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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.