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Weight loss doesn’t relieve fear, so it continuesObsessive-compulsive personalityoThoughts obsessed surrounding food and weightoImplements ritualistic weight loss behaviorsLow self-esteemoSelf-esteem based on size, shapeoWeight loss = achievementoWeight gain = failureSelf-criticism / guiltoSelf-imposed guiltoWeight gain fail = self-criticismAnxiety/DepressionoMood disturbances – Root in emotion and diet effectsDelayed sexual developmentoDecreased pituitaryoFollicle FSHoLuteinizing LHoAmenorrheaoDecreased ovarian/estrogenoBehind peer group in sexual developmentPhysical AssessmentProfound weight losso<85% weight “skin & bones”Hypothermia
oLow temp, maybe 35’CoLittle to no body fat to regulate tempMuscle wastingoIncreased BUN, decreased protein, nitrogen, albuminDecreased bone massoThin brittle bonesoFracture & osteoporosis later in lifeDehydrationoSevere, electrolyte imbalanceoDecrease perfusion, decreased urine output > can lead to renal failure. Need 30ml per hr. filteredBradycardiaor/t dehydrationodecreased cardiac output, easily fatiguedDizzinessoOrthostatic hypotension r/t dehydrationDependent edemaoPoor vascular returnoSmall legs with large swollen anklesPoor skin turgoror/t dehydration (deficient hydration and perfusion)oTenting, >30 secondsLanugooFine hair to provide warmthoNormal on newborn child, not normal on child/adultAmenorrheaAbnormal thyroidoDecreased metabolic demandsConstipationoDecreased diet, H2O, GI shut down, ileus, absence of GI motilityNursing DiagnosisAltered body weightAltered nutritionIneffective copingAltered self-conceptPotential for self-harmTreatment GoalsRestore nutritionoRefeeding program (restore back to normal)oBased on calculated weightNormal eating patterns - maintainRealistic self-concept and body imageoWhat she sees is real/trueSeparation without anxietyoAbility to cope with stressControl obsessive compulsive behaviors in adaptive waysPrimary Interventions- PhysiologicalDry scaly skin with yellow hue
Priority ----- SAFETY FIRST!!!!!!Structured environmentoOften involuntary hospitalizationBed rest - completeoDecreased metabolic needsoUse little energy to conserve muscle mass that is leftDaily weightoPost morning void “Dry weight”Intake and OutputoStrict I&OoPrevents manipulation of weightoSkin turgor, monitor hydrationMonitor vital signsoHR, BPMonitor labsoCBC, Electrolytes, Liver enzymes, Protein, Creatinine, Nitrogen, Kidney function, UAAdminister medicationoNot primary treatment modalityoAnti-anxiety medsoSSRI – stimulates appetite, helps with digestionoAntipsychotic – helps with impulsiveness Electrolyte balanceoIV potassium replacementControl vomitingoClose observation oMake bathroom inaccessible 2-3 hrs. during and after meal (will still try to