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EATING DISORDERS

EATING DISORDERS. RNSG 2213. Covered: Anorexia Nervosa Bulimia Nervosa. Not Covered: Overeating and Binge Eating Disorders Obesity and Bariatrics. Topics in this Presentation. Anorexia Nervosa. Females, 90% (male numbers are growing) Affects 3.7% of women Less common than bulimia

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EATING DISORDERS

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  1. EATING DISORDERS RNSG 2213

  2. Covered: Anorexia Nervosa Bulimia Nervosa Not Covered: Overeating and Binge Eating Disorders Obesity and Bariatrics Topics in this Presentation

  3. Anorexia Nervosa

  4. Females, 90% (male numbers are growing) Affects 3.7% of women Less common than bulimia 6 to 20% die as a result of the illness Higher death rate than any other psychiatric disorder Anorexia Nervosa: Incidence and Characteristics

  5. Anorexia Nervosa Characteristics, cont’d • Onset: • adolescence to early adulthood • age of onset is decreasing • often insidious • occurs during important life transitions • No loss of appetite • Deliberate Weight loss

  6. Cultural Factors and Influences • Weight and Shape very important in US culture • Unrealistic ideals: “culture of thinness” e.g. computer graphics make thin models even thinner

  7. Beauty Queens 2008 1920s

  8. Preoccupation with fitness Epidemic of obesity and dieting thinness = self-control Cultural Factors & Influences, cont’d

  9. DSM IV-TR Criteria for Anorexia Nervosa • Refusal to maintain normal weight • Intense fear of gaining weight, even if underweight • Body image disturbances • In female adults or adolescents, absence of at least 3 consecutive menstrual cycles • Types are: Restricting and Binge/Purging

  10. Psychosocial and Family Factors • Fears of becoming adult or independent • Rigid, competitive, perfectionistic • Anxious, compulsive and obsessive • the eating disorder is a way to have control • Compliant “people pleasers”

  11. Psychosocial and Family Factors, cont’d • Correlates with childhood sexual abuse • Family characteristics that correlate with anorexia: • over-controlling or rigid • emphasis on appearance • may have unusual eating habits

  12. Food-Related Behaviors in Anorexia 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 compulsions Many characteristic behaviors of Anorexia Nervosa are associated primarily with low weight/starvation symptoms

  13. How Anorexics Get Rid of the “Weight” • Use of laxatives and enemas • Exercise

  14. 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)

  15. Physical Assessment: Metabolic Consequences

  16. Anorexia: More Metabolic Consequences • GI: slowed peristalsis, delayed gastric emptying • Feel full much longer • Reproductive: loss of menses, loss of libido •  development of secondary sex characteristics • Osteopenia or Osteoporosis: bone mass loss may be irreversible

  17. Other Physical Assessment Data • Muscle wasting, weakness and fatigue • Dehydration • Pitting edema • Electrolyte imbalance: secondary to laxative, enema or emetic abuse and from starvation • Hypocalcemia, hypokalemia

  18. Anorexia: Complications • Heart failure, life threatening arrhythmias • Cardiac ventricular dilation • Decreased thickness of the ventricular wall • Decreased oxygenation of cardiac muscle • Renal failure • Metabolic alkalosis or acidosis

  19. Complication of Treatment: Re-feeding Syndrome • Severe Fluid Shifts from too rapid re-introduction of food • Cardiovascular, neurological and hematologic complications • Interventions: • Refeed slowly • Close supervision of physical status

  20. Nursing Diagnosis: Critical thinking Write a nursing diagnosis for each of these consequences of Anorexia Nervosa: 1) Hides food and is dishonest about intake 2) Heart Rate is persistently 48 bpm 3) Uses laxatives several times a week to achieve wt. loss

  21. Nursing Diagnosis: Critical thinking Some possible choices 1a) Ineffective coping or 1b)R/F nutrition less than body requirements r/t dishonesty about intake and compensatory behaviors 2) R/F falls r/t hypotension 3a) Fluid volume deficit r/t laxative overuse 3b)Constipation (or Diarrhea) r/t altered gastric motility

