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Eating-Disorders

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					       Eating Disorders
Bulimia Nervosa
Anorexia Nervosa
        Eating Disorders
Significant health problem among children,
adolescents and young WOMEN
1% of young women ages 12 to 25
affected by anorexia nervosa
Eating Disorders: Epidemiology
Affects more women than men
Depression commonly affects the clients
Anorexia= 1%
Bulimia= 3-5%
    Eating Disorders: Etiology
1. Biological factors= postulated changes in
   the neurotransmitters
2. Psychoanalytical= disturbed
   relationships, usually between mother
   and child, distorted body image with
   misperception of internal needs and
   anxiety control is by body control.
    Eating Disorders: Etiology
3. Socio-cultural= thinness is promoted by
    media and culture
4. Cognitive-behavioral= obsessive
    compulsive behavior and avoidant
    behavior are vulnerable to eating
    disorders
5. Physical and sexual abuse
           Eating Disorders:
Distortions attributed to eating disorders
   Selective abstraction = “I’m still fat”
   Superstitious thinking
            Eating Disorders:
Anorexia                     Bulimia
  Weight less than ideal       Binge eating and
  Intense fear of              purging
  becoming fat                 Binges commonly lead
  Body image                   to feelings of loss of
  disturbance                  control, guilt,
  Engages in exercise          humiliation
  and peculiar food
  habits
  Lack of sense of control
Eating Disorders: Personality traits
Anorexia                     Bulimia
  Resistance to                Feeling of helplessness
  acknowledging they
  have a problem               Variable moods=
                               fatigue, agitation
  Hyper-rigid behaviors
  Difficulty learning from     Sense of loss of control
  experience                   Low self-esteem
  Inflexible thinking          leading to self doubt
  Social introversion          Self-conscious
  Limited social               Sensitive to rejection
  spontaneity                  from others
Eating Disorders: Personality traits
Anorexia           Bulimia
 Younger (18-20)    Older (24-30 yo)
 Unable to          Weight fluctuates
 maintain body      considerably
 weight at 85%
 expected
 Amenorrhea         Amenorrhea
 Starvation         Binge eating
 Intense fear of    Fears loss of control
 becoming obese
Eating Disorders: Personality traits
Anorexia              Bulimia
 Prefers HEALTH        Prefers HIGH calorie
 food                  foods
 Preoccupation with    Repeated CRASH
 buying and
 preparing foods       dieting, use of
                       laxatives and
 Rigorous exercise
                       diuretics
 Views self as
 OVERWEIGHT            Aware that behavior
                       is ABNORMAL
        Anorexia Nervosa
A syndrome manifested by self-induced
starvation resulting from FEAR of fatness
rather than from true loss of appetite.
Onset: adolescent years
Female more than male
           Anorexia Nervosa
     FEATURES of Anorexia Nervosa
1.   Relentless pursuit of thinness
2.   Amenorrhea
3.   Refusal to maintain ideal weight
4.   Distorted body image
5.   Fear of loss of control
6.   Alexithymia: lack of awareness, mistrust
     of others and self, starvation-induced
     depression
          Anorexia Nervosa
FEATURES of Anorexia Nervosa
  The patient is pre-occupied with foods
  that prevent weight gain and is fearful of
  foods that increase weight
  They are usually the achievers and
  perfectionist

   Death usually occurs from starvation,
   suicide or electrolyte imbalance
  Anorexia Nervosa: FINDINGS
Physical           Cold intolerance, constipation, lethargy
Symptoms
Physical Signs     Younger, breast atrophy, dry skin, bradycardia,
                   hypotension, hypokalemia
Cardiovascular     ECG abnormalities, Prolonged QT intervals,
complications      myocardial damage
Hematologic        Anemia and Leukopenia
Gastrointestinal   Decreased gastric motility, delayed gastric
                   emptying
Renal              Dehydration, polyuria and peripheral edema
Endocrine          Amenorrhea due to starvation
Skeletal           Osteopenia and skeletal fractures
Anorexia Nervosa: FINDINGS
Refusal to eat
Loss of appetite
Feelings of lack of control
Excessive exercise
Weight Loss
         Bulimia Nervosa
A syndrome of binge eating followed by
self-induced vomiting or “purging” that is
also accompanied by an excessive pre-
occupation with weight and body shape

More prevalent than AN
Has LATE onset than AN
           Bulimia Nervosa
The client indulges in eating binges followed
 by purging behaviors
         Bulimia Nervosa
The measures to gain weight control
include use of laxative, cathartics,
enemas, and diuretics
The patient may resort to periods of strict
dieting, fasting and strenuous exercise
           Bulimia Nervosa
This disorder usually begins in late
   adolescence and follows a chronic
   course over many years
There is a HIGH rate of depression and the
   families of the client may be overly pre-
   occupied with food and physical
   appearance
They tend to have less SUPEREGO control
            Bulimia Nervosa
     Physical Features of the BN
1.   Thin body with swollen cheeks due to
     enlarge salivary glands
2.   Signs of fluid retention
3.   Erosion of the tooth enamel
4.   Skin is dry with cuts and abrasions over
     the knuckles (Russel’s sign)
5.   Electrolyte imbalances
            Bulimia Nervosa
Features of the BN
   Pre-occupied with body shape and weight
   Consumes high calorie food in secret with guilt
   about secretive eating
   Attempts to lose weight through diets,
   vomiting, laxatives enemas, cathartics,
   amphetamines and diuretics
   Low self-esteem and mood swings
   Self-mutilating behavior: suicide thoughts and
   attempts at suicide
      Other Eating Disorders
1. PICA= persistent eating of a non-nutritive
  substance. This is considered acceptable
  for children less than 18 months. This is
  believed to be due to ZINC and IRON
  deficiencies or related to lack of parenteral
  supervision
       Other Eating Disorders
2. RUMINATION= eating disorder
  characterized by repeated regurgitation of
  food with resultant weight loss or failure to
  gain weight

