Nursing Management of Eating Disorders

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Nursing Management of Eating Disorders

• NUR 265
• Pat Mitchell, RN, MS

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Eating Disorders

• Anorexia nervosa
• Bulimia nervosa
• Eating disorder not otherwise specified (NOS)
• Binge eating disorder

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Eating Disorders Theories

• Separate syndromes based on a cluster of
  symptoms
• Neurobiological
• Altered neurotransmitters
• Neuroendocrine
• Abnormalities noted
• Causal relationship possible
• May be result of starvation or abnormal eating
  behavior

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Eating Disorders TheoriesContinued

• Psychological models
• Core psychopathology
• Feelings of
• Low self esteem
• Self-doubts about personal worth
• Feelings produce harsh self-judgment focused on
  weight

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Eating Disorders TheoriesContinued

• Sociocultural models
• Incidence of eating disorders increases in
  societies in which women have a choice in social
  roles
• Genetic models
• Strong genetic link for eating disorders

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Eating Disorder Cycle
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Signs and Symptoms and Clinical Presentations of
Anorexia and Bulimia

• Anorexia nervosa (Table 17-1)
• Bulimia nervosa (Table 17-1)

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Anorexia Nervosa

• Physical Symptoms
• Weight loss 15 below ideal
• Amenorrhea
• Bradycardia, subnormal T
• Cachexia, sunken eyes, dry skin
• Lanugo on face
• Constipation
• Cold sensitivity

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Anorexia Nervosa

• Behavioral Symptoms
• Self-starvation
• Compulsive behaviors regarding food
• May use laxatives or diuretics, excessive
  exercise, vomiting
• Wearing baggy clothes

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Anorexia Nervosa

• Psychologic Symptoms
• Denial of seriousness of low weight
• Body image disturbance
• Irrational fear of weight gain
• Constant striving for perfect body
• Self-concept unduly influenced by shape and
  weight
• Preoccupation with food, cooking
• Delayed psychosexual development
• Little interest in sex, relationships

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Bulimia Nervosa

• Physical Symptoms
• Electrolyte imbalances
• Hypokalemia
• Alkalosis
• Dehydration
• Idiopathic edema
• Cardiovascular
• Hypotension
• Dysrhythmias
• Cardiomyopathy

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Bulimia Nervosa

• Physical Symptoms, contd.
• Endocrine
• Hypoglycemia
• Menstrual dysfunction
• Gastrointestinal
• Constipation, diarrhea
• Gastroparesis
• Esophageal reflux
• Esophagitis
• Esophageal tears

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Bulimia Nervosa

• Physical Symptoms, contd.
• Dental
• Enamel erosion
• Parotid Gland Enlargement

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Bulimia Nervosa

• Behavioral Symptoms
• Recurrent episode of binge eating
• Purging behavior to compensate
• Self-induced vomiting, use of laxatives,
  diuretics, enemas, fasting, excessive exercise

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Bulimia Nervosa

• Psychologic Symptoms
• Body image disturbance
• Persistent over concern with weight, shape,
  proportions
• Mood swings, irritability
• Self-concept unduly influenced by weight

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Medical Complications of Anorexia and Bulimia
Nervosa

• Medical complications are listed in Box 17-1

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Therapeutic Relationship Building Trust and
Having Empathy

• Client with anorexia nervosa
• Perfectionism
• Obsessive thoughts and actions relating to food
• Need to control

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Anorexia Nervosa Nursing Process

• Assessment
• Nursing diagnosis
• Outcome criteria
• Short-term
• Long-term
• Planning
• Refeeding syndrome

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Anorexia Nervosa Intervention

• Acute phase/basic level intervention
• Milieu therapy
• Precise meal times and menus
• Observation during and after meals
• Regularly scheduled weighing
  
• Counseling
• Cognitive distortions
• Health teaching
• Self-care

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Anorexia Nervosa Intervention Continued

• Long-term treatment/advanced practice
  interventions
• Psychotherapy
• Psychopharmacology
• Fluoxetine (Prozac)
• Olanzapine (Zyprexa)

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Anorexia Nervosa Evaluation

• If weight falls below the goal, treatment is
  changed

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Therapeutic Relationship Building Trust and
Having Empathy

• Client with bulimia nervosa
• Sensitive to perceptions of others
• May feel
• Shame
• Out of control
• Low self-esteem
• Unworthiness
• Dysphoria

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Bulimia Nervosa Nursing Process

• Assessment
• Nursing diagnosis
• Outcome criteria
• Short-term
• Long-term
• Planning

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Bulimia Nervosa Intervention

• Acute phase/basic level intervention
• Milieu therapy
• Interrupt binge-purge cycle
• Prevent disordered eating behaviors
• Counseling
• Health teaching
• Long-term treatment/advanced practice
  interventions
• Psychotherapy
• Cognitive-behavioral
• Psychopharmacology
• Fluoxetine (Prozac)

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Bulimia Nervosa Evaluation

• Normalize eating pattern
• Maintain regular exercise plan
• Weight in normal range for height

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Binge Eating Disorder

• A variant of compulsive overeating
• Reported in 20 to 30 of obese clients
• No compensatory behaviors
• Major depression a significant comorbidity
• Most effective treatment is cognitive-behavioral
  therapy
• Selective serotonin reuptake inhibitors used in
  treatment

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Binge Eating Disorder

• A variant of compulsive overeating
• Reported in 20 to 30 of obese clients
• No compensatory behaviors
• Major depression a significant comorbidity
• Most effective treatment is cognitive-behavioral
  therapy
• Selective serotonin reuptake inhibitors used in
  treatment