1. Eating Disorder West Coast University NURS 204 December 18, 2009

2. Sociocultural Factors Cultural stereotypes Preoccupation with the body Cultural ideal of thinness Identity and self-esteem are dependent on physical appearance

3. Female Attractiveness Equated with thinness, physical fitness Media glamorizes thinness Thinness equated with success and happiness Prejudice against overweight Self-esteem enhanced for those considered attractive

4. Male Attractiveness Ideal body type is lean and muscular Emphasis on strength and athleticism Less popular if they do not have the ideal body type

5. Biologic Theory There may be a genetic predisposition for anorexia. Relatives of clients with eating disorders are 5 to 10 times more likely to develop an eating disorder.

6. Psychological Factors Perfectionism Social and affective insecurities Low self-esteem Immaturity Sense of ineffectiveness Interpersonal distrust Poor conflict resolution Depression Obsessive-compulsive disorder

7. Psychosocial Pressures Frequent exposure to articles about dieting is significantly associated with lower self- esteem, depressed mood, and lower levels of body satisfaction. Occupations, such as modeling or ballet dancers Athletes, gymnastics

8. Psychosocial Considerations Use of anabolic steroids Increased risk for gay or bisexual males Predominately an issue in industrialized, developed countries Not solely a problem of specific cultural groups

10. Neurotransmitters affect eating disorders Serotonin Low levels: increase food intake High levels: decrease food intake Increase eating behavior: Norepinephrine Neuropeptide Y Suppresses food intake: Dopamine

11. Eating Disorders Anorexia nervosa and bulimia nervosa are not single diseases, but syndromes with multiple predisposing factors and a variety of characteristics.

12. Characteristics of Anorexia Nervosa Extreme perfectionism Fear of gaining weight Significant weight loss Body image disturbance Strenuous exercising Peculiar food handling practices Rigidity and control

13. Physical Manifestation of Anorexia Nervosa Reduction in the following: Heart rate Blood pressure Metabolic rate Production of estrogen or testosterone Body temperature

14. Physical Symptoms of Anorexia Nervosa Weight loss 15% below ideal Amenorrhea Cachexia Sunken eyes Dry skin Lanugo on face Constipation Cold sensitivity

15. Psychological Symptoms of Anorexia Nervosa Denial of low weight Body image disturbance Irrational fear of weight gain Preoccupied with food and cooking Delayed psychosexual development

16. Bulimia Nervosa Cyclical condition Episodes of binge-eating and purging Skipping meals sporadically Strict dieting or fasting

17. Physical Symptoms of Bulimia Nervosa Fluid and electrolyte imbalances Cardiovascular Symptoms Endocrine Symptoms Gastrointestinal Symptoms

18. Psychological Symptoms of Bulimia Nervosa Body image disturbance Persistent over concern with weight, shape and proportions Mood swings, irritability Self-concept influenced by weight

19. Binge-Eating Disorder Eating significantly larger-than-normal amounts in a discrete time period, until uncomfortably full Sense of lack of control No compensatory purging

20. Assessing Clients Willingness for treatment Treatment history Dramatic weight loss or gain Medical history and physical examination Patterns and perceptions regarding weight Body dissatisfaction and image distortion Physical symptoms Denial

21. Assessment Continued Assess: Dieting history Binge eating Feeling regarding binge behavior Food cravings Purging behaviors Menstrual history Medical side effects Co-morbidity factors

22. Nursing Diagnosis: NANDA Anorexia: Imbalance nutrition: Less than body requirements Disturbed body image Chronic low self-esteem Anxiety Bulimia Nervosa: Ineffective coping Deficient fluid volume Chronic low self-esteem

23. Outcome Identification: NOC Be free of self-harm Adequate nutrients taken into the body for height, frame, gender, and activity level Manage stressors, ability to self-restrain compulsive or impulsive behavior, ability to acquire, organize and use information Positive perception of own appearance and ability to self-restrain altered perception Verbalize understanding of underlying psychological issues

