Eating Disorders

EATING DISORDERS

LEARNING OBJECTIVES

  • Differentiate normal eating from an eating disorder.

  • Name four types of eating disorders.

  • Describe two forms of anorexia nervosa.

  • Name the neurotransmitters, neurohormones, and other chemicals that affect the appetite and satiety center in the brain.

  • Discuss two reasons why most people with anorexia nervosa induce self-starvation.

  • Identify the tool used to evaluate a person’s size in relation to norms within the adult population.

  • Give the healthy range for body mass index (BMI).

  • List four components of treatment for clients with anorexia nervosa.

  • Discuss the nurse’s role in managing the care of a client with anorexia nervosa.

  • Give two examples of how people with bulimia nervosa compensate for binging.

  • Name two problems, besides nutrition, that are the nursing focus when caring for clients with bulimia nervosa.

  • Differentiate between binge eating disorder and compulsive overeating.

  • Discuss at least three psychosocial problems that may accompany overeating syndromes.

  • Describe nursing care for a client with binge eating disorder or compulsive overeating.

  • Name at least two types of bariatric surgery and potential complications.

KEY FEATURES OF ANOREXIA NERVOSA

  • Definition: An eating disorder characterized by food restriction leading to significantly low body weight.

  • Food Intake: Restriction often falls between 600-900 calories/day.

  • Symptoms:

    • Extended periods of self-starvation.

    • Low Body Mass Index (BMI) < 16%.

    • Amenorrhea (absence of menstruation), lanugo (fine hair on body), alopecia (hair loss).

    • Often associated with perfectionism and low self-esteem.

  • Self-Image: Individuals may believe they are obese despite being emaciated in appearance.

TREATMENT FOR ANOREXIA NERVOSA

  • Nutritional Therapy: First step in treatment.

  • Drug Therapy:

    • SSRIs (Selective Serotonin Reuptake Inhibitors).

    • Fluoxetine (Prozac).

    • Atypical antipsychotics such as Olanzapine (Zyprexa) and Aripiprazole (Abilify).

  • Psychotherapy: Counseling to address psychological components of the disorder.

  • Family Counseling: Engaging family members in treatment process.

KEY FEATURES OF BULIMIA NERVOSA

  • Definition: Characterized by binge eating followed by compensatory behaviors to prevent weight gain.

  • Behavior:

    • Binging and purging cycles, associated with shame.

    • Can involve laxative abuse and excessive exercise.

  • Physical Effects of Purging:

    • Damaged teeth enamel.

    • Fluid and electrolyte abnormalities, potentially leading to serious cardiac problems.

TREATMENT FOR BULIMIA NERVOSA

  • Drug Therapy:

    • SSRIs, particularly Fluoxetine (Prozac), are FDA approved for treatment.

  • Individual and Group Psychotherapy: Counselling methods to support recovery.

  • Behavior Modification Techniques: Strategies to change disordered eating behaviors.

CASE STUDY: KATIE LONG

  • Profile: 18-year-old college female diagnosed with bulimarexia, a type of anorexia nervosa.

  • Eating Habits:

    • Total daily calories: 500 (eats salads without dressing, fruits, and water).

    • Exercises post meal for 1 hour (walking/riding a bike).

  • Psychological Factors: Fear of becoming fat like her controlling mother; believes losing another 20lbs will suffice.

  • Height & BMI: 5'9" height, BMI of 15.

  • Symptoms:

    • Avoids tight-fitting clothes, feels cold frequently, presents with lanugo and dependent edema in feet.

    • Menstrual cycle absent (amenorrhea).

  • Incident: Passed out during a walk; requires emergency intervention.

ADMISSION TO EATING DISORDERS UNIT

  • Vital Signs:

    • Temperature: 97°F;

    • Blood Pressure: 88/50 mm Hg;

    • Heart Rate: 40 beats/minute (bradycardia);

    • Respiratory Rate: 16 breaths/minute.

  • Lab Findings:

    • Bradycardia on ECG with prominent U wave indicative of hypokalemia.

    • Abnormal levels: Hypoglycemia, hyponatremia, hypokalemia, hypocalcemia, anemia, low albumin.

INITIAL TREATMENT PLAN

  • Diet: Ordered a 1500 calorie diet with 1.2 g/kg protein for ideal body weight.

  • Supplements: Calcium, vitamin D, multivitamin with iron, stool softener, potassium to restore levels.

  • Goal: Gain 1 to 2 lbs per week; stabilize laboratory values.

  • Medications: Started Olanzapine (Zyprexa) and Fluoxetine (Prozac).

  • Therapy Initiation: Daily meetings with a psychiatrist for behavioral therapy, plan for family therapy once stabilized.

NURSE'S ROLE IN CLIENT MANAGEMENT

  • Client's Request: Inquires about living with a friend’s family if she gains weight (desire for a supportive environment).

  • Nurse's Response: Must handle the request sensitively; focus on education and the importance of a stable, supportive care setting during recovery.

  • General Role:

    • Monitor physical health and vital signs;

    • Provide emotional support;

    • Educate the patient about the disorder and coping strategies;

    • Facilitate communication with family to support involvement in treatment.