  22. Mental Health Problems Associated with Anorexia • Anxiety • If perceives loss of control over eating will lose weight by any means, e.g. exercising, laxatives, enemas or emetics • Sexual dysfunctions, low sex drive • Feelings of helplessness, inadequacy • Obsessive-compulsive Disorder

  23. Mental Health Disorders Associated with Anorexia Nervosa, cont’d • Major Depression • (Dx and tx only after weight gain is established) • Substance abuse: laxatives and enemas rather than alcohol or illegal drugs • Personality disorders

  24. Neurobiology of Anorexia • High levels of serotonin • SSRIs are not effective • If used should not be started until weight restoration is established

  25. Bulimia Nervosa

  26. Bulimia Nervosa • Age of onset: adolescence to young adulthood • Primarily in women • 4% of young adults • Symptoms overlap with Anorexia, making diagnosis difficult

  27. Bulimia Characteristics • Often develops after period of dieting • Weight loss NOT a characteristic sign of bulimia • Purging develops as a way to compensate for massive amounts of food eaten Restrictive eating...bingeing…purging cycle

  28. Binge Eating Episode • Precipitated by feelings of lack of control or anxiety • Often done in secret • High calorie-High carbohydrate intake • Consumed in less than 2 hours • Become addicted to the “high” experienced when eating

  29. Purging = Compensatory Behavior for Binge Eating • May use manual stimulation, laxatives, and/or emetics • Over time, self-induced vomiting occurs with minimal stimulation • Post-purging: sense of relief, calm

  30. Consequences and Complications of Purging • Electrolyte imbalances • Metabolic Acidosis • Metabolic Alkalosis • Cardiomyopathy • Enlarged salivary glands • Erosion of dental enamel • Russell’s sign • Pancreatitis

  31. Etiology: Psychosocial and Family Factors in Bulimia • Depression, low self-esteem • Shame: will hide the excessive eating • Associated family characteristics: • Mood disorders • Lack of nurturing • food is a form of self-nurturing • Substance abuse • Family conflict or disorganization • evidence Bulimia is a response to chaos

  32. Etiology: Neurobiology of Bulimia • Lowered serotonin activity • Binge eating raises levels of serotonin • Treat with SSRI, particularly fluoxetine (Prozac)

  33. Goals for client with Anorexia Nervosa Increase weight to 90% of average body weight for height Increase self-esteem Decrease need for perfection (provided by thinness) Goals for client with Bulimia Stabilize weight without purging Management of Eating Disorders

  34. Management of Eating Disorders, cont’d • Both Anorexia and Bulimia: • Inpatient treatment for medical stabilization and dietary management • Long-term outpatient tx. addresses psychosocial issues

  35. Interventions: Starvation Phase of Anorexia • Assess labs: • Monitor intake/output • Assess for cardiovascular, neurological complications • Refeed slowly; careful dietary supervision • Intravenous lines and feeding tubes if client refuses food

  36. Anorexia Nervosa Usually forced into tx. Tx means loss of control over eating Nurse is the enemy Bulimia Nervosa More likely to want help: break the cycle More likely to enter treatment of their own volition Tendency to manipulate Hide the degree of the problem Nurse Patient Relationship

  37. Critical Thinking: Nursing Interventions Give rationales for interventions listed on next slide 

  38. Do not confront denial, but encourage feelings identification Honesty Collaborate TEACH patient about their disorder Assist to identify positive qualities Eat with the client Set appropriate limits Encourage decision -making concerning issues other than food Behavior modification: Patient input Rewards for weight gain Some Interventions for Eating Disorders

  39. 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 severe depression

  40. Milieu Management • Orient to program and goals of treatment • Warm nurturing environment • Convey an understanding of their fears • Close observation during and after meals Do we let these patient go to the rest room alone? Should we let them go to their room right after a meal? • Nonjudgmental confrontation of eating disordered behavior • CONSISTENCY • Encourage the patient to talk to staff when they feel the need to purge

  41. Milieu Management, cont’d • Dietitian: individual planning and consultation • Weighing protocols • Group Therapy Which groups would be best for clients with eating disorders?

  42. Art Therapy & Expressive Arts Meditation & Relaxation Movement Therapy

  43. Other Interventions • Family Involvement: teaching and family therapy • Follow-up therapy (outpatient)

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