24. Planning and Implementing: NIC Manage nutrition Establish adequate eating patterns and fluid and electrolyte balance Assume a calm, matter-of-fact attitude Gradual weight restoration Tube feeding or intravenous therapy Weigh the client daily Record intake and output Observe client during meals Observe bathroom behavior

25. Nursing Interventions Help increase client understanding of treatment plan. Emphasize client capability to eat small portions without binging. Avoid power struggles. Intervene with anxiety. Give positive feedback for adherence to plan. Engage in group therapy. Assist to identify issues (e.g., esteem, identity disturbance). Collaborate with dietician to teach nutrition. Collaborate with interdisciplinary staff.

26. Goals - continued The overall goal of treatment for the individual with anorexia nervosa is gradual weight restoration/ A target weight is usually chosen by the treatment team in collaboration with a dietitian. Target weight for discharge from treatment is usually 90% of average for age and height.

27. Goals - continued The goal of nursing interventions with anxious clients with bulimia is to help them: Recognize events that create anxiety Avoid binge eating and purging in response to anxiety Verbalize acceptance of normal body weight without intense anxiety

28. Goals - continued Providing basic nutritional education is the goal of interventions with clients that have a knowledge deficit in this area.

29. Nursing Interventions: Client with Anorexia Nervosa Help the client to learn more effective ways of coping with the demands of life. Tube feeding Intravenous therapy Weighing the client daily Observing bathroom behavior Recording intake and output Observing the client during meals

30. Nursing Interventions: Client with Bulimia Nervosa Managing medications Reducing anxiety Managing fluids and electrolytes Facilitating coping Mobilizing the family

31. Pharmacologic SSRIs Reduce binge eating and vomiting Symptom control Anxiety Depression Obsessions Impulse control

32. Psychotherapeutic Treatment Modalities Individual psychotherapy Family Therapy Group Therapy Behavioral Contracts Exposure and response prevention Cognitive Reframing Cognitive restructuring

33. Adjunctive Therapy Occupational therapy Nutrition education and counseling Interdisciplinary treatment team Community support groups

34. Prevention Nurses in community-based settings can play a valuable role in: Education Support Referral

35. Screening and Education Nurses can provide screening and education in schools, clinics, homes, health fairs, health clubs Individuals at risk: low self-esteem, irrational behavior related to food, excessive exercise, and other factors

36. Prevention and Screening Important to understand cultural factors contributing to eating disorders Nurses can implement primary prevention and secondary screening measures

37. Review Question What sociocultural factor has contributed to the increased incidence of eating disorders? 1.Increased knowledge about food and diet 2.Availability of a variety of foods throughout the year 3.Young people dating at earlier ages 4.Pressure on being thin and slim

38. Review Question When assessing the client with anorexia or bulimia, the nurse must be aware that the client is more likely to suffer from which of the following comorbid psychological conditions? A. Psychotic disorders B. Avoidant personality disorder C. Schizophrenia D. Depression

39. Review Question Which of the following physical findings would lead the nurse to suspect that the client has bulimia nervosa? A. Lanugo growth on face and extremities B. Sunken eyes C. A skeletal appearance D. Abrasions and calluses on the knuckles

40. Review Question A client with an eating disorder is trying to develop new coping skills. The process the nurse can use to help family members as they support the client is to A. Teach the family how to manipulate the client's environment to avoid problem situations. B. Encourage the family to avoid discussing their feelings about the client's illness. C. Assist the family to challenge the client's behavior. D. Assist the family to explore their own coping strategies.

41. Review Question The client is diagnosed with bulimia nervosa. What is the most appropriate nursing intervention that focuses on purging behaviors? A. Provide frequent small meals. B. Observe the client for at least one hour after meals. C. Weigh the client after eating. D. Have the nurse eat with the client.