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33 Cards in this Set
- Front
- Back
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Eating Disorders
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Affects more than 24 million Americans,
1-3% of US population 1 in 250 females anorexia; 1 out of 4 women ages 12-32 have some form of disordered eating; 1 out of 6 people with an eating disorder is male 2 out of 10 anorexics will DIE from their disease |
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Anorexia
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Body Image and Self Esteem
Anxiety Medical Complications Media Influence Feelings/Stress Personality Traits Associated Behaviors Control Fear of Maturity Obsessive/Perfectionistic Failure Physical mutilation Sexual Abuse Exercise Medications |
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Bulemia
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Feelings
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Causes of eating disorders
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1.Neurochemical
2.Genetics- unsure at this time 3. Individual Factors of Perfection and Self-Esteem 4.Sociocultural Factors- Various factors 5.Family/ Emotional Problems |
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Neurochemical
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Norepinephrine activates feeding and seratonin inhibits
Dopamine also seems to affect Peptides normally regulate eating Causes of eating disorders Leptin(hormone from adipose tissue) also acts to control eating |
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Genetics- unsure at this time
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Studies of twins, sisters, daughters of people with eating disorder show chromosome abnormality
May be related to hypothalamic disorders Excessive levels of vasopressin (brain hormone |
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Individual Factors of Perfection and Self-Esteem
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High need for perfection
Personality- overly critical of performance. Excessive need for approval, greatly concerned about making mistakes. Differ from high achiever- driven by goal to achieve Perfectionists are driven by a fear of Failure- need perfection for esteem |
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Sociocultural Factors- Various factors
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Social Acceptance
Values beauty Media Peer pressure Sports and Activities |
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Family/ Emotional Problems
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-Body conscious household (ie mother/ father diets,
exercises and/or comments about weight- copy behaviors -Ridiculed about weigh, constantly made fun of (name-calling, jokes) develops as coping mechanism. -Studies - emotional, physical, or sexual abuse. -protect, repress or block out memories, and numb feelings. -blame self-- must have done something wrong to deserve it -keep it a secret- shame and guilt -food =comfort help to numb feeling-means of coping -believe if too thin or too obese- unattractive- abuse will stop. -not eating can fade away and die, then the abuse will have to end. -feel no control over what was happening – eating is control -Purging way to release emotions- get feelings out. - feel relieved and calm after purging |
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Presence (co-morbidity) of other psychological problems
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Depression
Post Traumatic Stress Disorder Anxiety Obsessive Compulsive Disorder |
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ANOREXIA
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DSM diagnosis -dangerous, life-threatening
starve to be "thin." extreme weight loss--at least 15 % below ideal weight for age & height fears maintaining normal body weight Amenorrhea (absence of at least 3 menstrual cycles) |
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2 types of Anorexia
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Restricting type
Binge and purging type |
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Onset and Prognosis of Anorexia
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Usually begins around puberty-often associated with a stressful life event
More than 90% young women, # males increasing -probably diagnosed later Dangerous cycle emotional and physical disturbances: prolonged hunger leads to depression, which then seriously erodes self-esteem and self-confidence, which increases need for over controlling weight and an even firmer resolve to not eat. Some studies estimate that suicide is the cause of as many as half the deaths in anorexia nervosa. |
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Behaviors of Anorexia
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complains being "fat" "obese" "huge”
preoccupied with weight, counts calories and fat grams, Dieting, exercise, weighs self Drained, little energy wears loose fitting clothing. excuses not to eat, "I already ate, upset stomach” extremely defensive about weight. often cooks or bakes food but refuses to eat food themselves. extremely irritable, dramatic mood swings -isolated, avoids social situations non-caloric foods diet soda, gum, etc. withdraws from touching others. avoids restaurants, eating in front of others reflection- "funhouse“ mirror. (Distorted) Meal times ritualistic" e.g. eating in same bowl, cut food into tiny pieces, will not let food touch another, moves food around plate as if has eaten, etc. Uses laxatives, diuretics, or diet pills |
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Emotional Beliefs
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Weight loss =achievement- extraordinary self-discipline
Weight gain unacceptable failure of self-control. |
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Factors of Eating Disorders
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Depression, Insomnia
Bloating, constipation. Decreased interest in sexual activity. Sensitivity to cold Reproductive and hormonal changes |
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Physical symptoms of starvation
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Physical symptoms of starvation:
fatigue ↓ heart rate & temp, metabolism, menses heart disease tooth erosion, gum infection fine body hair on face and back, loss of hair, dry, brittle complexion pale, skin dry severe anemia, osteoporosis, impaired kidney function- edema Nerve damage -chronic nerve problems in hands, feet. Seizures |
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Outcomes of Anorexia
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EKG changes- cardiac disease most common cause of death-
dangerously slow(bradycardia) in many cases heart muscles literally starve, losing size Abnormal electrolytes due to vomiting, diarrhea elevated BUN Brain scans- structural changes and abnormal activity in parts of brain during anorexic states- some changes can return to normal if weight is gained, some damage may be permanent. |
