Download Chapter 23 Eating Disorders

Chapter 23Eating Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Eating disorders are fascinating, confusing,
challenging and deeply disturbing. Physicians,
nurses, psychotherapists and other medical
and mental health providers frequently find
themselves confused and feel overwhelmed
when dealing with these disorders.
—Sobel, 2005
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
• Differentiate the terms anorexia nervosa, bulimia
nervosa, and obesity
• Explain why obesity is not categorized as an eating
disorder
• Discuss the following theories of eating disorders:
genetic or biochemical; psychological or psychodynamic;
and family systems
• Discuss the following theories of obesity: genetic or
biologic, and behavioral
• Describe at least five clinical symptoms shared by
clients with anorexia nervosa and clients with bulimia
nervosa
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
• Articulate the rationale for medical evaluation of a client
with an eating disorder or the diagnosis of obesity
• State the criteria for inpatient treatment of a client with
an eating disorder
• Identify the medical complications of anorexia nervosa,
bulimia nervosa, and obesity
• Construct an assessment tool to identify clinical
symptoms of an eating disorder
• Formulate a plan of care for a client with the diagnosis
of bulimia nervosa
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Statistics of Eating Disorders
• About 1% of female adolescents between the ages of
10 and 20 have anorexia.
• Approximately 4% of college-aged women have
bulimia or bulimic patterns.
• There seems to be an increase in the incidence of
middle-aged women with anorexia and bulimia.
• An estimated 5% to 10% of individuals diagnosed
with anorexia and 10% to 15% diagnosed with
bulimia are male.
• Approximately 60% of adult Americans, both male
and female, are overweight. And 34% are considered
to be obese.
• About 31% of American teenage girls and about 28%
of boys are overweight.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Anorexia and Bulimia
• Genetic or biochemical theories
• Psychological and psychodynamic theories
• Family systems theories
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Obesity
• Genetic or biological theories
• Behavioral theories
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics: Anorexia Nervosa
• Dry, flaky, or cracked
skin
• Skeletal appearance; BMI
of 16 or below
• Brittle hair and nails; hair
beginning to fall out
• Presence of lanugo (downy
soft body hair seen on
newborn infants)
• Amenorrhea or menstrual
irregularity
• Constipation
• Hypothermia due to loss
of subcutaneous fat
• Decreased pulse, blood
pressure, and basal
metabolic rate
• Loss of appetite
• Callus formation on finger
(Russell’s sign) due to
self-induced purging
• Dental caries
• Total lack of concern
about symptoms
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Client with Anorexia Nervosa
Wearing of loose-fitting clothing to hide physical appearance as it
changes
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics: Bulimia Nervosa
• Chronic inflammation of the
lining of the esophagus
• Rupture of the esophagus
• Dilation of the stomach
• Rupture of the stomach
• Electrolyte imbalance or
abnormalities, leading to
arrhythmias of the heart and
metabolic alkalosis
• Heart problems, irreversible
heart failure, and death due to
abuse of ipecac syrup
• Chronic enlargement of the
parotid glands
• Dehydration
• Irritable bowel syndrome or
abnormal dilation of the colon
• Rectal prolapse, abscess, or
bleeding
• Rupture of the diaphragm, with
entrance of the abdominal
contents into the chest cavity
• Dental erosion; gum disease
• Chronic edema
• Fungal infections of the vagina
or rectum
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics: Binge Eating Disorder
• Recurrent episodes of binge eating without purging
• Lack of control over eating
• History of repeated attempts to lose or stabilize an
individual’s weight
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment
• Assessment tools
• Physical examination
• Laboratory tests
• Transcultural considerations
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Imbalanced nutrition less than body requirements
• Imbalanced nutrition more than body requirements
• Anxiety
• Disturbed body image
• Constipation
• Diarrhea
• Fatigue
• Deficient fluid volume
• Impaired social interaction
• Compromised family coping
• Risk for impaired skin integrity
• Chronic low self-esteem
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Identification
• Short-term outcomes
– Stabilizing any existing medical condition including weight
loss
– Normalizing eating behaviors
– Decreasing clinical symptoms of a comorbid psychiatric
disorder such as anxiety or depression
• Long-term outcomes
– Helping the client develop more constructive coping
mechanisms
– Helping the client and family resolve any psychological
issues that precipitated the eating disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning Interventions
• Criteria for hospitalization:
– Suicidal ideation is exhibited.
– Severe purging or self-destructive behavior is out of
control.
– Psychosis is evident.
– Family is demonstrating crisis.
– Environment is nonsupportive.
– The client fails to respond to outpatient interventions.
– Any life-threatening condition based on laboratory data
monitored during treatment is occurring.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementation
• Assistance with meeting basic needs
– Creation of a safe environment
– Stabilization of medical condition
– Stabilization of behavior
• Medication management
• Interactive therapies
– CBT and IPT
– Solution-focused brief therapy
– Family therapy
• Self-help and support groups
• Client education
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation
Evaluation is an ongoing process. Clients will improve their
prognosis by doing the following:
• Attending a specific support group
• Keeping scheduled appointments with a therapist or
community mental health nurse
• Participating in family therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Binge eating
• Body mass index
• Cachexia
• Developmental obesity
• Obesity
• Purging
• Reactive obesity
• Russell’s sign
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Reflect on the chapter-opening quote by Sobel: “Eating
disorders are fascinating, confusing, challenging and
deeply disturbing. Physicians, nurses, psychotherapists
and other medical and mental health providers frequently
find themselves confused and feel overwhelmed when
dealing with these disorders.”
• Why do you think Sobel stated that eating
disorders are fascinating?
• How are they confusing?
• Why are they challenging?
• In what way are they deeply disturbing?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
?