MealMGMTatDiffLOCs - Meal Management Through the Spectrum...

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Meal Management Through the Spectrum of Care in the Treatment of Eating Disorders Nancy Pancoast, RD Alta Bates Summit Medical Center -Herrick Campus, Center for Anorexia and Bulimia Berkeley, California April 14, 2010
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Objectives Review the Spectrum of Care Discuss Degree of Illness for Each Level of Care Discuss Nutrition Goals Discuss Continuum of Meal Management Guiding Principles
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SPECTRUM OF CARE -Overview Medical Hospital Acute Inpatient Psychiatric Hospital Residential Treatment Partial Psychiatric Hospital Program (Day Treatment) Intensive Outpatient Program Outpatient Therapy
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Medical Hospitalization Very high risk for Refeeding syndrome BMI <13.9 Requires 24-hr monitoring May need IV fluids or electrolyte replacement May require tube feeding (TF) BMI <12.0 with poor compliance to p.o. feeds Expect GI motility problems Goal = Transfer to Psychiatric Inpatient Level of Care when Medically Stable
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Acute Psychiatric Inpatient Hospital Medically Fragile - low HR and/or BP, requiring close monitoring for electrolyte imbalances May require IF fluids or TFs Body Weight <85% - Or acute Wt loss with food refusal regardless of current Wt Needs constant supervision: To consume all prescribed food To refrain from compulsive behaviors = purging, laxative abuse, excessive exercise Constant intrusive thoughts : Will only cooperate with treatment in highly structured setting Suicidality with a plan Motivation for Recovery = Poor to very poor
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Residential Treatment Medically stable - Does not need daily monitoring of labs, IV fluids or TFs Low Wt Status - Usually <85% of Healthy Wt Persistent Intrusive Thoughts : Preoccupied 4-5 hours/day Requires supervision of all food intake or would restrict eating Able to employ CBT techniques to avoid (minimize) compulsive behaviors Inadequate support system for lower level of care Motivation for Recovery = Poor to Fair
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Partial Psychiatric Hospital Program - “Day Treatment” Medically stable Weight generally > 80% of healthy range Preoccupied with intrusive thoughts >3 hours/day Requires some structure to comply with meals and
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This note was uploaded on 09/08/2010 for the course NUFS 124 at San Jose State University .

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MealMGMTatDiffLOCs - Meal Management Through the Spectrum...

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