Eating disorders


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Eating disorders

  2. 2. Topics Covered: Anorexia Nervosa Bulimia Nervosa Not Covered: Overeating and BingeEating Disorder (DSM) Obesity Bariatric
  3. 3. Anorexia
  4. 4. Anorexia Nervosa:Incidence and Characteristics Affects 3.7% of women Less common than bulimia 6 to 20% die as a result of the illness Higher death rate than any otherpsychiatric
  5. 5. Anorexia Nervosa Characteristics,cont’d Females, 90% (Male numbers are growing) Onset: Adolescence to early adulthood Age of onset is decreasing Often insidiousOccurs during important life transitions No loss of appetite Deliberate Weight
  6. 6. Cultural Influences Weight and Shape arevery important Computer Graphics:make thin modelseven thinner Preoccupation withfood, eating, fitness Unrealistic
  7. 7. DSM IV-TR Criteria Refusal to maintain normal weight Intense fear of gaining weight, even ifunderweight Body image disturbances In female adults or adolescents, absenceof at least 3 consecutive menstrual cycles Types are: Restricting and Binge/
  8. 8. Psychosocial Factors May be avoidant or havesocial problems Rigid, competitive, perfectionistic Compulsive and obsessive Hyperactive Anxious Compliant “people pleasers”
  9. 9. Food-Related Behaviors inAnorexia Nervosa Restricting intake, fasting Hoarding food Highly avoidant of certain foods Preoccupation with calories, meals, recipes, etc. Preparing/serving elaborate meals for others Rituals before and during eating become
  10. 10. Purging Behavior in Anorexia Purgers and vomiters Eat normally in a social situations Amount of food eaten is not excessive Purge if no success with severe restricting(Not on the test)
  11. 11. Metabolic
  12. 12. Anorexia: More Consequences Decreased peristalsis is exacerbated byoveruse of laxatives or enemas Delayed gastric emptying Feel full much longer
  13. 13. Anorexia: Consequences Amenorrhea, decreased development ofsecondary sex characteristics Osteopenia or Osteoporosis Bone mass loss may be irreversible Weakness and fatigue But will persist in excessive exercising to burn
  14. 14. Anorexia: Complications Heart failure, life threateningarrhythmias Cardiac ventricular dilation Decreased thickness of theventricular wall Decrease oxygenation of the cardiacmuscle Renal
  15. 15. Complications, cont’d Electrolyte imbalance Hypokalemia Hypocalcemia Metabolic imbalance Metabolic Acidosis Metabolic
  16. 16. Complication of Treatment:Re-feeding Syndrome Severe Fluid Shifts from too rapidre-introduction of food Extracellular to intracellular Cardiovascular, neurological andhematologic complications Refeed slowly Close
  17. 17. Nursing Diagnosis: Critical thinkingWrite a nursing diagnosis for each of theseconsequences of Anorexia Nervosa: 1) Severe weight loss to 60% of average bodyweight 2) Bradycardia 3) Overuse of laxatives to achieve wt. loss 4) Refeeding
  18. 18. Nursing Diagnosis: Critical thinkingSome possible choices1) Nutrition less than body requirements r/trefusal to eat; r/t excessive exercise2) R/F falls r/t hypotension3a) Fluid volume deficit r/t laxative overuse3b) Constipation r/t altered gastric motility4a) Imbalanced fluid volume r/t fluid shifts4b) Impaired cardiac or peripheral tissueperfusion r/t decreased cardiac
  19. 19. Mental Health ProblemsAssociated with Anorexia Fear of losing control (Anxiety) Low sex drive Feelings of helplessness Feel abandoned or inadequate Combat by controlling what they eat Obsessive-compulsive disorder Major Depression (Dx and tx only after weight gain is established) Substance abuse Personality
  20. 20. Etiology of Anorexia High levels of serotonin SSRIs are not effective If used should not bestarted until weightrestoration is
  21. 21. Etiology: Anorexia and theFamily Emotional restraint Enmeshed relationships Rigid organization Tight control Drive for thinness is a way to seek control Avoidance of conflict Odd eating habits Emphasis on
