eating disorders rnsg 2213. topics covered: covered: anorexia nervosa anorexia nervosa bulimia...

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EATING DISORDERS EATING DISORDERS RNSG 2213 RNSG 2213

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Page 1: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

EATING DISORDERSEATING DISORDERS

RNSG 2213RNSG 2213

Page 2: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

TopicsTopics

Covered:Covered: Anorexia Anorexia

NervosaNervosa

Bulimia NervosaBulimia Nervosa

Not Covered:Not Covered: Overeating and Overeating and

Binge Eating Binge Eating Disorder (DSM)Disorder (DSM)

ObesityObesity Bariatric SurgeryBariatric Surgery

Page 3: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia NervosaAnorexia Nervosa

Page 4: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia Nervosa:Anorexia Nervosa: Incidence and Incidence and CharacteristicsCharacteristics

Affects 3.7% of womenAffects 3.7% of women Less common than bulimiaLess common than bulimia 6 to 20% die as a result of the illness6 to 20% die as a result of the illness Higher death rate than any other Higher death rate than any other

psychiatric disorderpsychiatric disorder

Page 5: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia Nervosa Characteristics, Anorexia Nervosa Characteristics, cont’dcont’d

Females, 90% (Male numbers are growing)Females, 90% (Male numbers are growing)

Onset: Onset: Adolescence to early adulthoodAdolescence to early adulthood Age of onset is decreasingAge of onset is decreasing

Often insidiousOften insidious Occurs during important life transitionsOccurs during important life transitions

No loss of appetiteNo loss of appetite Deliberate Weight lossDeliberate Weight loss

Page 7: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

DSM IV-TR CriteriaDSM IV-TR Criteria

Refusal to maintain normal weightRefusal to maintain normal weight Intense fear of gaining weight, even if Intense fear of gaining weight, even if

underweightunderweight Body image disturbancesBody image disturbances In female adults or adolescents, absence In female adults or adolescents, absence

of at least 3 consecutive menstrual of at least 3 consecutive menstrual cyclescycles

Types are: Restricting and Binge/Purging Types are: Restricting and Binge/Purging

Page 8: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Psychosocial FactorsPsychosocial Factors

May be avoidant or have May be avoidant or have

social problemssocial problems Rigid, competitive, perfectionisticRigid, competitive, perfectionistic Compulsive and obsessive Compulsive and obsessive HyperactiveHyperactive AnxiousAnxious Compliant “people pleasers”Compliant “people pleasers”

Page 9: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Food-Related Behaviors in Food-Related Behaviors in Anorexia NervosaAnorexia Nervosa

Restricting intake, fastingRestricting intake, fasting Hoarding foodHoarding food Highly avoidant of certain foodsHighly avoidant of certain foods Preoccupation with calories, meals, recipes, Preoccupation with calories, meals, recipes,

etc.etc. Preparing/serving elaborate meals for othersPreparing/serving elaborate meals for others Rituals before and during eating Rituals before and during eating

become compulsionsbecome compulsions

Page 10: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Purging Behavior in Purging Behavior in AnorexiaAnorexia

Purgers and vomitersPurgers and vomiters Eat normally in a social situationsEat normally in a social situations Amount of food eaten is not excessiveAmount of food eaten is not excessive Purge if no success with severe Purge if no success with severe

restrictingrestricting

(Not on the test)(Not on the test)

Page 11: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Metabolic ConsequencesMetabolic Consequences

Page 12: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia: More Anorexia: More ConsequencesConsequences

Decreased peristalsis is exacerbated Decreased peristalsis is exacerbated by overuse of laxatives or enemasby overuse of laxatives or enemas Delayed gastric emptyingDelayed gastric emptying Feel full much longerFeel full much longer

DehydrationDehydration

Page 13: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia: ConsequencesAnorexia: Consequences

Amenorrhea, decreased development of Amenorrhea, decreased development of secondary sex characteristicssecondary sex characteristics

