Eating Disorders PPT

what is the clinical context of eating?

is goes beyond physical nutrition

what are the rates of anorexia?

they’re increasing

what can severe electrolyte imbalances cause?

cardiac arrythmias (can be fatal)

what are the lengths of eating disorder txs?

generally long-term (months to years)`

what’s the specific nursing care for eating disorders?

weigh daily, same scale, same time, same clothing, right after voiding in the morning

what should nurses do with regards to meal times?

stay with clients immediately after meals to prevent purging

what can rapid weight gain lead to?

refeeding syndrome

refeeding syndrome is associated w rapid weight gain, what is this?

the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally)

your pt presents w the following:

•Gross distortion of body image

•Preoccupation with food

•Refusal to eat

•Underweight/emaciated

  -BMI: <17

  -(Extreme <15)

•Hypothermia

•Bradycardia

•Hypotension

•Lanugo

•Amenorrhea

what’s going on?

anorexia nervosa

what are the different influences on eating disorders?

a social activity influenced by:

• Lack of access to food /food insecurity

  • Society and Culture - celebrations

  • Social Media-intake vs. How one should look

what are the characteristics/trends of anorexia nervosa?

•Increasing prevalence in U.S. and Western Europe

•Females 12-30 y.o.

•Approx. 2.4% of population in the U.S.

•Around 25% of cases are males

•Link to depression

•Hobbies/sports may increase problem – especially in weight limiting ones like ballet, gymnastics, horseback riding, wrestling, track, etc

your pt presents w the following:

•Weight fluctuations (within a normal weight range)

• Dehydration and electrolyte imbalance

•Erosion of tooth enamel

•Tears in gastric/esophageal mucosa

•Possibility of Russell’s Sign (calluses on the knuckles from inducing vomiting)

what’s going on?

bulimia nervosa

your pt presents w the following:

•Weight Gain

•Severe Obesity

what’s going on?

binge eating disorder (BED

what are the s/sx of anorexia nervosa?

•Gross distortion of body image

•Preoccupation with food

•Refusal to eat

•Underweight/emaciated

  -BMI: <17

  -(Extreme <15)

•Hypothermia

•Bradycardia

•Hypotension

•Lanugo

•Amenorrhea

what are the characteristics/trends of bulimia nervosa?

•Late Up to 2% of young women

•adolescence or early adulthood

•~20% women experience transient bulimic symptoms during college

•Especially related to value on thinness

•Mood disorders common, anxiety and substance abuse

•About 50% have history of anorexia

what are the s/sx of bulimia nervosa?

•Weight fluctuations (within a normal weight range)

• Dehydration and electrolyte imbalance

•Erosion of tooth enamel

•Tears in gastric/esophageal mucosa

•Possibility of Russell’s Sign (calluses on the knuckles from inducing vomiting)

what are the characteristics/trends of binge eating disorder (BED)?

•4% of U.S. population (most common)

•2:1 women to men

•About 50% have history of depression

•50-75% seeking care for obesity have BED

•Interpersonal stressors, low self-esteem, and boredom are possible triggers

what are the s/sx of binge eating disorder (BED)?

•Weight Gain

•Severe Obesity

what are the biological influences that predispose people to eating disorders?

•Genetics – history of anorexia in family produces 11 times the risk for other family members

•Neuroendocrine Abnormalities - may be associated with serotonin and norepinephrine and may have positive response to SSRIs

•Neurochemical Influences – delayed gastric emptying, etc

what are the psychodynamic influences that predispose people to eating disorders?

•Unfulfilled sense of separation-individuation and lack of control – food can be controlled

what are the family influences that predispose people to eating disorders?

•Previously thought that parents influenced development of eating disorder

•Do see perfectionism and depression as related to eating disorders

what are the possible problems (and thus things you hope to resolve) in the event of eating disorders?

• Imbalanced nutrition: less than body requirements

• Deficient fluid volume

• Denial

• Obesity

• Disturbed body image/Low self-esteem

• Anxiety (moderate to severe)

what are the goals in the event of Imbalanced nutrition: less than body requirements?

•Achieve/maintain expected BMI (gain 2-3 pounds per week)

•Maintain normal vital signs (especially BP), and lab serum studies WDL

•Verbalizes importance of adequate nutrition 

what are the goals in the event of deficient fluid volume?

•Verbalizes knowledge regarding consequences of fluid loss via self-induced vomiting/laxative/diuretic abuse

•Verbalizes importance of adequate fluid intake

what are the goals in the event of denial for an eating disorder?

•Verbalizes ways to gain more control of environment and thereby reduce feelings of powerlessness

•Demonstrates ability to take control of own life without resorting to maladaptive eating behaviors

what are the goals in the event of obesity for an eating disorder?

