Transcript Chapter 22 EatingDisorders

Eating Disorders
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The hypothalamus, an area within the brain,
contains the appetite regulation center.
It regulates the body’s
ability to recognize when
it is hungry, when it is not
hungry, and when it has
been sated.
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Eating behaviors are influenced by
◦ Society
◦ Culture
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Historically, society and culture
also have influenced what is
considered desirable in the
female body.
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Incidence rate of anorexia nervosa among
young women in the United States is
approximately 14 per 100,000 population.
Anorexia nervosa occurs predominantly in
females age 12 to 30 years.
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Bulimia nervosa is more prevalent than
anorexia nervosa.
Estimates range from 1 to 3 percent of
young women.
Onset of bulimia nervosa occurs in late
adolescence or early adulthood, with a
mean age of onset of 18 years.
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Obesity has been defined as a body mass
index of 30 or greater.
Approximately 1 in 5 adults (18.8 percent
of men and 19.3 percent of women) are
obese.
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Assessment
◦ Anorexia nervosa
 Characterized by a morbid fear of obesity
 Symptoms include gross distortion of body image,
preoccupation with food, and refusal to eat
 Thomson and Gray’s- Contour Drawing Rating Scale measures
perception
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Anorexia nervosa (cont.)
◦ Weight loss is extreme, usually more than 15
percent of expected weight.
◦ Other symptoms include hypothermia,
bradycardia, hypotension, edema, lanugo, and
a variety of metabolic changes.
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Anorexia nervosa
◦ Amenorrhea is typical
and may even precede
significant weight loss.
◦ There may be an
obsession with food.
◦ Feelings of anxiety
and depression are
common.
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Bulimia nervosa
◦ Bulimia is an episodic,
uncontrolled,
compulsive, rapid
ingestion of large
quantities of food over
a short period
(binging).
◦ The episode is followed
by inappropriate
compensatory
behaviors to rid the
body of the excess
calories (self-induced
vomiting or the misuse
of laxatives, diuretics,
or enemas).
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Bulimia nervosa (cont.)
◦ Associated fasting or excessive exercise may
also occur.
◦ Most individuals with bulimia are within a
normal weight range, some slightly
underweight, some slightly overweight.
◦ Depression, anxiety, and substance abuse are
not uncommon.
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Bulimia nervosa (cont.)
◦ Excessive vomiting and laxative
or diuretic abuse may lead to
problems with dehydration and electrolyte
imbalances.
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Etiological Implications
◦ Biological Influences
◦ Genetics: A hereditary predisposition to eating
disorders has been hypothesized.
 Anorexia nervosa is more common among sisters and
mothers of those with the
disorder than it is among the
general population.
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Biological Influences (cont.)
◦ Neuroendocrine abnormalities: There has been
some speculation about a primary hypothalamic
dysfunction in anorexia nervosa.
◦ Neurochemical influences:
Bulimia may be associated
with the neurotransmitters
serotonin and
norepinephrine.
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Psychodynamic Influences
◦ Suggest that eating disorders result from very early
and profound disturbances in mother-infant
interactions, resulting in
 Retarded ego development
 Unfulfilled sense of separationindividuation
Family Influences
◦ Conflict avoidance
 Families may promote and maintain psychosomatic
symptoms, including anorexia nervosa, in an effort
to avoid spousal conflict.
 The sick child becomes
the problem, and focus
on the conflict is
diverted.
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Family Influences (cont.)
◦ Elements of power and control
 Power and control may become the overriding
elements within the family.
 Parental criticism promotes an increase in obsessive
and perfectionistic
behavior on the part of
the child, who continues
to seek love, approval,
and recognition.
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Family Influences (cont.)
◦ Elements of power and control (cont.)
 Ambivalence toward the parents develops, and
distorted eating patterns may represent rebellion
against the parents.
 Eating disorder is seen as a way to gain control.
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Obesity
◦ A body mass index of 30 is considered obesity.
◦ At this level, weight alone can contribute to
increases in morbidity and mortality.
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Obesity (cont.)
◦ Obese people are at higher risk for
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Hyperlipidemia
Diabetes mellitus
Osteoarthritis
Angina
Respiratory insufficiency
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Biological Influences
◦ Genetics: 80 percent of children born of two
overweight parents are also overweight.
◦ Twin studies have also supported a hereditary
factor.
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Biological Influences (cont.)
◦ Physiological factors
 Lesions in the appetite and satiety
centers of the hypothalamus
 Hypothyroidism
 Decreased insulin production
 Increased cortisone production
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Biological Influences (cont.)
◦ Lifestyle factors
 Increased caloric intake
 Sedentary lifestyle
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Psychosocial Influences
◦ Unresolved dependency needs
◦ Fixation in the oral stage of psychosexual
development
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Nursing Diagnosis
◦ Imbalanced Nutrition: Less than body
requirements related to refusal to eat
◦ Deficient fluid volume (risk for or actual) related
to decreased fluid intake, self-induced vomiting,
and laxative and/or diuretic abuse
Nursing Diagnosis (cont.)
