Childhood/ adolescents- eating disorders CH.18

Compare and contrast the signs and symptoms of eating and feeding disorders.

( 6)

What is Anorexia nervosa

uIntense fear of gaining weight

uExperience significant differences in:

usensation of taste

uappetite

usatiety

uThese unique, unpleasant sensations help to perpetuate the disorder, leading to restriction and sometimes purging

uRestricting type

uDuring the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior

uBinge-eating/purging type

uDuring the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior

What assesment do we do for anorexia

uGeneral Assessment-

uPerception of the problem

uEating habits

uHistory of dieting or purging

uMethods used to achieve weight control

uValue attached to a specific shape and weight

uInterpersonal and social functioning

uMental status & physiological parameters- fear gaining wiegjt

uSelf assessment

uAssessment Guidelines

uPatient’s perception of the problem

uVital signs, review of systems, appearance- underweight, fine hair- lanugo, low bp, if purging- electrolyte imabalances, constipation,

uScreen for suicide or self-harm behaviors

uNutritional and fluid intake

uDaily activities

Laboratory testing review- electrolytes, glucose, throid, CBC, DEXA- bone denisty, ESR,

Significat low weight, disturbanc in body image, amenorrhea, yellow skin, cold extremti, perip edema, musc weakn, cardiac abnormalities, hypokalemia, decreased in bone density, rigorous exerc plann induced vommiting

What are the nursing diagnosis for anorexia nervosa

uNursing diagnoses

uimpaired nutritional status

uimpaired cardiac output

uElectrolyte/fluid imbalance

uDisturbed body image

uIneffective Coping

uChronic low self-esteem

Powerlessness

Ex. Arrythmias, inadeq inyale, decrease blood bp, ppoor concentrationm inadeq problem solving, indecisive behav, lack eye conactm reject pos feedback about themselves

What interventions do we do for anorexia

uSuicidal ideation first- if they are in a state of crisis- admitted to a inpatient psyç facility

uPsychosocial interventions

uPharmacotherapy/medical intervention- weight resortation program-

uPsychotherapy- eating disorder unit- plan meal times and adherence to selected menu. close monitoring to rr and for exercise.

uNutrition-90% of ideal body weight

uHealth teaching and health promotion- need to learn how to create meal plans, shop at grocery store, healthy coping, problem solving skills

uSafety and teamwork- work w dietecians

close moniotring- increase movment and exercise

What treatments do we do for anorexia

uBiological Treatments-

uPharmacotherapy- no specific drug but we can give psychotropic meds ( selective seretonin reuptake inhib, antianixety, antipyschotics, modd stabl)

uIntegrative Medicine- Yoga, massage, acupuncture, bright light therapy

uPsychological Therapies

uInsight-oriented individual therapy- patients learn more about themselves

uAdolescent-focused therapy (AFT)- self monitoring of eating and weight gain that is supported by therapeutic relationships with a nurse

uFamily therapy (F-BT)- more effective individ therapy- helps parents help their kids prevent starvation and ways to have a better aprroach to weight

Cognitive-behavioral therapy (CBT)- idenitfy autmoatic thoughts and to challnege them

What do we do for anorexia nervosa

uOutcomes identification- the most imporant outcome= maintaining a safe weight

uImproved nutritional intake, cardiac output, electrolyte balance, and fluid balance

uPositive body image: Congruence between body reality

uEffective coping & positive self-esteem

uPlanning

Refeeding syndrome- happens in severely malnourished pts- = abnormalities of fluid balance and glucose metabolism, hypo- electrolytes

How do we assess bulimia nervosa

uPatient’s perception

uVital signs, systems review & appearance- do not appear to be physically ill, look like body weight - normal to lighly low weight, gastric dilatoion, muscle weak, low electrolytes, cardio abnom, seizures, but they may have enlarged parotid glands dt vommiting, dental problems, calluses, esophagus, dental caries, perip edema, muscle weakening, electrolute imabalcnes, cardiovasc abnorm can lead to death, cardiac failure, seizures

uPsychosocial history- low self esteem, deppre, anxiety, impulsive disorders,

uNutritional & fluid intake

uDaily activities

uLaboratory testing review- same

enagage in repeated episodes of bing eating- 1,500-5,000 calories 2 hrs and then they purge

obsseded w food, feeling of shame and guilt, excessive seeking of reassurance, reports feeling alone