•Verbalize plan for maintenance of weight control and relapse prevention

•Established health pattern of eating for weight control

•Weight loss toward a desired goal is progressing

what are the goals in the event of disturbed body image/low self-esteem for an eating disorder?

•Express less preoccupation with own appearance

what are the goals in the event of anxiety (moderate to severe) for an eating disorder?

•Verbalizes events that precipitate anxiety and demonstrates reduction techniques

what are the nursing interventions for anorexia & bulimia?

•Determine needed nutritional requirements 

•Explain behavior modification plan 

•Daily weights and I&O

•Assess skin turgor and mucous membranes 

•Stay with client during and 1-2 hrs after meals 

•Develop trusting relationship – give positive regard

•Encourage client to verbalize feelings and unresolved issues 

•Assist with NG tube feedings

•Escort to restroom during and after meal

•Help understand negative consequences to eating behaviors 

•Convey knowledge that perfection is unrealistic 

•Give positive feedback 

•Help client develop realistic perception of body image

•Allow client independent decision-making 

•Help client accept self 

what are the nursing interventions for BED & obesity?

•Encourage client to keep food diary

•Discuss feelings associated with eating

•Establish healthy, low-calorie food plan

•Set realistic weight-loss goals

•Plan exercise program

•Discuss possibility of plateaus

•Instruct about medication

•Assess attitudes and feelings about weight

•Explore past eating behaviors

•Assess source and level of motivation

•Focus on strengths and past accomplishments unrelated to physical appearance

•Refer to support/therapy group

what are the patient and family education you should provide in the event of eating disorders?

•Engage the family in the plan

•Encourage the client to discuss emotions

•Promote feelings of control

•Nature of the Illness (symptoms, causes, effects of condition)

•Management of the Illness (alternative coping, medications, relaxation, problem-solving)

•Support Services 

•Weight Watchers :

—Overeaters Anonymous 

—National Association of Anorexia Nervosa and Associated Disorders (ANAD)

—National Eating Disorders Association 

what are the broad treatment modalities for eating disorders?

• Immediate aim is to restore nutritional status 

• Outpatient basis, if possible, may require hospitalization 

• Psychopharmacology – SSRIs (especially Prozac/fluoxetine), used in combination with therapy

• •Behavior Modification ​

• •Individual Therapy ​

• •Family Treatment (Maudsley Approach – evidence based) ​

what is “behavior modification” as a tx modality for eating disorders?

• Perceived control of treatment​

• Confront irrational thinking patterns/feelings​

• In conjunction with cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) ​

what is “individual therapy” as a tx modality for eating disorders?

Explore unresolved conflicts ​

what is “Family Treatment (Maudsley Approach – evidence based) ​” as a tx modality for eating disorders?

• 3 phases (weight restoration directed by parents, then directed by client, then at 95% of ideal weight shifts to healthy self-identity)​

• 90% of clients showed improvement in early controlled studies​

what are some reasons for hospitalization for eating disorders?

•Malnutrition – less than 80% of expected weight for hospitalization; less than 70% of expected weight needs long-term intensive treatment

•Severe dehydration shown by electrolytes or physical symptoms

•Severe electrolyte imbalances

•Cardiac arrythmias

•Severe bradycardia (less than 50 HR)

•Hypothermia (less than 96.8)

•Hypotension (change or orthostatic hypotension)

•Suicidal ideation 

what are the evaluations and nursing care goals for anorexia and bulimia?

•Steadily gaining weight to at least 80% of expected body weight for age/size (limit of about 2 pounds a week to prevent refeeding syndrome)  Actual weight is the most objective measure.

•Free of s/s malnutrition and dehydration 

•Client consumes adequate calories as determined by dietitian 

•reduced attempts to stash food and discard later 

•Reduced attempts to self-induce vomiting

•Client admits problem and that eating habits are maladaptive 

•Discontinued behaviors to manipulate environment 

•Willing to discuss underlying issues 

•Understand relationship between maladaptive behaviors and sense of control 

•Acknowledged perception of body image as “fat” is incorrect 

what are the evaluations and nursing care goals for BED & obesity

•Client showing steady weight loss since starting new eating plan 

•Verbalize relapse prevention plan to avoid triggers and abstain from binging

•Verbalize positive self-attributes not associated with body size or appearance

•Develop more realistic perception of body image

•Client acknowledged that past self-expectations may be unrealistic

•Accept self as less than perfect

•Developed adaptive coping strategies to deal with stress without resorting to maladaptive eating behaviors

What is the most objective measure of client progress?​

Daily weight on a scale – taken in a consistent manner

A 15-year-old client who repeatedly refuses to eat or drink may be tube fed with parental permission...

TRUE OR FALSE

TRUE.  The parent or guardian may give permission for this.  Generally used when client is less than 80% of goal weight