use other things like shoes, planter or anything else they can vomit in) Relieve constipation o Stool softeners o NO LAXATIVES Caloric intake o Start with 1500 and progress to 2500 + calories – Depends on desired weight o 6 equal feeding a day o ^ protein to build muscle o ^ fat/calories hyper alimentation solution (highly emaciated) o Feeding can be oral, NG, GT Refeeding syndrome/Occurs from rapid weight gain o Cardiac collapse (fluids/muscle) o SOB, Pulmonary edema, CHF, raspy voice Secondary Interventions – Psychological & Emotional Self-Awareness o How you feel and respond if reject care Recognize signs of disorder Behavioral contract o Outline expectation
Correcting behavior of not eating (not why) Weight gain amount How to gain Her role in the plan of care o Promote collaboration o Avoid power struggle with kids and adults Behavior modification o Tokens/privileges = reinforcement of adaptive behaviors o Eat meals = adaptive behavior (Operant conditioning) Assess for illusion of weight gain o Pocket heavy items, drink fluids prior to weight check Monitor activity o Pacing, bathroom, jumping jacks (don’t want excessive activity to lose weight) Realistic expectations o Self, others, parents, fears, open dialogue o Discuss impact of behavior, idea of perfection, impact of her unrealistic views Observe meals o Hoard, toss Relaxation o Decrease anxiety, alternate adaptive response o Teach relaxation exercises / promote hobbies Self-assertion o Role play – Increase autonomy, Increase empowerment Explore family dynamics o Communication, conflicts (who makes the rules, how are they enforced, what’s the punishment structure – Include family meeting as part of their care) Peer group support o Safe, supportive, share thoughts, feelings, perception – Like kind individuals Health teaching o Exercise – Weight bearing (add strength) o Nutrition importance (on body processes -cardiac, renal, GI) o Effects of starvation (impair physical development and emotional development) Evaluation Objective weight gain for size and height Long-term stabilization in appropriate weight Physiologic homeostasis (^perfusion, labs, hydration, electrolytes, BP, HR, ^muscle mass) Untoward outcome of self-imposed starvation – Death Bulimia Nervosa Definition: Episodic, uncontrolled and compulsive rapid ingestion of large quantities of food (carbs) over a short period of time (binge) Can be chronic Physical discomfort and emotional discomfort
o Guilt, self-disgust, depression Self-induced vomiting or use of laxative (purge) o This is a response to physical and emotional discomfort o Purge = Rid of food o Non-purge = laxative Etiology Secretly done Associated with depression o Follows depressed mood episode– usually how its revealed – found upon assessment Biochemical effects o Abnormal hypothalamic – pituitary – adrenal – pathways o Decreased serotonin levels (limited sense of calm, anxiety, promotes craving & low satiety level)
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- Winter '17
- Deborah Cridor