Eating Disorders

NUR 114
Module 5 Self
Introduction
The hypothalamus contains the
appetite regulation center within the
brain.
It regulates the bodys ability to
recognize when it is hungry and when
Introduction
Historically, society and culture also
have influenced what is considered
desirable in the female body.
Eating behaviors are influenced by:

______________
____________
Epidemiological Factors
Eating disorders are maladaptive
responses to stress/anxiety
characterized by obsessions with
food and weight.
Suffers deeply both emotionally and
physically
Low self-esteem, self-hatred, fear,
hopelessness
Epidemiological Factors
What is anorexia nervosa


What is bulimia nervosa
Epidemiological Factors
Obesity has been defined as a body
mass index that is 30 or greater
BMI >30
Nursing Process:
Application
Assessment
Anorexia nervosa
Characterized by a morbid fear of obesity.
Symptoms include gross distortion of body
image, preoccupation with food, and refusal
to eat.
Weight loss is extreme, >15%
Other symptoms include hypothermia,
bradycardia, hypotension, edema, lanugo, and
various metabolic changes.
Low self-esteem

Nursing Process:
Assessment
Anorexia nervosa
Amenorrhea is typical and may even
precede significant weight loss
Feelings of anxiety and depression are
common.
Nursing Process:
Assessment
Bulimia nervosa
Bulimia is the episodic, uncontrolled,
compulsive, and rapid ingestion of large
quantities of food over a short period of
time (bingeing).
Followed by inappropriate compensatory
behaviors to rid the body of excess
calories (self-induced vomiting or the
misuse of laxatives, diuretics, or
enemas).
Nursing Process:
Assessment
Bulimia nervosa
Fasting or excessive exercise may also occur.
Most patients with bulimia are within a normal
weight range, some slightly underweight, some
slightly overweight.
Depression, anxiety, and substance abuse are
common.
Excessive vomiting and laxative or diuretic
abuse may lead to problems with dehydration
and electrolyte imbalance.

TOOTH DAMAGE FROM
VOMITING
Etiologic Implications
Biological influences
Genetics: A hereditary predisposition to
eating disorders has been hypothesized.
Anorexia nervosa is more often found
among sisters and mothers of those with
the disorder than among the general
population.
Etiologic Implications (cont.)
Biological influences
Neuroendocrine abnormalities. Some
speculation exists about a primary
hypothalamic dysfunction in anorexia
nervosa.

Etiologic Implications
Psychodynamic influences
Suggest that eating disorders result
from very early and profound
disturbances in mother-infant
interactions that result in:
disrupted ego development
Unfulfilled sense of separation-
individuation
Etiologic Implications
Psychodynamic influences
Some researcher consider these obsessive-
compulsive disorders
Client has difficulty separating & individuating
from their families
See ambivalence & unexpressed anger
Family history may show that food is used to
express love or gain control
Clients often well-behaved, perfectionist youths
who restricted their personal feelings & did not
verbally communicate them
Clients have a self sacrificing attitude

Nursing Process:
Diagnosis
Altered nutrition less than body
requirements; fluid volume deficit, related
to refusal to eat/drink; self-induced
vomiting; abuse of laxatives/diuretics
Outcome: client will achieve 8085% of
normal body weight and be free from signs
and symptoms of malnutrition/dehydration
NURSING INTERVENTIONS
Nursing Process:
Interventions
Explain to the client that privileges
and restrictions will be based on
compliance with treatment and
direct weight gain.
Do not focus on food and eating.
Weigh client daily, immediately on
arising and following first voiding
Nursing Process:
Interventions
Always use same scale when possible.
Keep strict record of intake and
output.
Stay with client during established
time for meals (usually 30 minutes)
and for at least 1 hour after meals.
Planning and Implementation
Nursing care is aimed at restoring
nutritional balance.

Emphasis is also placed on helping the
client gain control over life situation
Planning and Implementation
Self-esteem and positive self-image
are promoted in ways that relate to
aspects other than appearance.
Treatment Modalities
Behavior modification
Issues of control are central to the
etiology of these disorders.
For the program to be successful, the
client must perceive that he or she is in
control of the treatment.
Treatment Modalities
Behavior modification
Successes have been observed
when the client:
Is allowed to contract for
privileges based on weight gain
Has input into the care plan
Clearly sees what the treatment
choices are
Treatment Modalities
Behavior modification
The client has control over:
Eating
Amount of exercise pursued
Whether or not to induce vomiting
Staff and client agree about:
Goals
System of rewards
Treatment Modalities
Behavior modification
The client has a choice of whether
or not to:
Abide by the contract
Gain weight
Earn the desired privilege
Treatment Modalities

Individual therapy is helpful when
underlying psychological problems are
contributing to the maladaptive
behaviors.
Treatment Modalities
Family therapy involves:
Educating the family about the disorder
Assessing the familys impact on
maintaining the disorder
Assisting in methods to promote normal
functioning of the patient
Treatment Modalities
Psychopharmacology
No medications are specifically indicated
for eating disorders.
Various medications have been
prescribed for associated symptoms,
such as anxiety and depression.
Case Study
Janice, a high school sophomore

What will be the primary consideration
in her care?
How will treatment be directed toward
helping her gain weight?
How will the nurse know if Janice is
using self-induced vomiting to rid
herself of food consumed at meals?
Which client with an eating disorder would be at
greatest risk for hypokalemia?
a. An anorexic who loses weight by restricting
food intake
b. A bulemic who purges to promote weight loss
c. A non-purging bulimic
d. Eating disorder clients who are at risk for
hyponatremia rather than hypokalemia

Which medication is likely to be used in treatment
of clients with eating disorders?
a. An SSRI such as fluoxetine
b. A neuroleptic such as respirdone
c. An anxiolytic such as alprazolam
d. An anticonvulsant such as carbamazepine.

Which risk factor for eating disorder is most
commonly identified in the histories of
adolescents with eating disorders?
a. Dieting
b. Purging
c. Overeating
d. Excessive exercise

The nurse assesses a female client with
anorexia nervosa and identifies which of
the following physical symptoms
characteristic of this disorder?
a. Decreased pulse and blood pressure
b. Elevated temperature
c. Increased basal metabolic rate
d. Oily hair and skin
A personality characteristic that the nurse expects
to find in a client with anorexia nervosa is
a. Anger
b. Compliance
c. Rebellion
d. Suspicion


An adolescent client tells the nurse that she
frequently feels compelled to eat a large amount of
food in a small amount of time. The nurse
identifies this problem as characteristic of which of
the following?
a. Anorexia
b. Bulimia
c. Overeating
d. Compulsiveness

Which of the following questions would be most
appropriate for the nurse to ask a client who is
suspected to have an eating disorder of bulimia
nervosa?
a. Do you feel you have a problem controlling
your weight?
b. Do you use diet pills, diuretic, laxatives, or
purging to lose weight?
c. Do people tell you that you are too fat?
d. Do you eat only when you are hungry?