4. Anorexia Nervosa:
Incidence and Characteristics
Affects 3.7% of women
Less common than bulimia
6 to 20% die as a result of the illness
Higher death rate than any other
psychiatric disorder
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5. Anorexia Nervosa Characteristics,
cont’d
Females, 90% (Male numbers are growing)
Onset:
Adolescence to early adulthood
Age of onset is decreasing
Often insidious
Occurs during important life transitions
No loss of appetite
Deliberate Weight loss
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6. Cultural Influences
Weight and Shape are
very important
Computer Graphics:
make thin models
even thinner
Preoccupation with
food, eating, fitness
Unrealistic Ideals
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7. DSM IV-TR Criteria
Refusal to maintain normal weight
Intense fear of gaining weight, even if
underweight
Body image disturbances
In female adults or adolescents, absence
of at least 3 consecutive menstrual cycles
Types are: Restricting and Binge/Purging
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8. Psychosocial Factors
May be avoidant or have
social problems
Rigid, competitive, perfectionistic
Compulsive and obsessive
Hyperactive
Anxious
Compliant “people pleasers”
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9. Food-Related Behaviors in
Anorexia Nervosa
Restricting intake, fasting
Hoarding food
Highly avoidant of certain foods
Preoccupation with calories, meals, recipes, etc.
Preparing/serving elaborate meals for others
Rituals before and during eating
become compulsions
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10. Purging Behavior in Anorexia
Purgers and vomiters
Eat normally in a social situations
Amount of food eaten is not excessive
Purge if no success with severe restricting
(Not on the test)
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12. Anorexia: More Consequences
Decreased peristalsis is exacerbated by
overuse of laxatives or enemas
Delayed gastric emptying
Feel full much longer
Dehydration
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13. Anorexia: Consequences
Amenorrhea, decreased development of
secondary sex characteristics
Osteopenia or Osteoporosis
Bone mass loss may be irreversible
Weakness and fatigue
But will persist in excessive exercising to burn calories
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14. Anorexia: Complications
Heart failure, life threatening
arrhythmias
Cardiac ventricular dilation
Decreased thickness of the
ventricular wall
Decrease oxygenation of the cardiac
muscle
Renal failure
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16. Complication of Treatment:
Re-feeding Syndrome
Severe Fluid Shifts from too rapid
re-introduction of food
Extracellular to intracellular
Cardiovascular, neurological and
hematologic complications
Refeed slowly
Close supervision
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17. Nursing Diagnosis: Critical thinking
Write a nursing diagnosis for each of these
consequences of Anorexia Nervosa:
1) Severe weight loss to 60% of average body
weight
2) Bradycardia
3) Overuse of laxatives to achieve wt. loss
4) Refeeding Syndrome
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18. Nursing Diagnosis: Critical thinking
Some possible choices
1) Nutrition less than body requirements r/t
refusal to eat; r/t excessive exercise
2) R/F falls r/t hypotension
3a) Fluid volume deficit r/t laxative overuse
3b) Constipation r/t altered gastric motility
4a) Imbalanced fluid volume r/t fluid shifts
4b) Impaired cardiac or peripheral tissue
perfusion r/t decreased cardiac output
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19. Mental Health Problems
Associated with Anorexia
Fear of losing control (Anxiety)
Low sex drive
Feelings of helplessness
Feel abandoned or inadequate
Combat by controlling what they eat
Obsessive-compulsive disorder
Major Depression
(Dx and tx only after weight gain is established)
Substance abuse
Personality disorders
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20. Etiology of Anorexia
High levels of serotonin
SSRIs are not effective
If used should not be
started until weight
restoration is established
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21. Etiology: Anorexia and the
Family
Emotional restraint
Enmeshed relationships
Rigid organization
Tight control
Drive for thinness is a way to seek control
Avoidance of conflict
Odd eating habits
Emphasis on appearance
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23. Bulimia
Means to have an insatiable appetitive
Begins in adolescents
Primarily in women
4% of young adults
Symptom overlap with Anorexia, making
diagnosis difficult
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24. Bulimia Characteristics
Hide their eating-disordered behaviors
Lack of weight loss
Coexisting mental disorders:
Major Depression
Personality disorders
Post traumatic Stress Disorder
Purging develops as a way to compensate for
massive amounts of food eaten
Restrictive eating….then purging….cycle
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26. Binge Eating
Feelings of lack of control
Often done in secret
High calorie-High carbohydrate
Consumed in less than 2 hours
Addicted to the high experienced when eating
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27. Purging = Compensatory Behavior
for Binge Eating
May use manual stimulation, laxatives,
and/or emetics
Over time, self-induced vomiting occurs
with minimal stimulation
Post-purging: sense of relief, calm
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30. Differences in Bulimia from
Anorexia
Lowered serotonin activity
Binge eating raises levels of serotonin
Treatment with SSRI, particularly
fluoxetine (Prozac)
Depression; shame; hide their eating
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31. Bulima: Associated Family
Characteristics
Mood disorders
Substance abuse
Conflict
Disorganized
Lacking nurturance
Food is a symbolic form of nurturing
Evidence Bulimia is a response to chaos
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32. Management of Eating Disorders
Anorexia
Increase weight to
90% of average body
weight
Increase self-esteem
Decrease need for
perfection (provided
by thinness)
Bulimia
Stabilize weight
without purging
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33. Management of Eating Disorders
Both Anorexia and Bulimia:
Inpatient treatment for medical stabilization
and dietary management
Long-term outpatient tx. addresses
psychosocial issues
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34. Management: Starvation Phase
of Anorexia
Assess labs:
Monitor intake/output
Assess for cardiovascular, neurological and
complications
Refeed slowly; careful dietary supervision
Intravenous lines and feeding tubes if
client refuses food
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35. Nurse Patient Relationship
Anorexia Nervosa
Usually forced into tx.
Tx means loss of
control over eating
Nurse is the enemy
Bulimia Nervosa
More likely to want
help: break the cycle
More likely to enter
treatment of their on
volition
Tendency to
manipulate
Hide the degree of the
problem
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37. Nurse Patient Relationship:
Some Interventions for Eating
Disorders
Do not confront denial,
but encourage feelings
identification
Honesty
Collaborate
TEACH patient about
their disorder
Assist to identify positive
qualities
Eat with the client
Set appropriate limits
Encourage decision
making concerning issues
other than food
Behavior modification:
Patient input
Reward for weight
gain
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38. Psychopharmacology
Anxiolytics when re-feeding is occurring
SSRI for Bulimia
Equally effective for depressed and non-
depressed patients
Psychotherapy for Anorexia
Use antidepressant for co-morbid severe
depression
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39. Milieu Management
Orientation
Warm nurturing environment
Convey an understanding of their fears
Close observation
Do we let these patient go to the rest room alone?
Should we let them go to their room right after a meal?
Nonjudgmental confrontation
CONSISTENCY
Encourage the patient to talk to staff when they
feel the need to purgewww.drjayeshpatidar.blogspot.in
40. Milieu Management, cont’d
Weighing
Family Therapy
Group Therapy
Which groups would be best for clients with
eating disorders?
Dietitian
Follow-up Therapy (outpatient)
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41. Scenarios: Communication
1) Two clients on the eating disorders unit are
overheard discussing recipes and meal plans in
the day room. How should the nurse respond?
2) An inpatient with Anorexia Nervosa complains
of feeling very full after eating and says she is
being given too much to eat. How should the
nurse respond?
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