Eating Disorder

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Eating Disorder

• West Coast University
• NURS 204

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Sociocultural Factors

• Cultural stereotypes
• Preoccupation with the body
• Cultural ideal of thinness
• Identity and self-esteem are dependent on
  physical appearance

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Female Attractiveness

• Equated with thinness, physical fitness
• Media glamorizes thinness
• Thinness equated with success and happiness
• Prejudice against overweight
• Self-esteem enhanced for those considered
  attractive

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Male Attractiveness

• Ideal body type is lean and muscular
• Emphasis on strength and athleticism
• Less popular if they do not have the ideal body
  type

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Biologic Theory

• 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.

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Psychological Factors

• Perfectionism
• Social and affective insecurities
• Low self-esteem
• Immaturity
• Sense of ineffectiveness
• Interpersonal distrust
• Poor conflict resolution
• Depression
• Obsessive-compulsive disorder

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Psychosocial Pressures

• Frequent exposure to articles about dieting is
  significantly associated with lower self-esteem,
  depressed mood, and lower levels of body
  satisfaction.
• Occupations, such as modeling or ballet dancers
• Athletes, gymnastics

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Psychosocial Considerations

• Use of anabolic steroids
• Predominately an issue in industrialized,
  developed countries
• Not solely a problem of specific cultural groups

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Neurotransmitters affect eating disorders

• Serotonin
• Low levels increase food intake
• High levels decrease food intake
• Increase eating behavior
• Norepinephrine
• Neuropeptide Y
• Suppresses food intake
• Dopamine

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Eating Disorders

• Anorexia nervosa and bulimia nervosa are not
  single diseases, but syndromes with multiple
  predisposing factors and a variety of
  characteristics.

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Characteristics ofAnorexia Nervosa

• Extreme perfectionism
• Fear of gaining weight
• Significant weight loss
• Body image disturbance
• Strenuous exercising
• Peculiar food handling practices
• Rigidity and control

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Physical Manifestation of Anorexia Nervosa

• Reduction in the following
• Heart rate
• Blood pressure
• Metabolic rate
• Production of estrogen or testosterone
• Body temperature

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Physical Symptoms of Anorexia Nervosa

• Weight loss 15 below ideal
• Amenorrhea
• Cachexia
• Sunken eyes
• Dry skin
• Lanugo on face
• Constipation
• Cold sensitivity

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Psychological Symptoms of Anorexia Nervosa

• Denial of low weight
• Body image disturbance
• Irrational fear of weight gain
• Preoccupied with food and cooking
• Delayed psychosexual development

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Bulimia Nervosa

• Cyclical condition
• Episodes of binge-eating and purging
• Skipping meals sporadically
• Strict dieting or fasting

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Physical Symptoms of Bulimia Nervosa

• Fluid and electrolyte imbalances
• Cardiovascular Symptoms
• Endocrine Symptoms
• Gastrointestinal Symptoms

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Psychological Symptoms of Bulimia Nervosa

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

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Binge-Eating Disorder

• 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

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Assessing Clients

• 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

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Assessment Continued

• Assess
• Dieting history
• Binge eating
• Feeling regarding binge behavior
• Food cravings
• Purging behaviors
• Menstrual history
• Medical side effects
• Co-morbidity factors

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Nursing Diagnosis NANDA

• Anorexia
• Imbalance nutrition Less than body requirements
• Disturbed body image
• Chronic low self-esteem
• Anxiety
• Bulimia Nervosa
• Ineffective coping
• Deficient fluid volume
• Chronic low self-esteem

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Outcome Identification NOC

• 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

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Goals

• The goal of nursing interventions with anxious
  clients with bulimia is to help them
• Recognize events that create anxiety
• Avoid binge eating and purging in response to
  anxiety
• Verbalize acceptance of normal body weight
  without intense anxiety

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Goals - continued

• 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.

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Planning and Implementing NIC

• Manage nutrition
• 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

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Nursing Interventions

• 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.

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Goals - continued

• Providing basic nutritional education is the goal
  of interventions with clients that have a
  knowledge deficit in this area.

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Nursing Interventions Client with Anorexia
Nervosa

• Establish Trust
• Tube feeding
• Intravenous therapy
• Avoid weighing the client daily
• Observing bathroom behavior
• Recording intake and output
• Observing the client during meals

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Nursing Interventions Client with Bulimia Nervosa

• Managing medications
• Reducing anxiety
• Managing fluids and electrolytes
• Facilitating coping
• Mobilizing the family
• Health Teaching and Promotion

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Pharmacologic

• SSRIs
• Reduce binge eating and vomiting

• Symptom control
• Anxiety
• Depression
• Obsessions
• Impulse control

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Psychotherapeutic Treatment Modalities

• Individual Psychotherapy
• Family Therapy
• Group Therapy
• Behavioral
• Contracts
• Exposure and response prevention
• Cognitive
• Reframing
• Cognitive restructuring

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Adjunctive Therapy

• Occupational therapy
• Nutrition education and counseling
• Interdisciplinary treatment team
• Community support groups

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Prevention

• Nurses in community-based settings can play a
  valuable role in
• Education
• Support
• Referral

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Screening and Education

• 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

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Prevention and Screening

• Important to understand cultural factors
  contributing to eating disorders
• Nurses can implement primary prevention and
  secondary screening measures