PowerPoint Slideshow about 'Chapter 18 Eating Disorders' - libitha
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Eating disorders can be viewed on a continuum: the anorexic eats too little or is starving, the bulimic eats in a chaotic way, and the obese person eats too much. There is much overlap among the eating disorders: 50% of clients with anorexia exhibit bulimic behavior and 35% of normal-weight clients with bulimia have a history of anorexia. More than 90% of cases of anorexia nervosa and bulimia occur in females.
Characterized by recurrent episodes of binge eating(uncontrollable craving for food), inappropriate compensatory behaviors to avoid weight gain (purging: self-induced vomiting, use of laxatives, diuretics, enemas, emetics, fasting, excessive exercise).
Binge eating is done in secret and the client recognizes the eating behavior as pathologic, causing feelings of guilt, shame, remorse, or contempt. Clients with bulimia are usually in normal weight range but may be underweight or overweight.
Generally client is supervised during meals to ensure eating and after meals while using bathroom to prevent purging. Up 2 hours after closely watched. Nurse will sit quietly with client while he or she eats.
Weight gain and adequate intake are often criteria for judging treatment effectiveness.
Many drugs have been studied and tried, but few show success. Fluozetine (Prozac) may help prevent relapse but only when weight has been gained because it can cause weight loss due to appetite suppressant.
Family therapy- resolve family conflicts-restoring control issues
Most clients are treated on outpatient basis; inpatient only if bingeing and purging behavior is out of control or medical status is compromised
Cognitive-behavioral therapy has been effective; designed to change client’s thinking and actions about food, eating, weight, body image, and self-concept-Have client write about all feelings and experience related to food-self- monitoring.
Medications are marginally effective; antidepressants do improve mood, reduce preoccupation with shape and weight, reduce bingeing and purging behaviors
Many assessment tools have been developed to identify eating disorders and measure progress toward achieving outcomes.
History: Client with anorexia is described by parents as a model child, no trouble, dependable, before onset of anorexia. Clients with bulimia are eager to please and conform, avoid conflict, but may have history of impulsive behavior. Self imposed dieting-leading to severe weight loss.
General appearance and motor behavior: Clients with anorexia are slow, lethargic, even emaciated; slow to respond to questions, difficulty deciding what to say, reluctant to answer questions fully; often wear baggy clothes or layers to hide weight or keep warm; limited eye contact; unwilling to discuss problems or enter treatment. Clients with bulimia generally have a normal appearance, are open and talkative.
Mood and affect: Moods are labile, corresponding to eating or dieting behavior. Clients with anorexia may look sad and anxious and seldom smile or laugh. Clients with bulimia are initially cheerful but express intense emotions of guilt, shame, and embarrassment when discussing bingeing and purging behaviors.
Ask clients with eating disorders about suicidal ideas and self-harm urges; both are common.
Thought processes and content: Clients spend most of their time thinking about food, dieting, food-related issues. Body image disturbance can be almost delusional. Clients with anorexia may have paranoid ideas about their family and health care professionals being the “enemy,” trying to make them fat.
Sensorium and intellectual processes: generally alert, oriented, intact; exception is the severely malnourished client with anorexia, who may have mild confusion, slowed mental processes, and difficulty with concentration and attention.
Judgment and insight: Clients with anorexia have very limited insight and poor judgment about health status. Giving factual information has no effect. Restrictive dieting continues despite failing health and malnutrition. Clients with bulimia have insight into the pathologic nature of their eating behavior but feel out of control and unable to change that behavior.
Self-concept: Low self-esteem is prominent in clients with eating disorders; they see themselves only in(anorexic’s) terms of their ability to control food intake and weight and judge themselves harshly and see themselves as “bad” if they eat certain foods or fail to lose weight. Other personal characteristics are overlooked or ignored. Clients see themselves as powerless, helpless, and ineffective.
Roles and relationships: Eating disorders interfere with clients’ abilities to fulfill roles and have satisfying relationships. The client with anorexia may have failing grades in school, in sharp contrast to previous high-level performance. She withdraws from her peers, believing others will not understand. The client with bulimia is ashamed of bingeing and purging and hides it from others. The amount of time spent buying and consuming food can interfere with role performance at work and home.
Physiologic and self-care considerations: Client’s health status is directly related to severity of self-starvation and purging behavior. Excessive exercise may lead to exhaustion. Many clients have trouble sleeping. Frequent vomiting causes sores in the mouth and dental problems.( need good oral hygiene) Thorough medical evaluation is essential.
In addition to outpatient treatment, includes individual or group therapy and self-help groups
Prevention and early detection are essential.
Nurses play a key role in educating parents, children, and young people on issues of unrealistic “ideal” images in the media: realistic ideas about body size and shape, resisting peer pressure to diet, improving self-esteem, coping strategies for dealing with emotions and life issues