Eating Disorders on the NCLEX

Anorexia has the highest mortality of the psychiatric disorders. Know the physical findings cold.

Anorexia nervosa findings

Restriction, intense fear of weight gain, distorted body image, denial of the problem. Physical: low BMI, bradycardia, hypotension, hypothermia, lanugo (fine body hair), amenorrhea, dry skin, brittle hair, osteoporosis. Often overexercises. Cardiac arrhythmia from electrolyte loss is the lethal mechanism.

Bulimia nervosa findings

Binge-purge cycles. Weight often normal or slightly above, which hides the disorder. Physical: Russell's sign (knuckle calluses from induced vomiting), dental enamel erosion, parotid gland swelling, esophageal tears. Labs: hypokalemia and metabolic alkalosis from vomiting. Hypokalemia drives the arrhythmia risk.

Refeeding syndrome

Feeding a severely malnourished patient triggers an insulin surge that drives phosphate, potassium, and magnesium into cells. Hallmark: hypophosphatemia. Consequences: heart failure, arrhythmias, respiratory failure. Prevention: start feeds low, advance slowly, monitor and replace electrolytes before and during refeeding.

Meal supervision rules

Structured, consistent, no bargaining. Stay with the patient during meals and for about 1 hour after to prevent purging or hiding food. Supervise bathroom trips after meals. Weigh daily: same time, same scale, gown only, after voiding, often with the patient facing away from the number. Do not negotiate food choices at the table. Set time limits for meals.

Frequently asked

Which patient is more likely to seek help?

Bulimia. The behavior is ego-dystonic (distressing to the patient). Anorexia is typically denied.

First priority in severe anorexia?

Medical stabilization: cardiac status, electrolytes, nutrition. Psychotherapy comes after the body is safe.

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