What implementation do we do for bulimia nervosa

uInpatient care

uInterrupt destructive cycles

uNormalize eating habits

uTherapy for underlying causes

uTreatment of comorbidities- ex. Evaluate do they have depression, subatcne use

uCounseling- comapres to anorexia- they want help- see it as a problem

uHealth teaching and health promotion- meal planning, mainatining a healthy diet, daily movement. The impact of cognitive disortions and development of coping skills

uTeamwork and safety- observation of meals, pts will expereince irratibility, acitvation or depression as they are now confroting their emotions for the first time.

uAdvanced practice interventions

uPsychotherapy-

What treatment do we do for bulimia nervosa

uBiological Treatment: Pharmacotherapy

uAntidepressants: Fluoxetine (Prozac) an SSRI antidepressant.

uOther antidepressants- serta;ine zoloft, paxil, celexa

uAdvanced Practice Interventions

uCognitive-behavioral therapy (CBT)- restucture faulty perceptions and helping individuals develop accepting attitudes toward themselves and their body.

uMixed-method approach for refractory cases

uOthers:  dialectical behavioral therapy (DBT), interpersonal therapy (IPT), and acceptance and commitment therapy (ACT)

What is binge eating

u

Have episodes where they eat beyond the point of satiety and causes distress afterwards, may start off normal weight but then might end up obsese

DSM-5 Criteria

uRecurrent episodes of binge eating

uEating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than wha]t most people would eat in a similar period of time under similar circumstances.

uA sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

uMarked distress over binge eating

uOccurs at least 1X/week for 3 months & is not associated with other disorders

uEpisodes are associated with three (or more) of the following:

uEating much more rapidly than normal.

uEating until feeling uncomfortably full.

uEating large amounts of food when not feeling physically hungry.

uEating alone because of feeling embarrassed by how much one is eating.

uFeeling disgusted with oneself, depressed, or very guilty afterward.

What are the s/s of binge eating

• seden lifestyle, eats as coping mechanis,m, emaressment due to weight gain, body dissatisfcationk increased blood pressure and pulse, hide eating behabiors, feel alone

How do we assess bing eating

uPatient’s perception

uVital signs, systems review & appearance

uPsychosocial history

uNutritional pattern

uHistory of weight cycling ex. gains and losses

uHistory of binge-eating triggers, foods, and frequency

Diagnosis binge eating

Imapired high nutritionsal intake, impaired body image, coping, anxiety, low self esteem, risk for pwerlessness, risk for socual isolation.

What planning do we do for binge eating

uPlanning: Balanced intake- frequency and volume & healthy movement physical acvitiyty as a slow pace

uImplementation

uAvoid judgmental language: binge eating is not about food, but about coping with emotion

uHelp patient track what events triggered an episode

uHelp patient explore community activities or groups

uUse incremental approach in goal setting- Ex. Try one new activity such as lunch w a friend or particiapting in a yoga class 1x week

uHealth teaching and health promotion- feel socaial isolation- geeting them in groups

uEvaluation

Episodes of abonrmal eating can cause GI abnormalities- dysphagia, heart nirm, abdominal pain

What treatment do we do for binge eating

˜Biological: Pharmacotherapy

uSSRIs- use high dosages

uWeight tends to return after treatment- work short term but then they gain weifht after

uSNRIs- w depression disorder too

uLisdexamfetamine

uLowered relapse risk in binge eating

uSurgical Interventions- bariatric surgery- but then as stomach expands after surgery behaviors may resune, should be accompanied w conusling.

uBariatric surgery

uPsychological Therapies-

uCognitive-behavioral therapy

uDialectical behavior therapy

uInterpersonal therapy

What is pica

uEating nonfood items well past toddlerhood

uNot part of other menatl illness

behaviovarl interventions such as rewarding approriate eating.

What is rumination

uRegurgitation with rechewing, re-swallowing, or spitting

uNo medical or mental reason

not part of other illness or eatung siorder\

What is avoidant/ restrictive food intake

uStarts in childhood

uNote:  40% of “picky” eaters resolve on their own

uLow BMI

No distorted body image

dependent of enteral feeding or expericne nutritonal deficenices

No other mental illness

form of behavoiral modifica tion to increase regular food consumption.

Apply the nursing process to patients with eating and feeding
disorders. (3)

Identify pharmacologic interventions for patients with eating
and feeding disorders (2)

Evaluate adherence to treatment plan (3)

Discuss education on eating disorders (2)