight loss, abdominal pain, headaches, decreased appetite, sleeplessness,
increased crying, irritability, nervous stimulation, cardiovascular stimulation.