Ch18 PPT Eating Disorders
Chapter 18: Feeding, Eating, and Elimination Disorders
1. Eating Disorders
Types: Anorexia, Bulimia, Binge Eating
Anorexia:
Characterized by an intense fear of gaining weight, leading to self-imposed starvation and excessive weight loss.
Individuals often exhibit a refusal to maintain a minimally normal weight for their age and height, defining this as less than 85% of their expected body weight.
Commonly associated with a distorted body image where the individual sees themselves as overweight despite being underweight.
A significant fixation on weight, body, food, and exercise, often engaging in extreme dieting or exercise regimens.
Some individuals may also engage in binge eating followed by purging behaviors, blurring the lines with bulimia.
Bulimia:
Involves cycles of binge eating followed by compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, misuse of laxatives, or excessive exercise.
The binge eating episodes are often accompanied by a sense of lack of control over eating during the episode.
Individuals may experience feelings of guilt, shame, or distress after binge eating, which perpetuates the cycle.
They typically maintain a body weight that is normal or slightly above average, distinguishing it from anorexia.
Binge Eating:
Defined by repeated episodes of binge eating without subsequent compensatory behaviors.
Individuals with binge eating disorder often eat large quantities of food rapidly, often in response to emotional distress rather than hunger.
This disorder is accompanied by feelings of guilt or shame related to eating behaviors.
2. Anorexia Nervosa
Symptoms:
Distorted body image and an intense fear of gaining weight.
Significant food restriction is particularly prevalent among women and adolescent girls during puberty.
Comorbidity:
Anorexia nervosa is often associated with various mental health disorders including bipolar disorder, anxiety disorders, depressive disorders, PTSD, and substance abuse issues.
3. Risk Factors
Biological:
Genetic predisposition and familial tendencies towards eating disorders. glucose and lipid metabolism which can indicate differences in metabolism, following food restriction.
neurobiological
tryptophan, an amino acid essential to serotonin synthesis available only through diet.
temporary decline in diet Tryptophan may relieve symptoms of anxiety and dysphoria. which provides a reward for cal restriction.
Psychological:
Learned behaviors, such as perfectionism or associations of self-worth with weight and appearance that can reinforce eating disorder behaviors.
Environmental:
Cultural pressures related to body image and self-esteem; societal norms regarding beauty and weight can significantly influence the development of eating disorders.
more common among athletes, and gays
4. Nursing Process for Anorexia Nervosa
Assessment:
Physiological Indicators:
Look for low body weight
, amenorrhea (absence of menstruation),
lanugo (fine hair growth),
cold extremities
peripheral edema
muscle weakness ( electrolyte imbalance and starvation)
constipation
hypotension (low blood pressure)
bradycardia (slow heart rate)
impaired renal function (dehydration)
anemia caused by starvation
leukopenia (low white blood cell count),
loss of bone density.
Psychological Indicators:
Cognitive distortions related to body image,
intense fear of weight gain,
preoccupation with food and weight.
4.1 Physiological Assessment
Key signs include dangerously low body weight, peripheral edema, hypotension and bradycardia, significant loss of bone density, and other medical complications due to malnutrition.
5. Nursing Diagnoses for Anorexia Nervosa
Physiological:
Imbalanced nutrition: less than body requirements with a goal to reach at least 90% of ideal body weight
decreased cardiac output
risk for injury
risk for fluid volume deficit.
Psychological:
Disturbed body image, chronic low self-esteem, and ineffective coping strategies.
6. Physiological Needs and Hospitalization
Hospitalization is typically required when an individual's weight falls below 75% of the ideal body weight.
they exhibit severe physiological complications such as significant electrolyte imbalances,
daytime heart rates under 50 bpm, systemic blood pressure below 90 mmHg,
temperatures under 96°F, or arrhythmias.
Focus during hospitalization is on medical stabilization and monitoring for refeeding syndrome with a slow and careful reintroduction of nutrients.
may result in abnormalities of fluid balance and glucose metabolism as well as hypophosphatemia, hypomagnesemia and hypokalemia
7. Interventions for Anorexia Nervosa
Acute Care:
Psychosocial interventions aimed at improving self-esteem, managing eating behaviors and anxiety, and fostering control.
Avoid discussions surrounding personal appearance to reduce pressure on the patient.
Establish a structured environment with precise meal times, unit-selected menus, and close observation during and after meals.
Routine weighing to monitor progress and ensure safety.
Pharmacological interventions are limited to treating comorbid conditions.
Psychotherapy Options:
Options include individual, group, and family therapy, emphasizing non-blaming approaches, setting healthy relationship boundaries, and promoting the patient’s internal locus of control while addressing cognitive distortions.
8. Bulimia Nervosa
Nursing Process:
Physiological Assessment: May show dental erosion/decay, normal or slightly low weight, parotid gland swelling, gastric dilation, peripheral edema, muscle weakness, hypokalemia (low potassium levels), and cardiac dysrhythmias.
Psychological Assessment: Focuses on binge eating episodes, purging behaviors, history of anorexia, and coexisting issues such as depression, social anxiety, and poor self-concept.
Treatment:
Common pharmacological treatment includes antidepressants like SSRIs ( fluoxetine, zoloft, paroxetine, citalopram) and tricyclics ( tofranil).
Addressing the patient's guilt and shame regarding their eating behaviors while providing acceptance and non-judgmental care is crucial.
Nursing Diagnoses:
Include decreased cardiac output
electrolyte imbalance
disturbed body image
ineffective coping
powerlessness
chronic low self-esteem
social isolation.
Goals (Outcomes):
Prioritize supporting physiological needs, achieving congruence between body reality and perception, enhanced self-esteem, promoting healthy coping mechanisms, and decreasing anxiety.
9. Bulimia Nervosa Interventions
Encourage the development of healthy coping strategies through cognitive behavioral therapy to interrupt binging/purging cycles and normalize eating habits.
Counselling and therapeutic relationships centered on health education, meal planning, and coping skills.
advanced practise interventions
CBT to address distortions and foster acceptance of body
10. Binge Eating Disorder
Assessment:
Characterized by overeating behaviors often connected to emotional stress, typically resulting in being overweight and eating larger quantities of food.
Nursing Diagnosis:
Common diagnoses include imbalanced nutrition: more than body requirements, disturbed body image, ineffective coping, anxiety, chronic low self-esteem, powerlessness, and social isolation.
11. Goals for Treatment
Ensure that nutritional needs are met while encouraging the development of positive coping mechanisms and increasing self-esteem and confidence.
12. Binge Eating Interventions
Focus on providing psychosocial support while promoting healthy eating practices; a team-oriented approach to ensure safety in care.
Pharmacological interventions may include
SSRIs ( duloxetine, desvenlafaxine, venlafaxine)
Vyvanse ( severe, moderate binge eating)
13. Assessment Scenario
Example Case: An adolescent female exhibiting signs of anorexia.
Key Assessment Question: "When was your last menstrual period?" This question can help evaluate for potential amenorrhea, a common concern in individuals with anorexia.