NUR 256 Exam 4: Review Notes on Feeding and Eating Disorders

Review for Exam 4

Chapter 18 Feeding, Eating & Elimination Disorders

Eating Disorders
oAnorexia nervosa
Doesn’t eat, has a need for control and feels powerlessness
Found in household that are more chaotic and relationships are strained.
Always see themselves as overweight.
Push it around the plate & over exercise.
Laxatives or regurgitation.
Fear of gaining weight
Distorted body image
Restricted calories and low BMI
Comorbidities
Bipolar
Depressive
Anxiety
OCD
oBulimia nervosa
Eats a whole lot at one time and then purges via self-induced vomiting, often hasn’t achieved a status in life
that person had hoped to achieve, feels powerlessness.
As coping
More normal weight in appearance.
Recurrent episodes of uncontrollable binging
Inappropriate compensatory behaviors, vomiting, laxatives, diuretics, or exercise
Self image largely influenced by body image
Etiology
oBiological factors
Genetics – strong genetic link 60% inheritiable
Neurobiological – altered use of serotonin, perfectionists traits & OCD
oPsychological factors – currently, some say it is a learned behavior that has (+) reinforcement
Symptoms as a defense against a feeling of ineffectiveness and powerlessness
oEnvironmental factors – culture and how we see beautiful women as tall and thin
oThis represents the diathesis stress model where the disorder can be caused from genetic disposition and/or
environmental stressors
Anorexia Nervosa Nursing Process
oAssessment

Box 18.2 Thoughts & Behaviors Associated with Anorexia
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
Peculiar handling of food, cutting food into small bits
Pushing pieces of food around plate
Possible development of rigorous exercise regimen
Possible self induced vomiting, use of laxatives and diuretics
Cognition so disturbed that individual judges self worth by their weight

weight loss of 30% or more in 6 months, rapid decline in weight.
Hypothermia, decreased HR, low systolic criteria for admission.
 Electrolytes and arrhythmias and become suicidal or hurting themselves.
Must gain 2 lbs a week and then things may have things taken from them.
oNursing diagnosis
oOutcomes identification
oPlanning

, Immediate medical stabilization if experiencing extremem fluid electrolyte imbalance
Weighs below 75% of ideal body weight
Less than 10% fat
HR less than 50 bpm
Systolic less than 90
Temp less than 96 and arrhythmias
oImplementation
oEvaluation – is it effective?
Assessment: Clinical Picture
oUnder-nourished
oUnder-weight
oSunken eyes
oSagging skin
oPoor skin turgor
oAmenorrhea
oBradycardia
oElectrolyte Imbalance
oDisturbed Body Image
oDehydration
Addressing physiological needs FIRST
oPatient may need TPN & fluids
May be resistant
DO NOT DISCUSS WHAT THEIR WEIGHT IS
Nursing Diagnosis
oAlterations in nutrition; less than body requirements
oLess Than Body Requirements r/t decrease intake
oBody Image Disturbance – takes longer
oAlterations in (or potential for) skin integrity r/t cellular starvation
oIneffective Coping
Outcome
oThe client will gain a minimum of 2 pounds per week.
oTherefore, privileges and restrictions are based on compliance with treatment as evidenced by weight gain
Anorexia Nervosa Interventions
oAcute care
Medical Intervention- What has to be treated?
Psychosocial interventions- What are the considerations?
Pharmacological interventions- What might be ordered for this client?
Integrative medicine- What does integrative mean?
Health teaching and health promotion- Topics to discuss?
Safety and teamwork- NPSG stick to menu
oPsychological needs need to be met first
oPsychosocial – investigate home life,
oNo meds SSRI helpful with OCD part
oYoga, acupuncture
oUnderstanding what is happening to their body that they are doing
oMonitor their bathroom
Nursing Interventions
oWeigh each morning after 1st void with the same amount of clothing on each morning
oSmall, frequent feedings (shift in electrolytes)
Refeeding syndrome
oProvide protein shakes (muscle)
oMonitor intake
oAccompany to bathroom for at least up to 1 hour after meals
oAdm. meds as ordered
oWeigh daily/weekly/as ordered
oParticipant in the milieu
oParticipant in group
oIndividual, family, and group therapy
oHealth and nutrition teaching

, oAlternative, adaptive, coping skills
oProblem solving skills
oLimit exercise (may do yoga)
Advanced Practice
oPsychotherapy
Individual therapy
Group therapy
Family therapy
Bulima Nervosa Nursing Process
oAssessment
Not going to look ill
May be overweight or at healthy weight
Cavities or dental erosion
Swollen carotid glands puffy cheeks
Russells sign calluses on fingers from GI secretions
Swollen feet and hands
Shifts in electrolytes
ekg changes
oComorbidities
At least one psych disorder
Depression, bipolar anxiety
oUsing the nursing process assist the nurse in developing the plan of care
oThese patients know it is unacceptable and they try to hide it
Assessment
o“fluffy”
oAppears healthy looking
oS/S
 Vomiting
 Dehydration
 Electrolyte Imbalance
oThese symptoms will result in visual hallucinations, restlessness, and dry MM’s
oPsychosis from dehydration & electrolyte shifts

Box 18.3 Thoughts & Behaviors with Bulimia
Binge eating behaviors
Often self induced vomiting or laxative or diuretic use after binging
Hx of anorexia in1/3 or ¼ of individuals
Depressive s/s
Problems with interpersonal relationships, self concept, impulsive behaviors
Increased levels of anxiety and compulsivity
Possible substance use disorders
Possible impulsive stealing

Bulimia Nervosa Interventions
oAcute care (inpatient)
Teamwork and safety – primary goals the interruption of binge purge cycle. Including observation during
and after meals, normalization of eating patterns, maintenance of appropriate exercise.
Pharmacological interventions – antidepressants with CBT
Counseling
Health teaching and health promotion – meal planning, realization techniques, maintenance of a healthy
diet and exercise, coping skills, physical and emotional affects of binging and impact on cognitive
distortions
oAdvanced practice interventions
Psychotherapy
oCoping mechanism
o2 other functional coping mechanisms before d/c
oMeds – antidepressants
Outcome
oAlways linked to the diagnosis
oIdentify 2 alternative coping mechanisms besides eating.