The document discusses eating disorders including anorexia nervosa and bulimia nervosa. It covers predisposing factors, symptoms, assessment findings, treatment modalities including behavior modification, individual therapy, and psychopharmacology.
The document discusses eating disorders including anorexia nervosa and bulimia nervosa. It covers predisposing factors, symptoms, assessment findings, treatment modalities including behavior modification, individual therapy, and psychopharmacology.
Original Description:
For Nursing Students; Psychiatric Mental Health Notes
The document discusses eating disorders including anorexia nervosa and bulimia nervosa. It covers predisposing factors, symptoms, assessment findings, treatment modalities including behavior modification, individual therapy, and psychopharmacology.
The document discusses eating disorders including anorexia nervosa and bulimia nervosa. It covers predisposing factors, symptoms, assessment findings, treatment modalities including behavior modification, individual therapy, and psychopharmacology.
• Discuss theories related to eating disorders • Discuss treatment modalities used for eating disorders. Introduction
• The hypothalamus contains the appetite regulation
center within the brain. • It regulates the body’s ability to recognize when it is hungry, when it is not hungry, and when it has been sated. Predisposing Factors
• 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. • Possible chromosomal linkage sites have been suggested. Predisposing Factors (cont’d)
• Biological influences (cont’d)
• Neuroendocrine abnormalities • There has been some speculation about a primary hypothalamic dysfunction in anorexia nervosa. • Neurochemical influences • Bulimia nervosa may be associated with the neurotransmitters serotonin and norepinephrine. • Anorexia nervosa may be associated with high levels of endogenous opioids. Predisposing Factors (cont’d)
• Psychodynamic influences • Suggests that eating disorders result from very early and profound disturbances in mother-infant interactions, resulting in: • Delayed ego development • Unfulfilled sense of separation-individuation
Freud Application of Nursing Process
• Assessment • Anorexia nervosa • Characterized by a morbid fear of obesity • Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. Anorexia Nervosa (cont’d)
• 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. Client may self induce vomiting. Important to inspect hands for calluses, called Russell sign. Anorexia Nervosa (cont’d)
• Amenorrhea is typical and may even precede significant weight loss.
• There may be an obsession with food. • Feelings of anxiety and depression are common. Body Mass Index
• A BMI range for normal weight is 20 to 24.9.
• Obesity is defined as a BMI of 30 or greater. • Anorexia nervosa is characterized by a BMI of 17 or lower, or less than 15 in extreme cases. Anorexia Nervosa (cont’d) 1. Which is characteristic of the diagnosis of anorexia nervosa?
a) Obsession with weight gain
b) Body image disturbance c) Disregard for the feelings of others d) Healthy family relationships Anorexia Nervosa (cont’d)
Correct answer: B
The distortion in body image by clients diagnosed
with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated. Nursing Process: Assessment
• Bulimia nervosa • Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (bingeing). • The episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (self-induced vomiting (check for Russell sign) or the misuse of laxatives, diuretics, or enemas). Bulimia Nervosa (cont’d)
• Fasting or excessive exercise may also occur.
• Most patients with bulimia are within a normal weight range, some slightly underweight, and some slightly overweight. • Depression, anxiety, and substance abuse are not uncommon. Bulimia Nervosa (cont’d)
• Excessive vomiting and laxative or diuretic abuse may lead to
problems with dehydration and electrolyte imbalances. Bulimia Nervosa (cont’d)
2. Which assessment finding would the nurse
expect in clients diagnosed with bulimia?
a) They are below normal weight.
b) They binge when they experience hunger. c) They will be highly motivated to seek help. d) They are within their normal weight range. Bulimia Nervosa (cont’d)
Correct answer: D
Clients diagnosed with bulimia nervosa are often
able to maintain a normal weight by purging after binging. Planning and Implementation
• Hospitalization may be necessary in cases of:
• Malnutrition • Dehydration • Severe electrolyte imbalance • Cardiac arrhythmia or severe bradycardia • Hypothermia • Hypotension • Suicidal ideation Outcomes The client • Has achieved and maintained at least 80 percent of expected body weight • Has vital signs, blood pressure, and laboratory serum studies within normal limits • Verbalizes importance of adequate nutrition Outcomes (cont’d)
The client (cont’d)
• Verbalizes that image of body as “fat” was misperception and demonstrates ability to take control of own life without resorting to maladaptive eating behaviors (anorexia nervosa) Treatment Modalities
• 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. • The nurse must monitor weights and I/O’s. Treatment Modalities (cont’d)
• Behavior modification (cont’d)
• 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 Treatment Modalities (cont’d)
• Behavior modification (cont’d)
• The client has control over • Eating • Amount of exercise pursued • Whether to induce vomiting • Staff and client agree about • Goals • System of rewards Treatment Modalities (cont’d)
• Individual therapy • Helpful when underlying psychological problems are contributing to the maladaptive behaviors Treatment Modalities (cont’d)
• Psychopharmacology • No medications are specifically indicated for eating disorders. • Various medications have been prescribed for associated symptoms. • Anxiety • Depression Treatment Modalities (cont’d) • Psychopharmacology (cont’d) • Medications that have been tried with some success include: • For anorexia nervosa • Fluoxetine (Prozac) • Clomipramine (Anafranil) • Cyproheptadine (Pariactin) • Chlorpromazine (Thorazine) • Olanzapine (Zyprexa) • For severe malnutrition – a nasogastric tube may be inserted to maintain nutritional status. If the client refuses the NG tube, the team may take the client to court and allow the judge to decide if the tube is necessary. Treatment Modalities (cont’d)
• Psychopharmacology (cont’d) • Medications that have been tried with some success include: (cont’d) • For bulimia nervosa • Fluoxetine (Prozac) • Imipramine (Tofranil) • Desipramine (Norpramine) • Amitriptyline (Elavil) • Nortriptyline (Aventyl) • Phenelzine (Nardil)
