Transcript Eating Disorder

Eating Disorder
West Coast University
NURS 204
Sociocultural Factors
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Cultural stereotypes
Preoccupation with the body
Cultural ideal of thinness
Identity and self-esteem are dependent
on physical appearance
Female Attractiveness
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Equated with thinness, physical fitness
Media glamorizes thinness
Thinness equated with success and
happiness
Prejudice against overweight
Self-esteem enhanced for those
considered attractive
Male Attractiveness
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Ideal body type is lean and muscular
Emphasis on strength and athleticism
Less popular if they do not have the ideal
body type
Biologic Theory
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There may be a genetic predisposition
for anorexia.
Relatives of clients with eating disorders
are 5 to 10 times more likely to develop
an eating disorder.
Psychological Factors
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Perfectionism
Social and affective insecurities
Low self-esteem
Immaturity
Sense of ineffectiveness
Interpersonal distrust
Poor conflict resolution
Depression
Obsessive-compulsive disorder
Psychosocial Pressures
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Frequent exposure to articles about dieting is
significantly associated with lower selfesteem, depressed mood, and lower levels of
body satisfaction.
Occupations, such as modeling or ballet
dancers
Athletes, gymnastics
Psychosocial Considerations
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Use of anabolic steroids
Predominately an issue in industrialized,
developed countries
Not solely a problem of specific cultural
groups
Neurotransmitters affect
eating disorders
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Serotonin
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Increase eating behavior:
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Low levels: increase food intake
High levels: decrease food intake
Norepinephrine
Neuropeptide Y
Suppresses food intake:
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Dopamine
Eating Disorders
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Anorexia nervosa and bulimia nervosa
are not single diseases, but syndromes
with multiple predisposing factors and a
variety of characteristics.
Characteristics of
Anorexia Nervosa
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Extreme perfectionism
Fear of gaining weight
Significant weight loss
Body image disturbance
Strenuous exercising
Peculiar food handling practices
Rigidity and control
Physical Manifestation of
Anorexia Nervosa
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Reduction in the following:
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Heart rate
Blood pressure
Metabolic rate
Production of estrogen or testosterone
Body temperature
Physical Symptoms of
Anorexia Nervosa
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Weight loss 15% below ideal
Amenorrhea
Cachexia
Sunken eyes
Dry skin
Lanugo on face
Constipation
Cold sensitivity
Psychological Symptoms of
Anorexia Nervosa
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Denial of low weight
Body image disturbance
Irrational fear of weight gain
Preoccupied with food and cooking
Delayed psychosexual development
Bulimia Nervosa
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Cyclical condition
Episodes of binge-eating and purging
Skipping meals sporadically
Strict dieting or fasting
Physical Symptoms of Bulimia
Nervosa
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Fluid and electrolyte imbalances
Cardiovascular Symptoms
Endocrine Symptoms
Gastrointestinal Symptoms
Psychological Symptoms of
Bulimia Nervosa
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Body image disturbance
Persistent over concern with weight,
shape and proportions
Mood swings, irritability
Self-concept influenced by weight
Binge-Eating Disorder
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Eating significantly larger-than-normal
amounts in a discrete time period, until
uncomfortably full
Sense of lack of control
No compensatory purging
Frequently symptoms of
an affective disorder
Assessing Clients
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Willingness for treatment
Treatment history
Dramatic weight loss or gain
Medical history and physical examination
Patterns and perceptions regarding weight
Body dissatisfaction and image distortion
Physical symptoms
Denial
Assessment Continued
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Assess:
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Dieting history
Binge eating
Feeling regarding binge behavior
Food cravings
Purging behaviors
Menstrual history
Medical side effects
Co-morbidity factors
Nursing Diagnosis: NANDA
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Anorexia:
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Imbalance nutrition: Less than body requirements
Disturbed body image
Chronic low self-esteem
Anxiety
Bulimia Nervosa:
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Ineffective coping
Deficient fluid volume
Chronic low self-esteem
Outcome Identification: NOC
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Be free of self-harm
Adequate nutrients taken into the body for
height, frame, gender, and activity level
Manage stressors, ability to self-restrain
compulsive or impulsive behavior, ability to
acquire, organize and use information
Positive perception of own appearance and
ability to self-restrain altered perception
Verbalize understanding of underlying
psychological issues
Goals
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anxious clients with bulimia is to help
them:
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Recognize events that create anxiety
Avoid binge eating and purging in
response to anxiety
Verbalize acceptance of normal body
weight without intense anxiety
Goals - continued
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The overall goal of treatment for the individual
with anorexia nervosa is gradual weight
restoration/
A target weight is usually chosen by the
treatment team in collaboration with a
dietitian.
Target weight for discharge from treatment is
usually 90% of average for age and height.
Planning and Implementing:
NIC
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Manage nutrition
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Establish adequate eating patterns and fluid and
electrolyte balance
Assume a calm, matter-of-fact attitude
Gradual weight restoration
Tube feeding or intravenous therapy
Weigh the client daily
Record intake and output
Observe client during meals
Observe bathroom behavior
Nursing Interventions
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Help increase client understanding of treatment plan.
Emphasize client capability to eat small portions
without binging.
Avoid power struggles.
Intervene with anxiety.
Give positive feedback for adherence to plan.
Engage in group therapy.
Assist to identify issues (e.g., esteem, identity
disturbance).
Collaborate with dietician to teach nutrition.
Collaborate with interdisciplinary staff.
Goals - continued
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Providing basic nutritional education is
the goal of interventions with clients that
have a knowledge deficit in this area.
Nursing Interventions: Client
with Anorexia Nervosa
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Establish Trust
Tube feeding
Intravenous therapy
Avoid weighing the client daily
Observing bathroom behavior
Recording intake and output
Observing the client during meals
Nursing Interventions: Client
with Bulimia Nervosa
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Managing medications
Reducing anxiety
Managing fluids and electrolytes
Facilitating coping
Mobilizing the family
Health Teaching and Promotion
Pharmacologic
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SSRIs
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Reduce binge
eating and
vomiting
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Symptom
control
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Anxiety
Depression
Obsessions
Impulse control
Psychotherapeutic
Treatment Modalities
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Individual Psychotherapy
Family Therapy
Group Therapy
Behavioral
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Contracts
Exposure and response prevention
Cognitive
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Reframing
Cognitive restructuring
Adjunctive Therapy
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Occupational therapy
Nutrition education and counseling
Interdisciplinary treatment team
Community support groups
Prevention
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Nurses in community-based settings
can play a valuable role in:
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Education
Support
Referral
Screening and Education
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Nurses can provide screening and
education in schools, clinics, homes,
health fairs, health clubs
Individuals at risk: low self-esteem,
irrational behavior related to food,
excessive exercise, and other factors
Prevention and Screening
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Important to understand cultural factors
contributing to eating disorders
Nurses can implement primary
prevention and secondary screening
measures