eating disorders order 10
DESCRIPTION
Mental Health Fall '12TRANSCRIPT
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Eating Eating DisordersDisorders
Renee Franquiz MSN, RN
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Eating DisordersEating Disorders
Anorexia Nervosa
Bulimia Nervosa
Eating disorder not otherwise specified (NOS)
Binge eating
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TheoriesTheories Neurobiological: altered neurotransmitters
Neuroendocrine: abnormalities, hypothalmic dysfunction
Genetic: there is a heriditary predisposition to developing disorders
Psychodynamic Influences/ Family Relationships
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More theoriesMore theories
Psychological: feelings of low self- esteem/ harsh self judgement due to feelings of doubt
Sociocultural: Increases in societies where women have a choice in role models
Genetic: strong link for eating disorders
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Clinical PresentationClinical Presentation
Anorexia: Terror of gaining weight Preoccupied with thoughts of food View self as fat Peculiar handling of food Exercise obsessed May use vomiting/ diuretics Determines self worth through weight
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Bulimia: Binge eating Self-induced vomiting May have a hx of anorexia Depressive signs Problems with interpersonal
relationships. Self concept, and impulsive behaviors
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Anorexia Low weight Amenorrhea peripheral edema Constipation Cardiac px
BP failure
Bulimia Usually normal
weight Tooth erosion Calluses on hands Electrolyte
imbalance failure
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Client with Anorexia Perfectionisn Obsessive thoughts and actions relating
to food Need to control
Therefore, MUST build a trusting empathetic relationship
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Assessment malnourished, underweight,lanugo on face, mottled skin,
dehydration
Nursing Diagnosis Imbalanced Nutrition : less than body requirements… Decreased cardiac output Disturbed body image
Planning Inpatient vs Outpatient Refeeding Syndrome Stabilize first if pt is under 75% idea weight or with
extreme electrolyte imbalance Outpatient therapy then begins
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Acute phase/ basic level Milieu therapy (precise meal times,
observation, weigh ins) Counseling (to deal with cognitive
distortions) Health Teaching (self care)
Coping skills Learning to shop and choose food Eating forbidden foods
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Psychotherapy For not only pt but family as well
Psychopharmology Prozac ( increases mood which may directly
affect disorder) Zyprexa (decreases agitation and
obsessive behaviors)
EVALUATION : If weight fails below goal.. Methods are revised.
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Bulimia These clients are sensitive to the
perceptions of others May feel: shame, low self-esteem,
unworthiness
Must build an empathetic and trusting relationship to be successful in helping these clients
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Assessment: May not appear ill, normal weight Dental erosion Family relationships may lack nurturing May have hx of impulsive behaviors
(stealing etc) Electrolyte imbalanceDiagnosis
Risk for injury due to ineffective coping
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Outcome Criteria Short vs long term: electrolyte / acid
base balance Planning: tx life threatening
complications May be at risk for suicidal tendencies Begin treatment to deal with issues leading
to bulimia and prepare for discharge therapies
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Acute phase: Milieu therapy: interrupt binge/purge
cycle Counseling Health teaching
Long term treatment: Psychotherapy Psychopharmacolgy (Prozac)
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Normalize eating habits
Maintain regular exercise plan
Weight in normal range for height
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A different type of compulsive overeating
Reported in 20-30% obese clients Major depression Most effective treatment is cognitive-
behavioral therapy SSRI’s (Zoloft) used to reduce
binging