3. OBESITY
  The Nursing Process for Eating
            Disorders
ASSESSMENT
 Psychosocial assessment begins when
 the nurse establishes a trusting
 relationship with the client and families
 The nurse must identify the reason for
 hospitalization and a complete family
 assessment
  The Nursing Process for Eating
            Disorders
ASSESSMENT
 Other parts of assessment include a
 biological history and medical history
 Nutritional assessment is also very
 important
 PHYSICAL examination and laboratory
 exams should be included
  The Nursing Process for Eating
            Disorders
ASSESSMENT
  Other assessment components:
  1.   Mental status examination
  2.   Substance abuse history
  3.   Family and social history
  4.   Past and present psychiatric treatment
  The Nursing Process for Eating
            Disorders
DIAGNOSES
1. Imbalanced Nutrition: Less than body
   requirements related to dysfunctional
   eating patterns
2. Disturbed body image related to fear of
   weight gain
3. Powerlessness related to lack of control
   over food avoidance
4. Anxiety
5. Constipation/Diarrhea
6. Decreased cardiac output
7. Ineffective coping
  The Nursing Process for Eating
            Disorders
PLANNING
1. To maintain ideal body weight
2. To provide insight and teach coping
   skills
  The Nursing Process for Eating
            Disorders
IMPLEMENTATION for Anorexia Nervosa
   Weigh the patient at specific and regular
   intervals (About 2x-3x a week) with minimal
   clothing (hospital gown), patient facing
   away from the weighing scale
   Provide for safety and physical needs
   STAY with the patient and observe her
   within 1 to 2 hours AFTER EATING
   Encourage the client to share feelings to
   staff
  The Nursing Process for Eating
            Disorders
IMPLEMENTATION for Anorexia Nervosa
   Teach relaxation techniques
   Discuss factors interfering with client’s
   inability to eat
   Document intake and output
   Educate the client about the negative
   effects of dietary restriction and LOW
   weight and the rationale for normal weight
   Instruct the client on how to increase
   caloric intake and developing strategies for
   coping with anxiety
  The Nursing Process for Eating
            Disorders
IMPLEMENTATION for Bulimia
1. Encourage development of behavioral
    diary
2. Encourage expression of feelings
3. Educate about the physical
    consequences of binging, self-
    induced vomiting and use of drugs
4. Limit exercising, frequent weighing
    and obsessive caloric counting
  The Nursing Process for Eating
            Disorders
IMPLEMENTATION for Bulimia
5. Stay with client after eating for 1-2
    hours
7. Reinforce healthy coping
8. Monitor F and E status
     General Interventions
Assess the client’s nutritional status
Establish a CONTRACT with the client
concerning the diet plan for the day
Assist the client in identifying
precipitators of the eating disorder
Encourage the client to state feelings
about the eating behavior
Encourage behavior modification
    General Interventions
Convey an accepting and non-
judgmental attitude
Provide POSITIVE reinforcement for
accomplishments
SUPERVISE client during mealtimes
and few hours after
SET A TIME LIMIT FOR EACH MEAL
Provide a pleasant atmosphere for
eating
     General Interventions
Monitor for signs of physical
complications related to the eating
disorder
WEIGH client daily with same scale,
same time, same clothing (hospital
gown) and AFTER VOIDING
Encourage participation in diversional
activities
ASSESS AND MANAGE SUICIDAL
BEHAVIORS
       General Interventions
LIMIT SETTING:
   Restrict use of bathroom for 2 hours after
    eating
   Accompany to bathroom to ensure that
    they will not self-induce vomiting
   Stay with client during meals
   DO NOT accept excuses to leaving the
    area
   Limit Eating to 20 minutes
       General Interventions
DIET
   HIGH protein
   HIGH carbohydrates
   Serve foods preferred by patient
   Small frequent feedings
   NGT if patient refuses to eat
       General Interventions
DRUG
   Antidepressant drugs may be given after
    correcting the electrolyte and nutritional
    imbalances
Treatment modalities for Eating
          disorders
PSYCHOTHERAPY
   Individual psychotherapy= anorexia is
    considered food phobia. Goal of therapy is
    to remove the phobia, restore weight and
    restructure cognitive process


FAMILY therapy
   Helping family define the problem in the
    context of eating behaviors
 Treatment modalities for Eating
           disorders

GROUP THERAPY
    The group composed of patient and a
     nurse talk openly about their concerns
Treatment modalities for Eating
          disorders
BEHAVIORAL THERAPY


PHARMACOTHERAPY
   Fluoxetine (Prozac)


NUTRITIONAL THERAPY
   Dietician should be consulted
  The Nursing Process for Eating
            Disorders
EVALUATION
  Evaluate response to treatment
  Bulimia should have abstained from
  purging and decrease time to count
  the calories of food
  Anorexia nervosa should stabilize her
  weight without loss and able to ingest
  food

				
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posted:7/1/2011
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