Osteopenia or OsteoporosisOsteopenia or Osteoporosis Bone mass loss may be irreversibleBone mass loss may be irreversible

Weakness and fatigueWeakness and fatigue But will persist in excessive exercising to burn But will persist in excessive exercising to burn

caloriescalories

Page 14: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Anorexia: ComplicationsAnorexia: Complications

Heart failure, life Heart failure, life threatening arrhythmiasthreatening arrhythmias

Cardiac ventricular dilationCardiac ventricular dilation Decreased thickness of the Decreased thickness of the

ventricular wall ventricular wall Decrease oxygenation of the Decrease oxygenation of the

cardiac musclecardiac muscle

Renal failureRenal failure

Page 15: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Complications, cont’dComplications, cont’d

Electrolyte Electrolyte imbalanceimbalance HypokalemiaHypokalemia

HypocalcemiaHypocalcemia

Metabolic Metabolic imbalanceimbalance Metabolic Metabolic

AcidosisAcidosis

Metabolic Metabolic AlkalosisAlkalosis

Page 16: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Complication of Treatment: Complication of Treatment: Re-feeding SyndromeRe-feeding Syndrome

Severe Fluid Shifts from too rapid Severe Fluid Shifts from too rapid re-introduction of food re-introduction of food Extracellular to intracellularExtracellular to intracellular

Cardiovascular, neurological and Cardiovascular, neurological and hematologic complicationshematologic complications

Refeed slowlyRefeed slowly Close supervisionClose supervision

Page 17: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Nursing Diagnosis: Critical Nursing Diagnosis: Critical thinkingthinking

Write a nursing diagnosis for each of Write a nursing diagnosis for each of these consequences of Anorexia these consequences of Anorexia Nervosa:Nervosa: 1) Severe weight loss to 60% of average 1) Severe weight loss to 60% of average

body weightbody weight 2) Bradycardia2) Bradycardia 3) Overuse of laxatives to achieve wt. loss3) Overuse of laxatives to achieve wt. loss 4) Refeeding Syndrome4) Refeeding Syndrome

Page 18: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Nursing DiagnosisNursing Diagnosis: Critical thinking : Critical thinking Some possible choicesSome possible choices

1)1) Nutrition less than body requirements Nutrition less than body requirements r/t refusal to eat; r/t excessive exerciser/t refusal to eat; r/t excessive exercise

2)2) R/F falls r/t hypotensionR/F falls r/t hypotension3a)3a) Fluid volume deficit r/t laxative overuse Fluid volume deficit r/t laxative overuse3b)3b) Constipation r/t altered gastric motilityConstipation r/t altered gastric motility4a)4a) Imbalanced fluid volume r/t fluid shifts Imbalanced fluid volume r/t fluid shifts4b)4b) Impaired cardiac or peripheral tissue Impaired cardiac or peripheral tissue

perfusion r/t decreased cardiac outputperfusion r/t decreased cardiac output

Page 19: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Mental Health Problems Mental Health Problems Associated with AnorexiaAssociated with Anorexia

Fear of losing control (Anxiety)Fear of losing control (Anxiety) Low sex drive Low sex drive Feelings of helplessnessFeelings of helplessness

Feel abandoned or inadequateFeel abandoned or inadequate Combat by controlling what they eatCombat by controlling what they eat

Obsessive-compulsive disorderObsessive-compulsive disorder Major Depression Major Depression

(Dx and tx only after weight gain is established)(Dx and tx only after weight gain is established) Substance abuseSubstance abuse Personality disordersPersonality disorders

Page 20: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Etiology of AnorexiaEtiology of Anorexia

High levels of serotoninHigh levels of serotonin SSRIs are not effectiveSSRIs are not effective If used should not be If used should not be

started until weight started until weight

restoration is establishedrestoration is established

Page 21: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Etiology: Anorexia and the Etiology: Anorexia and the FamilyFamily

