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Eating Disorders ejn

Eating Disorders ejn - N311 Mental Health Nursing N311...

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Unformatted text preview: N311: Mental Health Nursing N311: Mental Health Nursing Eating Disorders Evelyn J. Norton RN, DNP, CNL, NEA­BC Learning Objectives Learning Objectives • Identify factors important in the assessment of eating disorders • Define anorexia nervosa, bulimia nervosa, binge eating disorder and obesity Learning Objectives Learning Objectives • Distinguish anorexia nervosa restricting type from anorexia nervosa binge eating/purging type • Distinguish anorexia nervosa binge/purging type from bulimia nervosa • Delineate treatment modalities of the different types of eating disorders Eating Disorders Eating Disorders • Anorexia nervosa (binge eating/purging & restricting types) • Bulimia nervosa (purging and nonpurging types) • Eating Disorder NOS • Obesity (non­DSM­IV classified) Anorexia Nervosa Anorexia Nervosa • It is the extreme pursuit of a thin body accompanied by a profoundly disturbed body image • Clients have a morbid fear of gaining weight and losing control of the amount of food that they consume • Clients view themselves as fat, even if emaciated (disturbed body image) Types of Anorexia Nervosa Types of Anorexia Nervosa • Binge eating/purging type – Client perceives self as out of control – Cannot resist the temptation to eat certain foods and/or quantities – Cannot stop eating until food is no longer available or physical distress is so uncomfortable – Self­induced vomiting & laxative/diuretic abuse Types of Anorexia Nervosa Types of Anorexia Nervosa • Restricting type – Clients curtail their intake – Do not binge or purge Anorexia Nervosa Anorexia Nervosa • Occurs 10 to 20X more often in women with mid­adolescence onset • Strong genetic component • Mortality rates of 5­18% • Societal pressures to be “thin” Anorexia Nervosa Anorexia Nervosa • http://www.youtube.com/watch? v=YNlnl7pQFuI • http://www.youtube.com/watch? v=uKUSGOB­0V8 Anorexia Nervosa Anorexia Nervosa • Fear of normal developmental tasks and sexuality • Possible dysfunction of the hypothalamus and/or neurotransmitters • Can lead to metabolic collapse/starvation Bulimia Nervosa Bulimia Nervosa • Persons with bulimia experience recurrent, rapid episodes of eating large amounts of food while feeling out of control • Binging terminates with severe abdominal pain and/or nausea Bulimia Nervosa Bulimia Nervosa • Experience extreme guilt, self­disgust and depression • Utilize compensatory behaviors (fasting & excessive exercise) Types of Bulimia Nervosa Types of Bulimia Nervosa • Purging type – Self­induced vomiting – Laxative and diuretic abuse – Compensatory behaviors • Nonpurging type – No purging – Relies on compensatory behaviors to control weight Physical Characteristics Physical Characteristics • Anorexia and Bulimia – Skin and hair (cachexia, lanugo) – Malaise – Gastric symptoms – Abnormal blood chemistries – Cardiac conditions – Diarrhea & hypokalemia – Menstrual changes Bulimia Nervosa Bulimia Nervosa • Approx. 1 to 3% of persons in US, mostly • • • • • women Onset occurs in adolescence Can be of normal weight or obese Societal pressures to be “thin” Possible etiology involves the neurotransmitters (serotonin & norepinephrine) Tend to be high achievers Binge Eating Disorder Binge Eating Disorder • Previously classified as compulsive overeaters or obese bingers • Do not engage in purging or laxative/diuretic abuse • May experience frequent weight cycling as they gain weight and diet to lose the weight Medical Concerns Medical Concerns • Eating disorders create havoc with one’s physiological status • The more extreme the dieting, purging, vomiting, and abuse of laxatives/diuretics, the more physically­ill a person can become • Hospitalization may be a “life­saving” occurrence Criteria for hospital admission of Criteria for hospital admission of clients with eating disorders • Physical Criteria – – – – – – – – Greater than 30% wt loss over 6 months Rapid decline in weight Inability to gain weight with out pt Rx Temp less than 36 C or 96.8 F Heart rate less that 40 BPM Systolic B/P less than 70 mm Hg K less than 3.0 mEq/L EKG Changes / arrhythmias