eating disorders
TRANSCRIPT
EATING DISORDERS
JAYESH PATIDAR
www.drjayeshpatidar.blogspot.com
Topics
Covered:
Anorexia Nervosa
Bulimia Nervosa Not Covered:
Overeating and Binge Eating Disorder (DSM)
Obesity
Bariatric Surgery
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Anorexia Nervosa
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Anorexia Nervosa:Incidence and Characteristics
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
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Anorexia Nervosa Characteristics, cont’d
Females, 90% (Male numbers are growing)
Onset: Adolescence to early adulthood Age of onset is decreasing
Often insidiousOccurs during important life transitions
No loss of appetite Deliberate Weight loss
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Cultural Influences
Weight and Shape are very important
Computer Graphics: make thin models even thinner
Preoccupation with food, eating, fitness
Unrealistic Ideals
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DSM IV-TR Criteria
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
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Psychosocial Factors
May be avoidant or have
social problems
Rigid, competitive, perfectionistic
Compulsive and obsessive
Hyperactive
Anxious
Compliant “people pleasers”
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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
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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)
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Metabolic Consequences
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Anorexia: More Consequences
Decreased peristalsis is exacerbated by overuse of laxatives or enemas
Delayed gastric emptying
Feel full much longer
Dehydration
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Anorexia: Consequences
Amenorrhea, decreased development of secondary sex characteristics
Osteopenia or Osteoporosis
Bone mass loss may be irreversible
Weakness and fatigue
But will persist in excessive exercising to burn calories
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Anorexia: Complications
Heart failure, life threatening arrhythmias
Cardiac ventricular dilation Decreased thickness of the
ventricular wall
Decrease oxygenation of the cardiac muscle
Renal failure
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Complications, cont’d
Electrolyte imbalance
Hypokalemia
Hypocalcemia
Metabolic imbalance
Metabolic Acidosis
Metabolic Alkalosis
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Complication of Treatment: Re-feeding Syndrome
Severe Fluid Shifts from too rapid re-introduction of food
Extracellular to intracellular
Cardiovascular, neurological and hematologic complications
Refeed slowly
Close supervision
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Nursing Diagnosis: Critical thinking
Write a nursing diagnosis for each of these consequences of Anorexia Nervosa:
1) Severe weight loss to 60% of average body weight
2) Bradycardia
3) Overuse of laxatives to achieve wt. loss
4) Refeeding Syndrome
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Nursing Diagnosis: Critical thinking Some possible choices
1) Nutrition less than body requirements r/t refusal to eat; r/t excessive exercise
2) R/F falls r/t hypotension
3a) Fluid volume deficit r/t laxative overuse
3b) Constipation r/t altered gastric motility
4a) Imbalanced fluid volume r/t fluid shifts
4b) Impaired cardiac or peripheral tissue perfusion r/t decreased cardiac output
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Mental Health Problems Associated with Anorexia
Fear of losing control (Anxiety) Low sex drive Feelings of helplessness
Feel abandoned or inadequate Combat by controlling what they eat
Obsessive-compulsive disorder Major Depression
(Dx and tx only after weight gain is established)
Substance abuse Personality disorders
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Etiology of Anorexia
High levels of serotonin
SSRIs are not effective
If used should not be
started until weight
restoration is established
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Etiology: Anorexia and the Family
Emotional restraint Enmeshed relationships
Rigid organization
Tight control Drive for thinness is a way to seek control
Avoidance of conflict
Odd eating habits Emphasis on appearance
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Bulimia Nervosa
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Bulimia
Means to have an insatiable appetitive
Begins in adolescents
Primarily in women
4% of young adults
Symptom overlap with Anorexia, making diagnosis difficult
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Bulimia Characteristics
Hide their eating-disordered behaviors Lack of weight loss Coexisting mental disorders:
Major Depression Personality disorders Post traumatic Stress Disorder
Purging develops as a way to compensate for massive amounts of food eaten
Restrictive eating….then purging….cycle
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Binge EpisodeMassive Amounts of Food
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Binge Eating
Feelings of lack of control
Often done in secret
High calorie-High carbohydrate
Consumed in less than 2 hours
Addicted to the high experienced when eating
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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
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Consequences and Complications of Purging
Electrolyte imbalances
Metabolic Acidosis
Metabolic Alkalosis
Cardiomyopathy
Enlarged salivary glands
Erosion of dental enamel
Russell’s sign
Pancreatitiswww.drjayeshpatidar.blogspot.in
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Differences in Bulimia from Anorexia
Lowered serotonin activity
Binge eating raises levels of serotonin
Treatment with SSRI, particularly fluoxetine (Prozac)
Depression; shame; hide their eating
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Bulima: Associated Family Characteristics
Mood disorders
Substance abuse
Conflict
Disorganized
Lacking nurturance
Food is a symbolic form of nurturing
Evidence Bulimia is a response to chaos
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Management of Eating Disorders
Anorexia
Increase weight to 90% of average body weight
Increase self-esteem
Decrease need for perfection (provided by thinness)
Bulimia
Stabilize weight without purging
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Management of Eating Disorders
Both Anorexia and Bulimia:
Inpatient treatment for medical stabilization and dietary management
Long-term outpatient tx. addresses psychosocial issues
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Management: Starvation Phase of Anorexia
Assess labs:
Monitor intake/output
Assess for cardiovascular, neurological and complications
Refeed slowly; careful dietary supervision
Intravenous lines and feeding tubes if client refuses food
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Nurse Patient Relationship
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 on volition
Tendency to manipulate
Hide the degree of the problem
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Critical Thinking: Nursing Interventions
Give rationales for each of the following
interventions listed on next slide
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Nurse Patient Relationship:
Some Interventions for Eating Disorders
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
Reward for weight gain
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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
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Milieu Management
Orientation
Warm nurturing environment
Convey an understanding of their fears
Close observation
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
CONSISTENCY
Encourage the patient to talk to staff when they feel the need to purge
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Milieu Management, cont’d
Weighing
Family Therapy
Group Therapy
Which groups would be best for clients with eating disorders?
Dietitian
Follow-up Therapy (outpatient)
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Scenarios: Communication
1) Two clients on the eating disorders unit are overheard discussing recipes and meal plans in the day room. How should the nurse respond?
2) An inpatient with Anorexia Nervosa complains of feeling very full after eating and says she is being given too much to eat. How should the nurse respond?
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