Eating and Sleeping Disorders Chapter 23 Eating and Sleeping Disorders Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Learning Objectives List three criteria for the diagnosis of an eating disorder. Compare anorexia nervosa and bulimia. Forecast the prognosis (outcome) for a client with an untreated eating disorder. Explain why obesity can be considered an eating disorder. Examine the main therapeutic goal for treating clients with eating disorders. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Learning Objectives Develop four therapeutic interventions for clients with eating disorders. Describe three functions of sleep. Discuss the signs and symptoms of a client experiencing insomnia. Plan four therapeutic (nursing) interventions to assist clients with sleeping problems. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Eating Disorders (p. 261) Eating disorder An ongoing disturbance in behaviors associated with the ingestion of food 30% of all adults believe that their actual weight is greater than their desirable weight. Result of the quest for the perfect body What criteria are needed for the diagnosis of an eating disorder? Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 262) Anorexia nervosa Individual does not maintain a normal body weight because of an intense fear of becoming fat. Approximately 90% to 95% of people with anorexia nervosa are female. Classic description of person with anorexia nervosa: Tense Alert Hyperactive Rigid Young woman What population is most affected by anorexia nervosa? Why are young females at greater risk for developing anorexia nervosa? Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 263) Clinical presentation Anorexia nervosa is a life-threatening disorder. For the client with anorexia, the smallest gain in weight is seen as a threat and a failure in self-control. Criteria Refusal to maintain a body weight greater than 15% below normal Even though the individual is underweight, he or she has an intense fear of becoming fat. A distorted significance is placed on body weight and shape. Absence of at least three menstrual cycles in a female who has previously menstruated Individuals with anorexia often go to great measures to monitor their bodies, such as weighing themselves three to four times each day, measuring body parts, and frequently looking in the mirror to check areas for fat. Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 263) Clinical presentation Mortality rate for anorexia is due to Complications of starvation Cardiac arrest Suicide The death rate associated with anorexia disorders is far higher than for any other mental illness. Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 264) Bulimia A disorder of binge eating and the use of inappropriate methods to prevent weight gain Binge and purge Often found in young, white, middle-class, and upper-class women Perfectionism is important with bulimia and contributes to maintenance of bulimic behaviors. Identify the population most affected by bulimia. Why are individuals from modern, industrialized countries more at risk for developing bulimia? Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 265) Obesity Excess of body weight Result of too many calories consumed or not enough calories burned It has not been established that obesity is consistently associated with mental health or behavioral problems. Explain why obesity can be characterized as an eating disorder. Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 267) Other eating disorders Pica Persistent eating of nonfood items that lasts for longer than 1 month Cravings for substances such as Clay Laundry starch Insects Leaves Pebbles Rumination disorder The regurgitation and rechewing of food Discuss the outcome that a client might experience if an eating disorder goes undiagnosed. Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 267) Guidelines for intervention Main therapeutic goal for all eating disorders is to establish behaviors that promote health for the client. Treatment and therapies Stabilize existing medical problems. Reestablish normal nutrition and eating patterns. Resolve the psychological/emotional issues that underlie disordered eating behaviors. What is the main therapeutic goal in the treatment of clients with an eating disorder? Copyright © 2013 by Elsevier Inc. All rights reserved.

Eating Disorders cont’d. (p. 268) Treatment and therapies Clients are assisted in identifying how food is used to provide comfort and reduce anxiety. Clients are helped to replace a distorted body image. Clients are taught problem-solving skills. List therapeutic interventions for clients with an eating disorder. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Sleep Disorders (p. 268) Normal sleep Bodily functions and metabolic rate slow Muscles relax and body conserves energy Renewal and repair of cells and tissues occurs. Dreaming allows humans to gain insights, solve problems, work through emotional reactions, and prepare for the future. Two phases of sleep: Non–rapid eye movement (NREM) sleep Rapid eye movement (REM) sleep What are the developmental considerations related to sleep disorders? Older adults usually do not have a full night of uninterrupted sleep. Copyright © 2013 by Elsevier Inc. All rights reserved.

Sleep Disorders cont’d. (p. 269) Condition or problem that repeatedly disrupts an individual’s pattern of sleep Diagnosis of a sleep disorder is based on Thorough history Physical examination findings Results of several tests: Polysomnogram Electroencephalogram Electromyogram Electrooculogram Primary sleep disorders Related to abnormal functioning of the sleep-wake or timing mechanisms of the body Dyssomnias Parasomnias Secondary sleep disorders Caused by illness Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Dyssomnias (p. 270) Insomnia Disorder of falling asleep or maintaining a sound sleep Primary hypersomnia Excessive sleepiness that usually begins at between 15 and 30 years of age Narcolepsy A condition in which an individual has repeated attacks of sleep Individual may experience cataplexy and inappropriate rapid eye movement. List the signs and symptoms of a client who is experiencing insomnia. What is cataplexy? What is inappropriate rapid eye movement? Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Dyssomnias cont’d. (p. 271) Obstructive sleep apnea syndrome Periods of apnea that repeatedly awaken the individual Circadian rhythm sleep disorder Persistent pattern of sleep disruption that results from a mismatch between personal body rhythms and environmental demands Restless legs syndrome Disagreeable sensations (tingling, itching) that occur while an individual is falling asleep or is asleep Obese people are at higher risk for obstructive sleep apnea. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Parasomnias (p. 271) Nightmare disorder Repeated frightening dreams that lead to abrupt awakenings Sleep terror disorder Repeated nightmares and abrupt awakenings accompanied by a panicky cry or scream and intense fear Sleepwalking disorder Episodes of complex motor movement during sleep What physical signs of stress accompany sleep terrors? Copyright © 2013 by Elsevier Inc. All rights reserved.

Guidelines for intervention (p. 272) Maintain a regular sleeping routine. Promote comfort. Control physical disturbances. Maintain a quiet, restful environment. List nursing interventions that can be used to assist clients with sleeping problems. Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 1 The nurse is taking care of a child who is regurgitating and rechewing her food. The child’s condition is known as what? Pica Rumination disorder Bulimia Cataplexy Correct Answer: 2 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 2 The care provider is admitting a 26-year-old female client who recently lost her mother. The client has had recent attacks of sleep lasting 10 to 20 minutes. The client’s condition is known as what? Cataplexy Narcolepsy Insomnia Dyssomnia Correct Answer: 2 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 3 Research has demonstrated that the body has a naturally occurring sleep hormone known as: Melatonin Magnesium Selenium Oxytocin Correct Answer: 1 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 4 For a disorder to meet the criteria for the diagnosis of an eating disorder, all of the following must be present except that: The problem interferes with the person’s daily life The person does not maintain a normal weight Significance is placed on body weight and shape The person engages in inappropriate episodes of eating Correct Answer: 3 Copyright © 2013 by Elsevier Inc. All rights reserved.

Copyright © 2013 by Elsevier Inc. All rights reserved. Question 5 Untreated eating disorders have what type of mortality rate? Insignificant Small Moderate High Correct Answer: 4 Copyright © 2013 by Elsevier Inc. All rights reserved.