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Portrait of an Eating Disorder

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Kendrea Todt

on 21 March 2016

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Transcript of Portrait of an Eating Disorder

Portrait of an Eating Disorder
Kendrea Todt
MSN Student King University



Bulimia Nervosa
Excessive, insatiable appetite.
Binging
Episodic, uncontrolled, rapid ingestion of large quantities of food over a short period time, usually occurs in secret.
Depressed mood and self-degradation are common post binge.
Bulimia Nervosa Continued
Two Types
Purging type
Non purging type
Exercise excessively, misuse laxatives, diuretics, and/or enemas.
Treatment focuses on normalizing eating patterns.
Comorbidities include major depressive disorders, dysthymia (50-70%), substance abuse and anxiety disorders.
Nursing Care
Highly structured milieu therapy.

Therapeutic relationship.
You as a nurse may be this patients only hope.
Positive approach encourages positive results..improved self image and self esteem.

Realistic goals for weight gain.

Cognitive-behavioral therapies.
Cognitive reframing
Relaxation techniques
Journaling
Desensitization exercises
Purging
Behaviors to rid the body of excessive calories.
Vomiting
Laxatives and Enemas
Diuretics
Fasting
Excessive Exercise
What Type of Problems May Occur?
Dehydration
Electrolyte Imbalances
Gastric acid in vomit may cause tooth erosion
Esophageal tears in the esophageal mucosa? What are they called?
Mallory-Weiss syndrome: Tears in the mucosal lining usually at the junction of the esophagus and stomach. May cause significant bleeding. Eating disorders is one of the causes.

Boerhaave Syndrome: Esophageal rupture from retching. Iatrogenesis
The Damage Continues
Self Loathing and Self Degradation
The Damage
Tooth Enamel Erosion
Anorexia Nervosa
Prolonged loss of appetite.
Anorexia nervosa occurs predominantly in females age 12-30 years of age.
Age of onset usually early to late adolescence.
Estimated occurrence rate 1 percent of adolescent females (Townsend, 2011).
Prevalence 10 times more likely in females.
Obsession with food.
Gross Distortion of Body Image.
What is Body Image? Personal perception of self image and the effects on others.
Two Types of Anorexia
Restricting Type
No regular engagement in binging or purging behavior.

Binge-Eating/Purging Type
Regular engagement in binge-eating or purging behaviors
Risk Factors
Females:
Genetics! Biological-hypothalmic, neurotransmitter, hormonal, or biochemical imbalance.

Interpersonal relationships (parental pressure) need to succeed.

Psychological Influences of rigidity, ritualism, feelings of ineffectiveness, helplessness, and depression, and body image distortion (ATI manual)
Risk Factors Continued
Environmental factors such as social pressure to have the "perfect body".

"Picky" eater in childhood.

Athletic participation at an elite level
Males:
Participation in a sport that prizes lean muscle mass, such as in cycling or wrestling.
History of obesity.
Nursing History
Include patients perception of the disease as well as their eating habits.

History of dieting.

How do they control their weight? (restrict, purge, exercise)

Interpersonal and social functioning

Impulsivity and compulsivity (ATI manual)
Criteria for Inpatient Treatment
Rapid weight loss greater than 30% of body weight over 6 months.

Unsuccessful weight gain.

ECG changes

Electrolyte disturbances

Depression

Suicidal behavior

Family Crisis

Affects of Bulimia
Binge Purge Cycle
References
Image of binge purge diagram retrieved from yogaeatrun.com
How bulimia effects your body image retrieved from rayur.com
ATI Manual RN Mental Health Nursing Edition 8.0
Townsend, M. C. (2011). Essentials of Psychiatric Mental Health Nursing. Philadelphia, PA: F. A. Davis company.
Nursing Care Continues
Monitor Vital Signs, weight, and Intake and output.

Behavioral contracts

Rewards

OBSERVATION during and post meals. No purging. No food hiding.
Observe for excess exercise.


Dietary
Interdisciplinary care should include a registered dietitian.

Nutritional planning should include preferences and patients ability to consume food.

Highly structured and inflexible eating schedule, no food in between scheduled times.

Small frequent meals are best, patient less overwhelmed.

High Fiber diet to prevent constipation.

Low Sodium to control fluid retention.

Limit high-fat foods.

Administer a multivitamin and mineral supplement.

Avoid caffeine.
Pharmacology
Selective Serotonin Reuptake Inhibitors (SSRIs):

May take 1-3 weeks to see an initial response, up to 2 months for maximal response.

Educate patient on side effects.
Care After Discharge
Maintenance plan:
Follow up in outpatient setting
Support group
Individual and family therapy
Client Outcomes: Maintain weight that was agreed upon
Establishment of normal eating habits.
Verbalize positive body image


Complications and Nursing Actions

Refeeding Syndrome, circulatory collapse: the compromised cardiac system is overwhelmed by a replenished vascular system.

Implement feeding over 7 days.

Monitor serum electrolytes and initiate fluid replacement as prescribed.

Place patient on continuous cardiac monitoring

Frequent Vital Signs

Prompt reporting of changes in status.
Treatment Modalities
Behavior Modification
Individual Therapy
Family Therapy

Psychopharmacology
Fluoxetine and Clomipramine have been effective with Anorexia, particularly with OCD.
Zyprexa (Anorexia)
Cyproheptadine, unabled use as appetite stimulant (Anorexia).
Fluoxetine is also effective with bulmia (SSRI) decreases Carbohydrate cravings. Works for obese patients as well.
Anorexiants: fenfluramine and dexfenfluramine were removed from market due to serious heart and lung disease.
Sibutramine (Merida) used to treat Obesity.
Obesity
Obesity is not classified as a psychiatric disorder. There are enough emotional ties however to explore psychological dynamics on the clients medical condition.

A third eating disorder is under consideration:
Binge-eating disorder.

Obesity is defined as a body mass index of 30% or greater.
Figure your own BMI... Weight in Kg/height =M2

African Americans have the highest rate of obesity as do those in the lower socioeconomic group.

5.9% of Americans are morbidly obese, defined as a BMI greater than 40%
Media Source References
12-19-2012. BarCroft TV. Extreme Anorexia Speaks Out About the Eating Disorder. Retrieved from Youtube

Dominique Di Fiore. June 27 2012, Dying to be Thin. Retrieved from Youtube

Wil Power, A. (1-28-2010). Dana, the 8 year old Anorexic ( part 1/5). Retrieved from Youtube

A& E. 2-1-2013.Intervention: Andrew Bulimia: Binging & Purging. Retrieved from Youtube.
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