Nursing 140-Mental Health-Eating Disor.ch.28-Ololc-Test 2

Front 1

Eating disorders

Back 1

1. Anorexia nervosa
2. Bulimia nervosa
3. Binge Eating Disorder

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Anorexia nervosa

Back 2

a life-threatening condition characterized by disturbed body image, emaciation, and intense fear of becoming obese

Front 3

Bulimia nervosa

Back 3

a disorder characterized by uncontrollable consumption of large amts of food, followed by attempts to eliminate the body of the excess calories.

Front 4

Binge Eating Disorder

Back 4

BED: recently added diagnostic category in the DSM, characterized by recurrent episodes of binge eatingm, regular use of compensatory behaviors such as purgin, laxative abuse, or excessive exercise; guilt, shame, and disquiet about binging; and marked psychological distress.

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Etiology

Back 5

complex interaction of individual, family and cosiocultural factors. a vulnerable personality, sociocultural emphasis on slimness, family functioning style, major life changes or stressorsm dieting, genetic factors and the onset of puberty all may contribute

Front 6

Biological etiology

Back 6

Norepineephrine activates the feeding in general and serotonin inhibiting it

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Individual Factors

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1. Genetic
2. Neurochemistry
3. Puberty
4. Perfectionism
5. Self-esteem
6. Substance abuse

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Signs and Symptoms: Diagnostic Criteria

Back 8

must rule out other psychiatric diagnoses

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Signs and Symptoms: Diagnostic Criteria:

Anorexia nervosa

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1. voluntary refusal to eat
2. typically weight less thatn 85% of what is considered normal for hgt and age
3. have distorted body image and view themselves as fat
4. may be obsessed with food and cooking for others
Physiologic s/s:
1. amenorrhea
2. lanugo hair
3. hypotension
4. bradycardia
5. hypothermia
6. constipation
7. polyuuria
8. electrolyte imbalances
Lab values:
1. increases serum cholesterol and carotene levels
2. decreased serum zinc and copper levels
3. increased blood urea nitrogen, cortisol and growth hormone levels
4. anemia
5. leukopenia
6. normal serum albumin
7. low serum calcium levels may cause leg cramps

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Signs and Symptoms: Diagnostic Criteria

Bulimia nervosa

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characterized by episodic, uncontrolled, rapid ingestion of large quantities of food.
self-induce vomiting, obsessive exercise, and use of laxatives and diuretics.
1.may develop dental caries
2. ECG changes
3. parotied gland enlargement
4. esophagitis
5. gastric dilation
6. menstrual irregularity
7. electrolyte imbalances

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Types of A.N.

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restricting type: not regularly engaged in binge eating or purging
Binge eating and purging type: regularly engaged in this

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Prevention Strategies:

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1. screen all client, especially young girls and women
2. with preteen & teenage clients discuss menses, puberty and wgt gain during this life stage: peer pressure; and emdia influences
3. if client is dieting, adk them to discuss their feelings, relationships and current stressors
4. emphasize to families that teasing about wgt can be damaging
5. avoid mentioning appearance related to wgt, even if the clien loos good.

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Goals and treatment

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denial is strong, treatment is long and often "2 steps forward, 1 step backward"

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BFST - Behavior Family Systems Theraphy

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1. Assessment- team engage family in trtmt & check wgt weekly.
2. Control rationale- put parents in charge of pt's eating and deals with their reactions
3. Weight gain- refine the wt gain program & introduces non-food related issues
4. Weight maintenance- return control over food gradually to the client.

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Pharmacologic Interventions

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jury out on meds for AN, SSrI's have found some success in helping keep wgt on
for BN antidepressants seem to work. TCA's MOIs and SSRI's

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Nursing Process:

Assessment

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1. History and Physical exam
look at labs, elimination, teeth, menses history, hormone imbalances, activity and rest
2. Lab findings:
a. nutrition related anemia
b. leukopenia
c. thrombocytopenia
d. decreased chloride, calcium, mag, & phos.levels.
e. elevated BUN levels
f. elevated hepatic enzymes and cholesterol
3. ECG studies: the cardiac muscle may atrophy, less CO,

Front 17

Nursing Diagnosis

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some med diag but most psychosocial problems
a. Imbalanced Nutrition
b. Disturbed Thought Processes
c. Disturbed body image...
see pg 567

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Planning

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with team, client & family
short-term goals;
a. decreasing anxiety
b. stopping wgt loss
c. restoring the person to an acceptable wgt
d. normalizing eating behaviors see pg 568
Long-term goals:
focus on helping the family and client to resolve the phychological issues that precipitated the eating disorder and to develop more constructive coping mechanisms
see pg 568

Front 19

Implementation:

Back 19

establish a relationship of open communication and trust
a. restoring nutritional balance
b. encouraging realistic thinking processes
c. improving body image
d. building self-esteem
e. exploring feelings of powerlessness
f. encouraging effective coping
g. restoring family processes

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Evaluation

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determining if goals were met or if the client and family have made progress toward meeting them
Physical outcomes:
a. weight gain
b. normal lab values and VS
c. return of secondary sexual charac. and menstruation
Psychosocial outcomes:
a. realistic perception of body image
b. direct expression of feelings
c. improved self-esteem
d. sense of control over self and environment
e. constructive family process
family outcomes:
a. members communicate directly with each other and deal openly with conflicts
b. that parents relinquish previous patterns of overcontrol and overprotectiveness to allow the client an appropriate degree of autonomy

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Problems with these diseases are

Back 21

hypokalemia from laxatives and diurectics -normal is: 3.5-5.0 mqs
hemoglobin level 12 g/dl