Emotional restraintEmotional restraint Enmeshed relationshipsEnmeshed relationships Rigid organizationRigid organization Tight controlTight control

Drive for thinness is a way to seek controlDrive for thinness is a way to seek control Avoidance of conflictAvoidance of conflict

Odd eating habitsOdd eating habits Emphasis on appearanceEmphasis on appearance

Page 22: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Bulimia NervosaBulimia Nervosa

Page 23: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

BulimiaBulimia

Means to have an insatiable Means to have an insatiable appetitiveappetitive

Begins in adolescentsBegins in adolescents Primarily in womenPrimarily in women 4% of young adults4% of young adults Symptom overlap with Anorexia, Symptom overlap with Anorexia,

making diagnosis difficultmaking diagnosis difficult

Page 24: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Bulimia CharacteristicsBulimia Characteristics

Hide their eating-disordered behaviorsHide their eating-disordered behaviors Lack of weight lossLack of weight loss Coexisting mental disorders:Coexisting mental disorders:

Major DepressionMajor Depression Personality disordersPersonality disorders Post traumatic Stress DisorderPost traumatic Stress Disorder

Purging develops as a way to compensate Purging develops as a way to compensate for massive amounts of food eatenfor massive amounts of food eaten

Restrictive eating….then purging….cycleRestrictive eating….then purging….cycle

Page 25: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Binge EpisodeBinge EpisodeMassive Amounts of FoodMassive Amounts of Food

Page 26: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Binge EatingBinge Eating

Feelings of lack of controlFeelings of lack of control Often done in secretOften done in secret High calorie-High carbohydrateHigh calorie-High carbohydrate Consumed in less than 2 hoursConsumed in less than 2 hours Addicted to the high experienced when Addicted to the high experienced when

eatingeating

Page 27: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Purging = Compensatory Purging = Compensatory Behavior for Binge EatingBehavior for Binge Eating

May use manual stimulation, May use manual stimulation, laxatives, and/or emetics laxatives, and/or emetics

Over time, self-induced vomiting Over time, self-induced vomiting occurs with minimal stimulationoccurs with minimal stimulation

Post-purging: sense of relief, calm Post-purging: sense of relief, calm

Page 29: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating
Page 30: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

DifferencesDifferences in Bulimia from in Bulimia from AnorexiaAnorexia

Lowered serotonin activityLowered serotonin activity Binge eating raises levels of Binge eating raises levels of

serotoninserotonin Treatment with SSRI, particularly Treatment with SSRI, particularly

fluoxetine (Prozac)fluoxetine (Prozac) Depression; shame; hide their eatingDepression; shame; hide their eating

Page 31: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Bulima: Associated Family Bulima: Associated Family CharacteristicsCharacteristics

Mood disordersMood disorders Substance abuseSubstance abuse ConflictConflict DisorganizedDisorganized Lacking nurturanceLacking nurturance

Food is a symbolic form of nurturingFood is a symbolic form of nurturing Evidence Bulimia is a response to chaosEvidence Bulimia is a response to chaos

Page 32: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Management of Eating Management of Eating DisordersDisorders

AnorexiaAnorexia Increase weight to Increase weight to

90% of average 90% of average body weight body weight

Increase self-Increase self-esteemesteem

Decrease need for Decrease need for perfection (provided perfection (provided by thinness)by thinness)

BulimiaBulimia Stabilize weight Stabilize weight

without purgingwithout purging

Page 33: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Management of Eating Management of Eating DisordersDisorders

Both Anorexia and Bulimia:Both Anorexia and Bulimia: Inpatient treatment for medical Inpatient treatment for medical

stabilization and dietary managementstabilization and dietary management Long-term outpatient tx. addresses Long-term outpatient tx. addresses

psychosocial issuespsychosocial issues

Page 34: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Management: Starvation Management: Starvation Phase of AnorexiaPhase of Anorexia

