Theories Neurobiological: altered neurotransmitters Neuroendocrine: abnormalities, hypothalmic dysfunction Genetic: there is a heriditary predisposition to developing disorders Psychodynamic Influences/ Family Relationships
More theories Psychological: feelings of low self- esteem/ harsh self judgement due to feelings of doubt Sociocultural: Increases in societies where women have a choice in role models Genetic: strong link for eating disorders
Clinical Presentation Anorexia: Terror of gaining weight Preoccupied with thoughts of food View self as fat Peculiar handling of food Exercise obsessed May use vomiting/ diuretics Determines self worth through weight
Bulimia: Binge eating Self-induced vomiting May have a hx of anorexia Depressive signs Problems with interpersonal relationships. Self concept, and impulsive behaviors
Anorexia Bulimia Low weight Usually normal weight Amenorrhea Tooth erosion peripheral edema Calluses on hands Constipation Electrolyte imbalance Cardiac px failure BP failure
Client with Anorexia Perfectionisn Obsessive thoughts and actions relating to food Need to control Therefore, MUST build a trusting empathetic relationship
Assessment: malnourished, underweight, lanugo on face, mottled skin, dehydrationô Nursing Diagnosis:Imbalanced Nutrition : less than body requirements…Decreased cardiac output…Disturbed body image…
Outcome criteria: short term vs long Planning: Inpatient vs Outpatient Refeeding Syndrome Stabilize first if pt is under 75% idea weight or with extreme electrolyte imbalance Outpatient therapy then begins
Acute phase/ basic level Milieu therapy (precise meal times, observation, weigh ins) Counseling (to deal with cognitive distortions) Health Teaching (self care) Coping skills Learning to shop and choose food Eating forbidden foods
Psychotherapy For not only pt but family as well Psychopharmology Prozac ( increases mood which may directly affect disorder) Zyprexa (decreases agitation and obsessive behaviors) EVALUATION : If weight fails below goal.. Methods are revised.
Bulimia These clients are sensitive to the perceptions of others May feel: shame, low self-esteem, unworthiness Must build an empathetic and trusting relationship to be successful in helping these clients
Assessment: May not appear ill, normal weight Dental erosion Family relationships may lack nurturing May have hx of impulsive behaviors (stealing etc) Electrolyte imbalance Diagnosis: Risk for injury due to ineffective coping…. Others???
Outcome Criteria Short vs long term: electrolyte / acid base balance Planning: tx life threatening complications May be at risk for suicidal tendencies Begin treatment to deal with issues leading to bulimia and prepare for discharge therapies
Acute phase: Milieu therapy: interrupt binge/purge cycle Counseling Health teaching Long term treatment: Psychotherapy Psychopharmacolgy (Prozac)
Normalize eating habits Maintain regular exercise plan Weight in normal range for height
A different type of compulsive overeating Reported in 20-30% obese clients Major depression Most effective treatment is cognitive- behavioral therapy SSRI’s (Zoloft) used to reduce binging
Do you know anyone with an eating disorder? Anything you feel comfortable sharing?Examples? Anyone? Only if you are comfortable?