Eating DisordersEating Disorders

Eating DisordersEating Disorders

Anorexia Nervosa

Bulimia Nervosa

Eating disorder not otherwise specified (NOS)

Binge eating

TheoriesTheories

Neurobiological: altered neurotransmitters

Neuroendocrine: abnormalities, hypothalmic dysfunction

Genetic: there is a heriditary predisposition to developing disorders

Psychodynamic Influences/ Family Relationships

More theoriesMore 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

Clinical PresentationClinical 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

Bulimia: Binge eating Self-induced vomiting May have a hx of anorexia Depressive signs Problems with interpersonal

relationships. Self concept, and impulsive behaviors

Anorexia Low weight Amenorrhea peripheral edema Constipation Cardiac px

BP failure

Bulimia Usually normal

weight Tooth erosion Calluses on hands Electrolyte

imbalance failure

Client with Anorexia Perfectionisn Obsessive thoughts and actions relating

to food Need to control

Therefore, MUST build a trusting empathetic relationship

Assessment: malnourished, underweight,lanugo on face, mottled skin, dehydration

ô Nursing Diagnosis: Imbalanced Nutrition : less than body requirements…

Decreased cardiac output…

Disturbed body image…

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

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

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.

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

Assessment: May not appear ill, normal weight Dental erosion Family relationships may lack nurturing May have hx of impulsive behaviors

(stealing etc) Electrolyte imbalanceDiagnosis: Risk for injury due to

ineffective coping…. Others???

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

Acute phase: Milieu therapy: interrupt binge/purge

cycle Counseling Health teaching

Long term treatment: Psychotherapy Psychopharmacolgy (Prozac)

Normalize eating habits

Maintain regular exercise plan

Weight in normal range for height

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

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