Assess labs:Assess labs: Monitor intake/output Monitor intake/output Assess for cardiovascular, neurological Assess for cardiovascular, neurological

and complicationsand complications Refeed slowly; careful dietary Refeed slowly; careful dietary

supervisionsupervision Intravenous lines and feeding tubes if Intravenous lines and feeding tubes if

client refuses foodclient refuses food

Page 35: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Nurse Patient RelationshipNurse Patient Relationship

Anorexia NervosaAnorexia Nervosa Usually forced into Usually forced into

tx.tx. Tx means loss of Tx means loss of

control over eatingcontrol over eating Nurse is the enemyNurse is the enemy

Bulimia NervosaBulimia Nervosa More likely to want More likely to want

help: break the cyclehelp: break the cycle More likely to enter More likely to enter

treatment of their on treatment of their on volitionvolition

Tendency to Tendency to manipulatemanipulate

Hide the degree of Hide the degree of the problemthe problem

Page 36: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Critical ThinkingCritical Thinking: Nursing : Nursing InterventionsInterventions

Give rationales for each of the Give rationales for each of the following interventions listed on next following interventions listed on next

slide slide

Page 37: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Nurse Patient Relationship: Nurse Patient Relationship: Some Some Interventions for Eating Interventions for Eating

DisordersDisorders Do not confront Do not confront

denial, but encourage denial, but encourage feelings identificationfeelings identification

HonestyHonesty CollaborateCollaborate TEACHTEACH patient about patient about

their disordertheir disorder Assist to identify Assist to identify

positive qualitiespositive qualities Eat with the clientEat with the client

Set appropriate limitsSet appropriate limits Encourage decision Encourage decision

making concerning making concerning issues other than foodissues other than food

Behavior modification:Behavior modification: Patient inputPatient input Reward for weight Reward for weight

gaingain

Page 38: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

PsychopharmacologyPsychopharmacology

Anxiolytics when re-feeding is Anxiolytics when re-feeding is occurringoccurring

SSRI for BulimiaSSRI for Bulimia Equally effective for depressed and non-Equally effective for depressed and non-

depressed patientsdepressed patients Psychotherapy for AnorexiaPsychotherapy for Anorexia

Use antidepressant for co-morbid severe Use antidepressant for co-morbid severe depressiondepression

Page 39: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Milieu ManagementMilieu Management

OrientationOrientation Warm nurturing environmentWarm nurturing environment

Convey an understanding of their fearsConvey an understanding of their fears Close observationClose observation

Do we let these patient go to the rest room alone?Do we let these patient go to the rest room alone?

Should we let them go to their room right after a Should we let them go to their room right after a meal?meal?

Nonjudgmental confrontationNonjudgmental confrontation CONSISTENCYCONSISTENCY

Encourage the patient to talk to staff when Encourage the patient to talk to staff when they feel the need to purgethey feel the need to purge

Page 40: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Milieu Management, cont’dMilieu Management, cont’d

WeighingWeighing Family TherapyFamily Therapy Group TherapyGroup Therapy

Which groups would be best for clients Which groups would be best for clients with eating disorders?with eating disorders?

DietitianDietitian Follow-up Therapy (outpatient)Follow-up Therapy (outpatient)

Page 41: EATING DISORDERS RNSG 2213. Topics Covered: Covered: Anorexia Nervosa Anorexia Nervosa Bulimia Nervosa Bulimia Nervosa Not Covered: Not Covered: Overeating

Scenarios: CommunicationScenarios: Communication

1) Two clients on the eating disorders unit 1) Two clients on the eating disorders unit are overheard discussing recipes and meal are overheard discussing recipes and meal plans in the day room. How should the plans in the day room. How should the nurse respond?nurse respond?

2) An inpatient with Anorexia Nervosa 2) An inpatient with Anorexia Nervosa complains of feeling very full after eating complains of feeling very full after eating and says she is being given too much to and says she is being given too much to eat. How should the nurse respond?eat. How should the nurse respond?