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Anorexia
Nervosa and
Bulimia Nervosa
Lauren Arnett
AN and BN
 AN:

Body weight maintenance is less than
85% of what is expected



Restricting
Binge Eating/ purging

 BN...
Background
 Client:

Paris Marshall (F)
 Age: 34
 Height: 5’8”
 Weight: 115 lbs (52.27kg)
 Attorney
 Lives by hersel...
Patient History
 Perfectionist
 Spent


a lot of time at the Rec center

1 hr swimming in the morning, 3 miles walking ...
 Made




an effort to keep weight <120lbs

Restricting her intake- the hungrier she was the
more determined to not gi...
 Tx:

tried to stop restricting her food and
purging, but coping mechanism for stress
 Hospitalized for the weekend- sev...
AN and BN
 AN:



Restricting
Binge Eating/ purging

 BN:



Purging
Non-purging

 BED:
What is her diagnosis?
 Anorexia

Nervosa with binging and
purging tendencies
 BP= 90/60
 BMI= 17.53kg/m
 Hamwi= IBW= ...
PESS statements
 Inadequate

energy intake related to
Anorexia Nervosa as evidenced by
induced vomiting, laxatives, BMI, ...
24 Hour Recall
Recommendations
 Recommended

weight gain per week: .5-1lb

1

month: 2-4lbs
 3 months: 6-12 lbs
 1 year: 20-25 lbs.
E...
Lab Values
 Anemia,

bone density test, leukocytopenia,
hyponatremia, hypokalemia, bradycardia,
hypotension, osteoporosis...
Response
 Metabolic




response to starvation

Relies on ketones instead of glucose for
energy
Decreases protein degr...
Professionals


Multidisciplinary team:
 Primary care physician
 Oversees the whole process
 Psychiatrist
 Emotional ...
Treatment
 Out

patient therapy while IBW% stays at
82.5%
 Increase calories 500-800kcals in first few
weeks; gradual pr...
 Not

purging/ restricting
 Enjoyable foods, benefits of food
 Ensure:

high calorie(350 calories and 13g
of protein)
...
Monitor
 Vital

signs
 Food and fluid intake/ output
 Changes in weight and height
 Body composition
 Lab values (pro...
Inpatient Care
 Regress

from 82.5% after 2 weeks
 Severe electrolyte imbalance or body
weight <75% of expected (105lbs)...
References



Nelms, M., Sucher, K., Lacey, K., Roth, S. L., & Habash, D. (2010). Nutrition
therapy and
pathophysiology....
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Case study final

