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    Eating Disorders

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    africanviolets9
    The document discusses eating disorders such as anorexia nervosa and bulimia nervosa. It describes their symptoms, predisposing factors, medical complications, and treatment approaches including nutrition management and nursing care focused on improving coping skills and body image issues.

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    Eating Disorders

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    africanviolets9
    189 views28 pages
    The document discusses eating disorders such as anorexia nervosa and bulimia nervosa. It describes their symptoms, predisposing factors, medical complications, and treatment approaches including nutrition management and nursing care focused on improving coping skills and body image issues.

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    The document discusses eating disorders such as anorexia nervosa and bulimia nervosa. It describes their symptoms, predisposing factors, medical complications, and treatment approaches including nutrition management and nursing care focused on improving coping skills and body image issues.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    189 views28 pages

    Eating Disorders

    Uploaded by

    africanviolets9
    The document discusses eating disorders such as anorexia nervosa and bulimia nervosa. It describes their symptoms, predisposing factors, medical complications, and treatment approaches including nutrition management and nursing care focused on improving coping skills and body image issues.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    of 28

    EATING DISORDERS

    EATING DISORDERS
    Anorexia prolonged loss of appetite

    Bulimia excessive, insatiable appetite

    CONTINUUM OF EATING DISORDERS


    Too little (starving)

    Too much eating

    Anorexia nervosa

    Bulimia nervosa

    Obesity

    Chaotic eating

    ANOREXIA VS BULIMIA
    ANOREXIA
    ONSET WEIGHT PERCEPTION OF PROBLEM below normal fails to perceive eating beahavior as a problem

    BULIMIA
    Late adolescence or early adulthood near-normal fluctuating ashamed or embarassed by behavior

    PREVALENCE

    females

    MEDICAL COMPLICATIONS OF EATING DISORDERS


    BODY SYSTEM R/T W T LOSS SYMPTOMS

    MUSCULOSKE loss os muscle mass, fat L. osteoporosis pathologic fractures


    CARDIAC METABOLIC GI REPRODUCTI VE DERMA HEMA NEUROPSYCHIATRIC bradycardai, hypotension, cardiac arrythmias, loss of cardiac muscle hypothyroidism, hypoglycemia delayed gastric emptying, bloating, abdominal pain, diarrhea amenorrhea, low levels of FSH and LH Dry, cracking skin, lanugo, edema, acocyanosis Pancytopenia, hypercholesterolemia, Apathy, abnormal taste sensation, sleep disturbances, mild organic mental symptoms

    MEDICAL COMPLICATIONS OF EATING DISORDERS

    BODY SYSTEM R/T PURGING AND LAXATIVE ABUSE Metabolic GI

    SYMPTOMS

    Electrolyte imbalance (K, mg; hypochloremic alkalosis, BUN) Salivary gland and pancreas inflammation, gastric erosion with rupture, dysfunctional bowel syndrome Perimyolysis, particularly front teeth SZ, fatigue, mild neuropathies, weakness

    Dental Neuropsychiatric

    1. ANOREXIA NERVOSA

    Characterized by morbid fear of obesity Body weight less than 85% of expected

    1. ANOREXIA NERVOSA

    Subgroups Restricting
    dieting, fasting, excessive excercising

    Binge eating and purging


    Vomiting, laxatives, enema

    1. ANOREXIA NERVOSA
    SYMPTOMS Morbid fear of obesity Refusal to eat Preoccupation with food Amenorrhea Delayd psychosexual development Compulsive behaviors may be present Extensive exercising common Feelings of depression and anxiety Gross distortion of body image

    BULIMIA NERVOSA

    Episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time followed by inappropriate compensatory behaviors to rid the body of the excess calories

    BULIMIA NERVOSA

    Types
    Purging type
    Self-induced vomiting, abude of laxatives/enemas/diuret ics during episodes

    Nonpurging type

    BULIMIA NERVOSA SYMPTOMS


    Binges solitary and secret
    Pleasurable activity Followed with guilt Ppt by strong emotions Alternate with normal eating and fasting Low-calorie foods bet binges