  22. 22. Bulimia
  23. 23. Bulimia Means to have an insatiable appetitive Begins in adolescents Primarily in women 4% of young adults Symptom overlap with Anorexia, makingdiagnosis
  24. 24. Bulimia Characteristics Hide their eating-disordered behaviors Lack of weight loss Coexisting mental disorders: Major Depression Personality disorders Post traumatic Stress Disorder Purging develops as a way to compensate formassive amounts of food eaten Restrictive eating….then purging…
  25. 25. Binge EpisodeMassive Amounts of
  26. 26. Binge Eating Feelings of lack of control Often done in secret High calorie-High carbohydrate Consumed in less than 2 hours Addicted to the high experienced when
  27. 27. Purging = Compensatory Behaviorfor Binge Eating May use manual stimulation, laxatives,and/or emetics Over time, self-induced vomiting occurswith minimal stimulation Post-purging: sense of relief,
  28. 28. Consequences and Complications ofPurging Electrolyte imbalances Metabolic Acidosis Metabolic Alkalosis Cardiomyopathy Enlarged salivaryglands Erosion of dentalenamel Russell’s sign
  29. 29.
  30. 30. Differences in Bulimia fromAnorexia Lowered serotonin activity Binge eating raises levels of serotonin Treatment with SSRI, particularlyfluoxetine (Prozac) Depression; shame; hide their
  31. 31. Bulima: Associated FamilyCharacteristics Mood disorders Substance abuse Conflict Disorganized Lacking nurturance Food is a symbolic form of nurturing Evidence Bulimia is a response to
  32. 32. Management of Eating Disorders Anorexia Increase weight to90% of average bodyweight Increase self-esteem Decrease need forperfection (providedby thinness) Bulimia Stabilize weightwithout
  33. 33. Management of Eating Disorders Both Anorexia and Bulimia: Inpatient treatment for medical stabilizationand dietary management Long-term outpatient tx. addressespsychosocial
  34. 34. Management: Starvation Phaseof Anorexia Assess labs: Monitor intake/output Assess for cardiovascular, neurological andcomplications Refeed slowly; careful dietary supervision Intravenous lines and feeding tubes ifclient refuses
  35. 35. Nurse Patient Relationship Anorexia Nervosa Usually forced into tx. Tx means loss ofcontrol over eating Nurse is the enemy Bulimia Nervosa More likely to wanthelp: break the cycle More likely to entertreatment of their onvolition Tendency tomanipulate Hide the degree of
  36. 36. Critical Thinking: NursingInterventions Give rationales for each of the followinginterventions listed on next slide 
  37. 37. Nurse Patient Relationship:Some Interventions for EatingDisorders Do not confront denial,but encourage feelingsidentification Honesty Collaborate TEACH patient abouttheir disorder Assist to identify positivequalities Eat with the client Set appropriate limits Encourage decisionmaking concerning issuesother than food Behavior modification: Patient input Reward for
  38. 38. Psychopharmacology Anxiolytics when re-feeding is occurring SSRI for Bulimia Equally effective for depressed and non-depressed patients Psychotherapy for Anorexia Use antidepressant for co-morbid
  39. 39. Milieu Management Orientation Warm nurturing environment Convey an understanding of their fears Close observationDo we let these patient go to the rest room alone?Should we let them go to their room right after a meal? Nonjudgmental confrontation CONSISTENCY Encourage the patient to talk to staff when theyfeel the need to
  40. 40. Milieu Management, cont’d Weighing Family Therapy Group TherapyWhich groups would be best for clients witheating disorders? Dietitian Follow-up Therapy (outpatient)
  41. 41. Scenarios: Communication1) Two clients on the eating disorders unit areoverheard discussing recipes and meal plans inthe day room. How should the nurse respond?2) An inpatient with Anorexia Nervosa complainsof feeling very full after eating and says she isbeing given too much to eat. How should thenurse respond?