 Ineffective Denial related to retarded ego
development and fear of losing the only
aspect of life over which he or she
perceives some control (eating)
 Imbalanced nutrition: More than body
requirements related to compulsive
overeating
Nursing Process (cont.)
Nursing Diagnosis (cont.)
 Disturbed body image/Low selfesteem/retarded ego development,
dysfunctional family system, or feelings
of dissatisfaction with body appearance.
 Anxiety (moderate to severe) related to
feelings of helplessness and lack
of control over life events
The client
 Has achieved and maintained at least 85
percent of expected body weight
 Has vital signs, blood pressure, and
laboratory serum studies within normal
limits
 Verbalizes importance of adequate
nutrition
The client (cont.)
 Verbalizes knowledge regarding
consequences of fluid loss caused by
self-induced vomiting (or
laxative/diuretic abuse) and importance
of adequate fluid intake
 Verbalizes events that precipitate anxiety
and demonstrates techniques for its
reduction
The client (cont.)
 Verbalizes ways in which he or she may
gain more control of the environment
and thereby reduce feelings of
helplessness
 Expresses interest in welfare of others
and less preoccupation with own
appearance
The client (cont.)
◦ Verbalizes that image of body as “fat” was
misperception and demonstrates ability to take
control of own life without resorting to
maladaptive eating behaviors
The client (cont.)
◦ Has established a healthy pattern of eating for
weight control, and weight loss toward a desired
goal is progressing
◦ Verbalizes plans for future maintenance of
weight control
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Nursing care of the client with an eating
disorder is aimed at restoring nutritional
balance.
Emphasis is also placed on helping the client
gain control over life situation in ways other
than inappropriate eating behaviors.
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Self-esteem and positive self-image are
promoted in ways that relate to aspects
other than appearance.
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The Little Girl who did not want to be Fat
http://www.huffingtonpost.com/2010/12/29
/isabelle-caro-dead-anorexicmodel_n_802424.html
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Nature of Illness
◦ Symptoms of anorexia nervosa and bulimia
nervosa
◦ What constitutes obesity?
◦ Causes of eating disorders
◦ Effects of the illness or
condition on the body
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Management of Illness
◦ Principles of nutrition
◦ Ways client may feel in control of life
◦ Importance of expressing fears and feelings,
rather than
holding them inside
◦ Alternative coping
strategies
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For the Obese Client
◦ How to:
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Plan a reduced-calorie, nutritious diet
Read food content labels
Establish a realistic weight loss plan
Establish a planned program of physical activity
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Correct administration of prescribed
medications
Indication for and side effects of
prescribed medications
Relaxation techniques
Problem-solving skills
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Support Services
◦ Weight Watchers International
◦ Overeaters Anonymous
◦ National Association of
Anorexia Nervosa and
Associated Disorders
◦ The American
Anorexia/Bulimia
Association, Inc.
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Evaluation of the client with an eating
disorder requires reassessment of the
behaviors for which the client sought
treatment.
Behavioral change will be required by client
and family members.
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Behavior Modification
◦ Issues of control are central to the etiology of
these disorders.
◦ For the program to be
successful, the client
must perceive that he
or she is in control of
the treatment.
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Behavior Modification
◦ Successes have been observed when the client
 Is allowed to contract for
privileges based on weight
gain
 Has input into the care plan
 Clearly sees what the
treatment choices are
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Behavior Modification
◦ The client has control over
 Eating
 Amount of exercise pursued
 Whether to induce vomiting
◦ Staff and client agree about
 Goals
 System of rewards
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Behavior Modification
◦ The client has a choice whether to
 Abide by the contract
 Gain weight
 Earn the desired privilege
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Individual Therapy
◦ Helpful when underlying psychological problems
are contributing to the maladaptive behaviors
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Family Therapy
◦ Involves educating the family about the disorder
◦ Assesses the family’s
impact on maintaining
the disorder
◦ Assists in methods to
promote normal
functioning of the
patient
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Psychopharmacology
◦ No medications are specifically indicated for eating
disorders.
◦ Various medications have been prescribed for
associated symptoms such as
 Anxiety
 Depression
Psychopharmacology (cont.)
 Medications that have been used for
anorexia nervosa with some success include
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Fluoxetine (Prozac)
Clomipramine (Anafranil)
Cyproheptadine (Periactin)
Chlorpromazine (Thorazine)
Olanzapine (Zyprexa)
Psychopharmacology (cont.)
 Medications that have been used for bulimia
nervosa with some success include
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Fluoxetine (Prozac)
Sertraline (Zoloft)
Imipramine (Tofranil)
Desipramine (Norpramin)
Amitriptyline (Elavil)
Nortriptyline (Aventyl)
Phenelzine (Nardil)
Psychopharmacology (cont.)
 Medications that have been used for bingeeating disorder with obesity with some
success include
 Topiramate (Topamax)
Psychopharmacology (cont.)
 Medications that have been used for obesity
with some success
 Fluoxetine (Prozac)
 Sibutramine (Meridia)
 Lorcaserin (Belviq)
 Various anorexiants (CNS
stimulants)