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EATING DISORDERS

EATING DISORDERS. Mary Vercoutere, RN Instructor. EATING DISORDERS ARE CHARACTERRIZED BY SEVERE DISTURBANCES IN EATING BEHAVIOR. ANOREXIA NERVOSA IS CHARACTERIZED BY REFUSAL TO MAINTAIN MINIMALLY NORMAL WEIGHT. Eating Disorders.

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EATING DISORDERS

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  1. EATING DISORDERS Mary Vercoutere, RN Instructor

  2. EATING DISORDERS ARE CHARACTERRIZED BY SEVERE DISTURBANCES IN EATING BEHAVIOR. • ANOREXIA NERVOSA IS CHARACTERIZED BY REFUSAL TO MAINTAIN MINIMALLY NORMAL WEIGHT

  3. Eating Disorders • Bulimia Nervosa is characterized by repeated episodes of binge eating, followed by purging behaviors (DSM-IV, 1994)

  4. Eating Disorders • An individual can demonstrate symptoms of both disorders, or can revert from one to the other. • Although eating disorders can exist in males, more than 90% of individuals with eating disorders are female. • Onset generally is during adolescence (13 to 17 years of age)

  5. Major Health Considerations • Eating disorders are a serious health problem that can cause death. The morality rate in affected individuals is 10% to 15%, and the risk for suicide is increased (especially when the client also has a depressive disorder)

  6. Features of Eating Disorders • Anorexia Nervosa - Individual’s weight is less than 85% of normal for age and height. Although underweight, individual has intense fear of becoming fat. Body image disturbance (self-image related to weight)

  7. Characteristics * Strenuous exercising and peculiar food-handling patterns. *Lack of sense of control or competence in any area of life besides weight control.

  8. Bulimia • Bulimia Nervosa - Binge eating: consuming enormous quantities of food in one continuous time period; anxiety often triggers a binge. Purging: compensatory behaviors to rid self and prevent weight gain. These behaviors include self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications or substances (example, syrup of ipecac).

  9. Binging Fasting or excessive exercise. Binges commonly led to feelings of loss of control, guilt, humiliation, and self-loathing.

  10. Possible Causes No single cause; complex interaction of risk factors and back ground factors to create susceptibility for developing an eating disorder. Western idealization of youthfulness and slimness in women, Media influences. More common in middle and upper socioeconomic status and in industrialized countries.

  11. Body Image, at risk for Adolescence: phobia of body changes; increasing academic demands; independence and rebelliousness; peer pressure Parental emphasis on thinness Genetic factors: susceptible personalities; high prevalence of another family member with an eating disorder or substance abuse disorder; childhood obesity.

  12. Positive Feedback Essential Achievement and praise is highly sought Positive reinforcement for friends and family. Pressure from coaches to be at a certain weight or attain a certain appearance. Family conflicts over control issues; stressful life/family. Reaction to a major stressor (PTSD)

  13. SYSTEMS EFFECTED • May present with symptoms (example, low energy, blood in stool, amenorrhea) without seeing eating disorder as an illness. • Initial complaints: Cold intolerance, dizziness, constipation (abdominal discomfort and bloating) diminished exercise capacity. • Lethargy is a late complaint and severe

  14. GI c/o “My stomach is full.” may initially complain of constipation. Esophegeal varacies Decreased gastric motility/emptying. Neuro changes - May not be able to clearly identify feelings of hunger or satiety. Low basal temp/cold intolerance 10% slower EED

  15. Systems • Cardio Vascular - 80% of patients with severe Anorexia Nervosa most often develop bradycardia, hypotension. Also develop ventricular dysfunction, due to myocardial mass reduction, cardiac failure due to lethal rhythm disturbances/ electrolyte imbalances. Cardiac arrest due to high potassium diets. Edema due to low albumin.

  16. Systems • Electrolyte Disturbances: Hyponatremia: due to “water loading” Bulimia Nervosa present with severe alkolosis and hypokalemia Fluid shifts/ increased intercrainal pressure, most commmon cause of death are patients who abuse laxatives and diuretics indulging in self-induced vomiting.

  17. Renal Complications Hematological Changes: 30% will have anemia, 50% leucopenia Endocrine Changes: Hypothyroidism, Hypoestrogenic ammonorrhea--won’t begin menstruating until body fat increases to 22%

  18. Osteo Complications • Skeletal Complications: Osteopenia--Long term mineral density may be compromised since bone accretion peaks in late adolescence. Stress fractures. Skin/ Hair/ Teeth--Alopecia, Lanugo and Dental gum erosion

  19. Management • Disrupt the cycle. • A Multidisciplinary approach is important, with collaboration among medical, psychiatric, psychological, nutritional, and nursing team members. Hospitalization is recommended for 2 or more years when the patient has persistent symptoms despite on-going treatment, or when severe depression with suicidal impulses is present.

  20. Patient Safety The priority is to maintain patient safety and stabilize physiologic problems ie address dehydration, electrolyte imbalance, arrhythmia. A re-feeding program to restore weight. Behavioral contracting is often used as part of treatment to reinforce appropriate eating and prevent harmful behaviors….(purging)

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