3. Theories
Neurobiological: altered neurotransmitters
Neuroendocrine: abnormalities, hypothalmic
dysfunction
Genetic: there is a heriditary predisposition to
developing disorders
Psychodynamic Influences/ Family Relationships
4. 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
5. 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
6. Bulimia:
Binge eating
Self-induced vomiting
May have a hx of anorexia
Depressive signs
Problems with interpersonal relationships. Self
concept, and impulsive behaviors
7. Anorexia Bulimia
Low weight Usually normal weight
Amenorrhea Tooth erosion
peripheral edema Calluses on hands
Constipation Electrolyte imbalance
Cardiac px failure
BP
failure
8. Client with Anorexia
Perfectionisn
Obsessive thoughts and actions relating to food
Need to control
Therefore, MUST build a trusting empathetic
relationship
9. Assessment: malnourished, underweight,
lanugo on face, mottled skin, dehydration
ô Nursing Diagnosis:
Imbalanced Nutrition : less than body requirements…
Decreased cardiac output…
Disturbed body image…
10. 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
11. 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
12. 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.
13. 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
14. 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???
15. 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
16. Acute phase:
Milieu therapy: interrupt binge/purge cycle
Counseling
Health teaching
Long term treatment:
Psychotherapy
Psychopharmacolgy (Prozac)
17. Normalize eating habits
Maintain regular exercise plan
Weight in normal range for height
18. 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
19. Do you know anyone with an eating
disorder?
Anything you feel comfortable sharing?
Examples? Anyone? Only if you are
comfortable?
Editor's Notes
There is no true med for these disorders, depression and anxiety accompany these therefore if we treat the underlying issues the hope is for behavior modification to occur together.