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Case study final

  1. 1. Anorexia Nervosa and Bulimia Nervosa Lauren Arnett
  2. 2. AN and BN  AN: Body weight maintenance is less than 85% of what is expected   Restricting Binge Eating/ purging  BN: Reoccurring binge eating habits; lack of control   Purging Non-purging  BED: Eat within a two hour period an amount that is much larger than most
  3. 3. Background  Client: Paris Marshall (F)  Age: 34  Height: 5’8”  Weight: 115 lbs (52.27kg)  Attorney  Lives by herself  Family Hx: Hypertension- father  Smoker: 1 pack per day
  4. 4. Patient History  Perfectionist  Spent  a lot of time at the Rec center 1 hr swimming in the morning, 3 miles walking on track after lunch, and 1 hr aerobics in the afternoon  Taught how to purge with toothbrush, and use of laxatives/ enemas  Continued with increased stress  She has not had a menstrual period in over 2 years
  5. 5.  Made    an effort to keep weight <120lbs Restricting her intake- the hungrier she was the more determined to not give in Thought that this “self control” would help her in the practice of law Graduated at the top of her class and recruited by the most prestigious law firm where she is trying to make partner.
  6. 6.  Tx: tried to stop restricting her food and purging, but coping mechanism for stress  Hospitalized for the weekend- severe dehydration  Meds: OTC laxatives every other day  Allergies/ intolerance: meat, dairy and “desserts”  Admitted: class lost consciousness in exercise
  7. 7. AN and BN  AN:   Restricting Binge Eating/ purging  BN:   Purging Non-purging  BED:
  8. 8. What is her diagnosis?  Anorexia Nervosa with binging and purging tendencies  BP= 90/60  BMI= 17.53kg/m  Hamwi= IBW= 140lbs  IBW%=115/140= 82.5% Primary nutrition goal: restoring the patients weight to at least 90% of the expected weight (126lbs)
  9. 9. PESS statements  Inadequate energy intake related to Anorexia Nervosa as evidenced by induced vomiting, laxatives, BMI, 24 hour recall.  Distorted beliefs about food related to malnourishment as evidenced by lab values, belief of “bad foods”, and food restriction.
  10. 10. 24 Hour Recall
  11. 11. Recommendations  Recommended weight gain per week: .5-1lb 1 month: 2-4lbs  3 months: 6-12 lbs  1 year: 20-25 lbs. Energy intake: 30-40kcal/kg of body weight per day
  12. 12. Lab Values  Anemia, bone density test, leukocytopenia, hyponatremia, hypokalemia, bradycardia, hypotension, osteoporosis, primary amennorrhea, Low levels  Albumin  Potassium  Magnesium  T3  WBC High levels o Sodium o Glucose o AST o LDH o CPK o Alk phosphate o HDL-C
  13. 13. Response  Metabolic    response to starvation Relies on ketones instead of glucose for energy Decreases protein degradation Allows body to function for 2-3 months at a stable level Refeeding Syndrome o Reintroducing the client to carbs the body switches back to relying on glucose for energy o Mineral levels decrease- in greater demand o Result in hemolysis, impaired cardiac function/respiratory function, and death
  14. 14. Professionals  Multidisciplinary team:  Primary care physician  Oversees the whole process  Psychiatrist  Emotional therapy  Dietitian  Nutrition therapy
  15. 15. Treatment  Out patient therapy while IBW% stays at 82.5%  Increase calories 500-800kcals in first few weeks; gradual progression      Break up into more frequent feedings Don’t use specific numbers Increase nutrient dense food high in protein Eat high kcal foods first Add margarine, butter, sauces and gravies  Stress management options  Group counseling
  16. 16.  Not purging/ restricting  Enjoyable foods, benefits of food  Ensure: high calorie(350 calories and 13g of protein)  24 essential vitamins and minerals  25-50% fully recover  Don’t “punish” make it fun!
  17. 17. Monitor  Vital signs  Food and fluid intake/ output  Changes in weight and height  Body composition  Lab values (protein and minerals)  Maintain contact with counselor, dental care (fluoride)  Weigh with her back to the scale
  18. 18. Inpatient Care  Regress from 82.5% after 2 weeks  Severe electrolyte imbalance or body weight <75% of expected (105lbs)  Oral feeds: No enteral or parenteral feedings unless life saving intervention  Energy intake 2-3lbs per week
  19. 19. References   Nelms, M., Sucher, K., Lacey, K., Roth, S. L., & Habash, D. (2010). Nutrition therapy and pathophysiology. (2/e ed. p. 269-270). Belmont: Brooks/Cole Pub Co Harvard Medical School. (2012, February 8). Bulimia prognosis. Retrieved from http://www.sparkpeople.com/resource/health_a-z_detail.asp?AZ=74&Page=8   sparkpeople.com. (26 A). Retrieved from http://www.sparkpeople.com/resource/health_a-z_detail.asp?AZ=32&Page=8    Mayo, S. (2012, October 09). Mayo clinic. Retrieved from http://www.mayoclinic.com/health/binge-eating-disorder/DS00608 National eating disorder association. (2005). Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Anorex ia.pdf    National Eating Disorders Association. (2005). Bulimia nervosa. Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/Bulimi a.pdf Smith, M. (2010). Binge eating disorder. Retrieved from http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/BingeE D.pdf   The free dictionary. (2011). Retrieved from http://medicaldictionary.thefreedictionary.com/starvation  The free dictionary. (2011). Retrieved from http://medicaldictionary.thefreedictionary.com/starvation Metabolic response to starvation metabolic response to starvation metabolic response to starvation . (2002). Retrieved from http://d3jonline.tripod.com/13Metabolism_and_Nutrition/Metabolic_Response_to_Starvation.htm (2010). Binge eating disorder. Retrieved from http://www.mayoclinic.com/health/binge-eatingdisorder/DS00608/DSECTION=treatments-and-drugs Brennan Silva, L. R. (2010, April 20). Retrieved from http://www.fitday.com/ International Dietetic & Nutrition Terminology (IDNT): Reference Manual. Standardized Language for Nutrition Care Process. 2nd ed. Chicago, IL: American Dietetic Association, 2009. Nelms, M. N., Long, S., & Lacey, K. (2008). Medical nutrition therapy, a case study approach. (p. 39, 41-42). Wadsworth Pub Co. http://nspt4kids.com/health-topics-conditions/binge-eating-disorder/ (2011). Retrieved from http://www.avalonhills.org/ (2002). Retrieved from http://renfrewcenter.com/ (2012) http://www.rosewoodranch.com/why-choose-rosewood/meet-our-leadership-team          

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