Criteria for hospital admission of Criteria for hospital admission of clients with eating disorders • Psychological Criteria – Suicidal or self­mutilating behavior – Out of control use of laxatives, emetics, diuretics or street drugs – Failure to comply with Rx contract – Severe depression – Psychosis – Family Crisis or dysfunction Medical Complications of Medical Complications of Anorexia Nervosa • • • • • • • • • Bradycardia Orthostatic B/P and Pulse changes Cardiac murmur – 1/3 MVP Sudden cardiac arrest due to electrolyte disturbances Prolonged QT interval on ECG Acrocyanosis Leukopenia Lymphocytosis Carotenemia – yellow pallor due to elevated serum carotene Medical Complications of Medical Complications of Anorexia Nervosa • • • • • • • • • Hypokalemic alkalosis Severe fatigue & weakness from electrolyte imbalances Osteoporosis Fatty degeneration of the liver (elevated serum enzymes) Elevated cholesterol levels Amenorrhea Abnormal thyroid function Hematuria Proteinurea Care Plan – Patient Outcomes Care Plan – Patient Outcomes • Improved self­esteem/body image • • • • Will gain sufficient weight Will demonstrate less denial Will report feeling hungry Will commit to long term remission/rehabilitation/ recovery Care Plan ­ Nursing Interventions Care Plan ­ Nursing Interventions • Develop a trusting relationship • Involve pt in decision making to allow for pt • • • • • • control Provide a safe environment Treat malnutrition and medical problems Record I & O Observe for vomiting after meals Goal of no more than 2 lb wt gain/week Refer for after­care treatment Care Plan ­ Evaluation Care Plan ­ Evaluation • Able to talk about body image and exhibits • • • • • gradual increase in self esteem Gradual wt gain Reports being hungry and eats with others at mealtimes Health status is stabilized Begins to accept illness Commits to continuation of treatment post hospitalization Medical Complications of Bulimia Nervosa Medical Complications of Bulimia Nervosa • Cardiomyopathy from ipecac intoxication • • • • • (usually results in death) Cardiac arrhythmias, bradycardia, sudden cardiac arrest Orthostatic pulse and B/P changes Electrolyte imbalances Hypokalemia, hypochloremia Attrition and erosion of teeth resulting in exposed pulp Medical Complications of Medical Complications of Bulimia Nervosa • • • Loss of dental arch Diminished chewing ability Parotid gland enlargement from elevated serum amylase • Esophageal tears • Severe abdominal pain from distention • Russell’s sign – callus on knuckles from self induced vomiting Obesity Obesity • Although not considered in the DSM­IV­TR as • • an eating disorder, obesity is considered a major health problem in the United States Over 60 million adults (ages 20 years and older) in the United States are considered obese, 30% of the population Over 9 million children and teens ages 6­19 are considered overweight, 16% of the population Manuel Uribe has gone from 1,230 to 730 lbs by eating right and exercising Body Mass Index (BMI) Body Mass Index (BMI) • The body mass index is used to determine weight classification. • Adults with a body mass index (BMI) between 25 and 29.9 are considered overweight and those with a BMI of 30 or greater are considered obese Body Mass Index (BMI) Body Mass Index (BMI) • In children and teens BMI is age and sex specific and referred to as BMI­for­age; it is calculated based on percentiles for size and growth patterns Factors Factors • Nutrition and physical activity determine one’s weight status. • An energy imbalance between how many calories are consumed and the amount of exercise performed results in obesity. • An individual’s personal characteristics, culture, finances and environment are all contributing factors. Factors Factors • Genetics is a contributing factor as to how one’s body burns calories to use for energy and how fat is stored. • Considerable research is being conducted regarding the relationship between hereditary and weight • 25% of individuals with obesity are depressed Treatment Treatment • Treatment may consist of: – dieting – increased physical activity – behavior modification – antidepressant medication – in cases of morbid obesity (BMI greater than 40) surgical interventions ...
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