    BULIMIA NERVOSA

    SYMPTOMS
    Feeling of loss or inability to control eating after binge Within normal wt Obsession with body image and appearance Vomiting: electrolyte imbalances, Perimyolysis

    PREDISPOSING FACTORS TO EATING DISORDERS


    PSYCHOYNAMIC THEORY
    developmental arrest in early childhood lack of trust, autonomy, separation-individuation unfulfilled, leaving individual in dependent position

    BIOLOGIC THEORY
    Neuroendocrine abnormalities w/in hypothalamus

    PREDISPOSING FACTORS TO EATING DISORDERS THEORY OF FAMILY DYNAMICS


    Control issues the overriding factor in the family Passive father, domineering mother, overly dependent child High value on perfectionism, child feels standards must be satisfied

    SOCIOCULTURAL FACTORS CULTURAL CONSIDERATIONS: more


    common in industrialized societies

    Treatment modalities
    Individual therapy Family therapy Psychopharmacology
    No meds specific for eating d/o For associated symptoms (anxiety and depression): Prozac, Anafranil, Thorazine Olanzapine for anorexia Toipiramate (Topamax) for binge-eating

    RELATED DISORDERS INFANCY: rumination, pica, feeding disorders Binge-eating disorder Night-eating d/o: associated with life stress, low self-esteem, anxiety, depression, adverse reactio to wt loss
    Usu. obese

    NURSING MANAGEMENT ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS


    If pt is unable or unwilling to maintain adequate oral intake, physicial may order a liquid diet given via NGT
    For oral diet Determine with dietician the number of calories required and realistic wt gain

    Explain to pt details of behavior modification program. Explain benefits of compliance with prandial routine and consequence for noncompliance

    NURSING MANAGEMENT ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS


    For oral diet

    Sit with pt during mealtime for support and to observe amount ingested. A limit (usu, 30min.) should be imposed on time alloted for meals Observe pt f or at least 1 hour after meals. Pt may need to be accompanied to bathroom is self-induced vomiting is suspected

    NURSING MANAGEMENT ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS For oral diet Strict MIO Weigh daily Do not discuss food or eating with patient, once protocol has been established discussing food provides positive feedback to eating behaviors

    NURSING MANAGEMENT ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS Explain to pt that, if due to poor oral intake, nutritional status does not improve, tube feedings will be initiated As nutritional status improves and eating habits are established, begin to explore with pat emotional issues associated with his/her extreme fear of gaining wt

    FLUID VOLUME DEFICIT Stric t MIO. Teach pt importance of daily OFI of 2000-3000ml/d Daily wts Assess and document skin turgor, condition of oral mucus membranes, Monitor lab serum values Observe pt for a t least 1 hour after meals

    INEFFECTIVE INDIVIDUAL COPING Establish a trusting relationship with the pt Acknowledge pts feelings of anger, loss of control due to established eating regimen Explore: Feelings associated with extreme fear of gaining wt Explore family dynamics

    INEFFECTIVE INDIVIDUAL COPING

    Initially allow the pt to be in a dependent role. As trust is developed and physical condition improves, encourage independence. Explore with pt ways in which he/she may feel in control with the environment, without resorting to maladaptive eating behaviors

    BODY IMAGE/SELF-ESTEEM DISTURBANCE Assist pt to re-examine negative perceptions of self and to recognize positive attributes

    Offer positive reinforcement for independently made decisions


    Make sure reinforcement is honestly made and directed towards autonomy/independence and separated from maladaptive eating behaviors

    BODY IMAGE/SELF-ESTEEM DISTURBANCE

    Promote feelings of control in the environment through participation and independent decision-making
    Through positive reinforcement, help pt to accept self as is, including weaknesses as well as strengths

    BODY IMAGE/SELF-ESTEEM DISTURBANCE Help pt realize perfection is unrealistic, and explore this need with him or her

    Help pt claim ownership of angry feelings and recognize that expressing them is acceptable if done so in an appropriate manner

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