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Eating Disorders
  • Viewed as a continuum
  • Anorexia: eat too little
  • Bulimia: chaotic eating
  • Obesity: eating too little
Sociocultural Factors
  • westerized view of beauty
  • advertisements for products to promote physical change (women and men)
  • peer pressure (starts at an earlier age each year, adults pressure)
Anorexia Nervosa
  • Life threatening: 10% die, most fatal mental illness
  • Multiple organs damaged
  • refusal or inability to gain weight
  • intense fear of being fat
  • disturbed body image
  • strong denial
  • prone to self harm
  • prone to depression and other mental illness
  • restricting and purging
Anorexia cont.
  • < 85% Ideal body weight
  • amenorrhea for 3 months
  • preoccupation with food and activities around food (cooking, shopping, feeding others)
  • ritualistic behaviors
Anorexia cont.
  • Onset: usually between 14-18
  • denial early on
  • depression and lability with progression
  • isolation can lead to paranois
  • treatment is often difficult d/t resistance from pt, denial, lack of interest
Anorexia: clinical presentation
  • low weight
  • amenorrhea
  • jaundice
  • lanugo
  • cold extremities
  • peripheral edema
  • muscle weakness
  • constipation
  • low T3, T4
  • hypotension
  • bradycardia
  • hypokalemia
  • decreased bone density
Anorexia: Hunger
  • Feels hunger
  • fights or ignores it
  • feels a sense of power by beating the feeling
  • givs them a sense of control
Anorexia: Myths
  • only teen girls suffer
  • you can never fully recover
  • eating disordes are a problem with food
  • you can tell if somone has an ED from appearance
Anorexia: Nursing process
  • planning is based on acutiy
  • <75% IBW = inpatient
  • limited weight restoration
  • correct lyte imbalances
  • address dysrhythmias
  • stabilize acute psych symptoms
Refeeding syndrome
  • circulatory system is overhwlemed during refeeding
  • leads to CV collapse and heart failure
Anorexia: interventions
  • Acute phase/ basic intervention
  • Milleu therapy: precise meal times and menus, observation post meals, regualr weights
  • Counseling: cognitive distortions, health teaching, self-care
Anorexia: treatment
  • Medication treatment is questionable
  • Elavil and Periactin can promote weight gain
  • Zyprexa d/t effects on body image distortions
  • Prozac to prevet relapse
  • Psychotherapy: family and individual
Anorexia and Bulimia
  • Often significant overlap of symptoms
  • both are perfectionistic
  • mood/depression issus
  • anxiety/OCD
  • substance abuse
  • sexual abuse before puberty
  • Onset: lade adolesence or early adulthood (average of 18-19)
  • often begins during or after a dieting episode
  • possible restritive eating between binges, secretive storage or hiding of food
  • treatment: CBT, self monitoring
  • psychophamaceuticals: antidepressants
Bulimia cont.
  • Age: 18-19
  • Binge eating: twice a week for three months
  • self induced vomiting, laxative, or diuretic use
  • depression
  • imulsive behavior
  • chemical dependency is common
  • increased anxiety or compulsivity
  • traits can be similar to borderline personality disorder
  • secretive, ashamed, guilty
  • loss of control
Bulimia: clinical presentation
  • normal to slightly low weight
  • dental caries, erosion
  • parotid swelling
  • gastric dialtion or rupture
  • peripheral edema
  • muscle weakness
  • abnormal K, Na values
  • EKG changes, cardiomyopathy
Bulimia: treatment
  • antidepressants
  • outpatient: less dangerous
  • CBT: self monitoring
Eating disorders: nursing assessment
  • History: model child, no trouble, dependable (anorexia)
  • eager to please and corform, avoids conflict (bulimia)
  • general appearance, mood: slow, lethargic, emaciation
  • mood, affect: labile
  • prone to self injury, suicide
Assessmenet cont.
  • thought process, content: preoccupation with food or dieting, delusional
  • sensorium, intellectual processes: starvation, confusion, slow respones, difficulty concentrating
  • judgement, insight: denial (anorexia), aware and ashamed (bulimia)
  • self concet: low self esteem
  • roles/relationships
  • physiological, self care considerations
Community based care
  • hospital admission only for medical necessity
  • community settings: PHP, day treatment, individual or group outpt, self-help groups
Mental health promotion
  • education of parents, children, young people about strategies to prevent eating disorders
  • early identification, appropriate referral
  • routine screening of  young women for eating disorders
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