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Treatment criteria
of Anorexia |
Usually hospitalized if weight loss over 30% over 6 months
Severe hypothermia due to loss of subcutaneous tissue or dehydration Heart rate less than 40/min Systolic blood pressure less than 70 mm Suicidal or self injurious behaviors- cutting, laxative, diuretic use |
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Assessment
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Physical aspects- labs, VS etc
History Health Patten assessment –page 564 Don’t think there is problem- secretive, denial, manipulation |
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Nursing Diagnosis See page 567
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Imbalanced nutrition: less than body requirements
Disturbed thought process Disturbed body image Chronic low self-esteem Powerless Ineffective coping Interrupted family processes |
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Interventions
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Altered Nutrition: less than body requirements r/t reduced intake, purging
Medical stabilization- IV and NG tube feeding if necessary Diet- contract for intake and weight gain (usually 1-2 pounds/week) Cannot refeed to rapidly if extremes- cardiac system would overload- montor electrolytes and cardiac functions Monitor weight- same time same place- patient’s back to scale Monitor after meals- 2 hours after eating Limit exercise Positive relationship- self-esteem, body image, thought processes |
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Outcomes (Anorexia)
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Adequate intake to meet body requirements and maintain weight appropriate for age and height
Verbalize decreased fears and demonstrate decreased anxiety regarding weight and loss of control Not engage in eating or purging behaviors Maintain appropriate activity levels Outcomes for other diagnoses: Exhibit realistic thinking process and body perception Verbalize positive self esteem Demonstrate positive coping skills Recognize and verbalize emotions and needs Family will demonstrate constructive communication patterns Family will manage conflict constructively |
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BULIMIA
DSM criteria for Bulimia |
Recurrent episodes of binge eating
Eating larger amount of food in specific period of time Lack of control over eating during episode Distress regarding binge eating feels guilty, disgusted Episodes occur at least 2 days week for months Binge eating episodes associated with 3 or more Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not hungry Eats alone, feels embarrassed about how much is being eaten Recurrent methods to avoid gaining weight( purging, laxatives, diuretics, enemas) Disturbance does not occur exclusively during episodes of anorexia |
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Physical Signs of Bulimia
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Goes to restroom right after meals
Feels does not have control overfood Hides food in secret locations for use during binges. Eats great deal- doesn’t gain or lose a lot of weight. Takes laxatives , enemas, Ipecac Syrup, diuretics, diet pills Complains about being "fat,“ "obese," or "huge. Eats nothing or very little in front of others-binges later Food disappears from refrigerator, pantry. Swollen glands in neck and/or face Scrape wounds on back of knuckles Drink, smoke, abuse drugs, or spend money. Defensive when questioned about weight. Tooth enamel eroded, increased cavities Tight fitting, figure revealing clothes. Dramatic weight fluctuations-10 # in short period Sexually overactive- promiscuous Numerous trips to stores Preoccupation with body weight and food. Constant sore throat Alternates between eating massive quantities of food and periods of self-starvation. |
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Emotional Aspects of Bulimia
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Dissociative quality of episodes, ( feels "numb" "spaced out“)
Does not look as debilitated as anorexic Many so good at concealing their binge-eating habits from others that even close family members or friends are unaware they suffer from an eating disorder. Untreated can be severe- often leads to obesity, or other serious eating disorders |
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Nursing Diagnosis
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Risk for Injury
Powerlessness Ineffective Coping |
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Nursing Interventions
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Monitor and treat physical complications
Monitor 2 hours after meals Encourage to have power over decisions on things other than food Focus on strengths, assume responsibility Identify issues that lead to self-esteem |
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OBESITY
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More than 20% over ideal body weight (based on gender, age, and typical activity level)
Body-fat percentage greater than 30% for women and 25% for men. Mental and physical complications - 300,000 deaths year Serious mental disorders- depression, personality disorders, or anxiety Can lead to chronic eating disorders At much greater risk of developing serious medical conditions Feelings of shame, profound sense of isolation often accompany obesity |
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Nursing Diagnosis
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Altered Nutrition: more than body requirements
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Interventions/Outcomes
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Acknowledge emotional aspects with food, weight gain
Identify thoughts feelings, that reinforce eating patterns Reinforce specific behavior change- focus on strengths Encourage relaxation techniques Expression of feelings- journal, group, individual Therapeutic milieu promoting optimal functioning Recognize anxiety and provide safety to prevent self mutilating or self-abusive behaviors Assist to develop or improve interpersonal social skill Set limit by establishing desirable behavior Encourage patient to assume responsibility for behavior Explore family issues and support ways of improving communication between patient/family members |
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Sports and Activities
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-"female athlete"- common and serious disorder of young female athletes and dancers
-Eating disorders restricting calories to compete or perform |
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Media and Acceptance
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-not the direct cause –image of unattainable perfection influences self-esteem.
-early age messages by media dictate what is desirable image -Average woman is 5"4' and weighs 140 pounds. -Average model is 5"11' and weighs 117 # thinner than 98% of women. -Peer pressure of adolescence |
