Weight loss doesnt relieve fear so it continues Obsessive compulsive

Weight loss doesnt relieve fear so it continues

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Weight loss doesn’t relieve fear, so it continues Obsessive-compulsive personality o Thoughts obsessed surrounding food and weight o Implements ritualistic weight loss behaviors Low self-esteem o Self-esteem based on size, shape o Weight loss = achievement o Weight gain = failure Self-criticism / guilt o Self-imposed guilt o Weight gain fail = self-criticism Anxiety/Depression o Mood disturbances – Root in emotion and diet effects Delayed sexual development o Decreased pituitary o Follicle FSH o Luteinizing LH o Amenorrhea o Decreased ovarian/estrogen o Behind peer group in sexual development Physical Assessment Profound weight loss o <85% weight “skin & bones” Hypothermia
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o Low temp, maybe 35’C o Little to no body fat to regulate temp Muscle wasting o Increased BUN, decreased protein, nitrogen, albumin Decreased bone mass o Thin brittle bones o Fracture & osteoporosis later in life Dehydration o Severe, electrolyte imbalance o Decrease perfusion, decreased urine output > can lead to renal failure. Need 30ml per hr. filtered Bradycardia o r/t dehydration o decreased cardiac output, easily fatigued Dizziness o Orthostatic hypotension r/t dehydration Dependent edema o Poor vascular return o Small legs with large swollen ankles Poor skin turgor o r/t dehydration (deficient hydration and perfusion) o Tenting, >30 seconds Lanugo o Fine hair to provide warmth o Normal on newborn child, not normal on child/adult Amenorrhea Abnormal thyroid o Decreased metabolic demands Constipation o Decreased diet, H2O, GI shut down, ileus, absence of GI motility Nursing Diagnosis Altered body weight Altered nutrition Ineffective coping Altered self-concept Potential for self-harm Treatment Goals Restore nutrition o Refeeding program (restore back to normal) o Based on calculated weight Normal eating patterns - maintain Realistic self-concept and body image o What she sees is real/true Separation without anxiety o Ability to cope with stress Control obsessive compulsive behaviors in adaptive ways Primary Interventions - Physiological Dry scaly skin with yellow hue
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Priority ----- SAFETY FIRST!!!!!! Structured environment o Often involuntary hospitalization Bed rest - complete o Decreased metabolic needs o Use little energy to conserve muscle mass that is left Daily weight o Post morning void “Dry weight” Intake and Output o Strict I&O o Prevents manipulation of weight o Skin turgor, monitor hydration Monitor vital signs o HR, BP Monitor labs o CBC, Electrolytes, Liver enzymes, Protein, Creatinine, Nitrogen, Kidney function, UA Administer medication o Not primary treatment modality o Anti-anxiety meds o SSRI – stimulates appetite, helps with digestion o Antipsychotic – helps with impulsiveness Electrolyte balance o IV potassium replacement Control vomiting o Close observation o Make bathroom inaccessible 2-3 hrs. during and after meal (will still try to
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  • Winter '17
  • Deborah Cridor

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