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Nursing Management of Eating Disorders

Nursing Management of Eating Disorders. NUR 265 Pat Mitchell, RN, MS. Eating Disorders. Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified (NOS) Binge eating disorder. Eating Disorders: Theories. Separate syndromes based on a cluster of symptoms Neurobiological

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Nursing Management of Eating Disorders

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  1. Nursing Management of Eating Disorders NUR 265 Pat Mitchell, RN, MS

  2. Eating Disorders • Anorexia nervosa • Bulimia nervosa • Eating disorder not otherwise specified (NOS) • Binge eating disorder

  3. Eating Disorders: Theories Separate syndromes based on a cluster of symptoms • Neurobiological • Altered neurotransmitters • Neuroendocrine • Abnormalities noted • Causal relationship possible • May be result of starvation or abnormal eating behavior

  4. Eating Disorders: TheoriesContinued • Psychological models • Core psychopathology • Feelings of • Low self esteem • Self-doubts about personal worth • Feelings produce harsh self-judgment focused on weight

  5. Eating Disorders: TheoriesContinued • Sociocultural models • Incidence of eating disorders increases in societies in which women have a choice in social roles • Genetic models • Strong genetic link for eating disorders

  6. Eating Disorder Cycle

  7. Signs and Symptoms and Clinical Presentations of Anorexia and Bulimia • Anorexia nervosa (Table 17-1) • Bulimia nervosa (Table 17-1)

  8. Anorexia Nervosa Physical Symptoms • Weight loss 15% below ideal • Amenorrhea • Bradycardia, subnormal T • Cachexia, sunken eyes, dry skin • Lanugo on face • Constipation • Cold sensitivity

  9. Anorexia Nervosa Behavioral Symptoms • Self-starvation • Compulsive behaviors regarding food • May use laxatives or diuretics, excessive exercise, vomiting • Wearing baggy clothes

  10. Anorexia Nervosa Psychologic Symptoms • Denial of seriousness of low weight • Body image disturbance • Irrational fear of weight gain • Constant striving for perfect body • Self-concept unduly influenced by shape and weight • Preoccupation with food, cooking • Delayed psychosexual development • Little interest in sex, relationships

  11. Bulimia Nervosa Physical Symptoms • Electrolyte imbalances • Hypokalemia • Alkalosis • Dehydration • Idiopathic edema Cardiovascular • Hypotension • Dysrhythmias • Cardiomyopathy

  12. Bulimia Nervosa Physical Symptoms, cont’d. Endocrine • Hypoglycemia • Menstrual dysfunction Gastrointestinal • Constipation, diarrhea • Gastroparesis • Esophageal reflux • Esophagitis • Esophageal tears

  13. Bulimia Nervosa Physical Symptoms, cont’d. Dental • Enamel erosion Parotid Gland Enlargement

  14. Bulimia Nervosa Behavioral Symptoms • Recurrent episode of binge eating • Purging behavior to compensate • Self-induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise

  15. Bulimia Nervosa Psychologic Symptoms • Body image disturbance • Persistent over concern with weight, shape, proportions • Mood swings, irritability • Self-concept unduly influenced by weight

  16. Medical Complications of Anorexia and Bulimia Nervosa • Medical complications are listed in Box 17-1

  17. Therapeutic Relationship: Building Trust and Having Empathy • Client with anorexia nervosa • Perfectionism • Obsessive thoughts and actions relating to food • Need to control

  18. Anorexia Nervosa: Nursing Process • Assessment • Nursing diagnosis • Outcome criteria • Short-term • Long-term • Planning • Refeeding syndrome

  19. Anorexia Nervosa: Intervention • Acute phase/basic level intervention • Milieu therapy • Precise meal times and menus • Observation during and after meals • Regularly scheduled weighing • Counseling • Cognitive distortions • Health teaching • Self-care

  20. Anorexia Nervosa: Intervention Continued • Long-term treatment/advanced practice interventions • Psychotherapy • Psychopharmacology • Fluoxetine (Prozac) • Olanzapine (Zyprexa)

  21. Anorexia Nervosa: Evaluation • If weight falls below the goal, treatment is changed

  22. Therapeutic Relationship: Building Trust and Having Empathy • Client with bulimia nervosa • Sensitive to perceptions of others • May feel • Shame • Out of control • Low self-esteem • Unworthiness • Dysphoria

  23. Bulimia Nervosa: Nursing Process • Assessment • Nursing diagnosis • Outcome criteria • Short-term • Long-term • Planning

  24. Bulimia Nervosa: Intervention • Acute phase/basic level intervention • Milieu therapy • Interrupt binge-purge cycle • Prevent disordered eating behaviors • Counseling • Health teaching • Long-term treatment/advanced practice interventions • Psychotherapy • Cognitive-behavioral • Psychopharmacology • Fluoxetine (Prozac)

  25. Bulimia Nervosa: Evaluation • Normalize eating pattern • Maintain regular exercise plan • Weight in normal range for height

  26. Binge Eating Disorder • A variant of compulsive overeating • Reported in 20% to 30% of obese clients • No compensatory behaviors • Major depression a significant comorbidity • Most effective treatment is cognitive-behavioral therapy • Selective serotonin reuptake inhibitors used in treatment

  27. Binge Eating Disorder • A variant of compulsive overeating • Reported in 20% to 30% of obese clients • No compensatory behaviors • Major depression a significant comorbidity • Most effective treatment is cognitive-behavioral therapy • Selective serotonin reuptake inhibitors used in treatment

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