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EATING DISORDERS: ANOREXIA NERVOSA/BULIMIA NERVOSA Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating followed by self-induced vomiting. It may include abuse of laxatives and diuretics. Although these disorders primarily affect women, approximately 5%–10% of those afflicted are men, and both disorders can be present in the same individual. CARE SETTING Acute care is provided through inpatient stay on medical or behavioral unit and for correction of severe nutritional deficits/electrolyte imbalances or initial psychiatric stabilization. Long-term care is provided in outpatient/day treatment program (partial hospitalization) or in the community. RELATED CONCERNS Dysrhythmias Fluid and electrolyte imbalances Metabolic alkalosis (primary base bicarbonate excess) Total nutritional support: parenteral/enteral feeding Psychosocial aspects of care Patient Assessment Database ACTIVITY/REST May report: Disturbed sleep patterns, e.g., early morning insomnia; fatigue Feeling “hyper” and/or anxious Increased activity/avid exerciser, participation in high-energy sports Employment in positions/professions that stress/require weight control (e.g., athletics such as gymnasts, swimmers, jockeys; modeling; flight attendants) May exhibit: Periods of hyperactivity, constant vigorous exercising CIRCULATION May report: Feeling cold even when room is warm May exhibit: Low blood pressure (BP) Tachycardia, bradycardia, dysrhythmias EGO INTEGRITY May report: Powerlessness/helplessness lack of control over eating (e.g., cannot stop eating/control what or how much is eaten [bulimia]); feeling disgusted with self, depressed or very guilty because of overeating Distorted (unrealistic) body image, reports self as fat regardless of weight (denial), and sees thin body as fat; persistent overconcern with body shape and weight (fears gaining weight) High self-expectations Stress factors, e.g., family move/divorce, onset of puberty Suppression of anger May exhibit: Emotional states of depression, withdrawal, anger, anxiety, pessimistic outlook ELIMINATION May report: Diarrhea/constipation Vague abdominal pain and distress, bloating Laxative/diuretic abuse FOOD/FLUID
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May report: Constant hunger or denial of hunger; normal or exaggerated appetite that rarely vanishes until late in the disorder (anorexia) Intense fear of gaining weight (females); may have prior history of being overweight (particularly males) Preoccupation with food, e.g., calorie counting, gourmet cooking An unrealistic pleasure in weight loss, while denying self pleasure in other areas Refusal to maintain body weight over minimal norm for age/height (anorexia) Recurrent episodes of binge eating; a feeling of lack of control over behavior during eating binges; a minimum average of two binge-eating episodes a week for at least 3 mo Regularly engages in self-induced vomiting (binge-purge syndrome bulimia) either
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