Mental Health Fall '12

1. Eating
Disorders
Renee Franquiz MSN, RN

2. Eating Disorders
 Anorexia Nervosa

Bulimia Nervosa
 Eating disorder not otherwise specified
(NOS)
 Binge eating

3. Theories
 Neurobiological: altered neurotransmitters
 Neuroendocrine: abnormalities, hypothalmic
dysfunction

Genetic: there is a heriditary predisposition to
developing disorders

Psychodynamic Influences/ Family Relationships

4. More theories
 Psychological: feelings of low self- esteem/
harsh self judgement due to feelings of
doubt
 Sociocultural: Increases in societies where
women have a choice in role models
 Genetic: strong link for eating disorders

5. Clinical Presentation
 Anorexia:

Terror of gaining weight
 Preoccupied with thoughts of food
 View self as fat

Peculiar handling of food
 Exercise obsessed

May use vomiting/ diuretics
 Determines self worth through weight

6.  Bulimia:
 Binge eating
 Self-induced vomiting
 May have a hx of anorexia
 Depressive signs
 Problems with interpersonal relationships. Self
concept, and impulsive behaviors

7.  Anorexia  Bulimia
 Low weight  Usually normal weight
 Amenorrhea  Tooth erosion
 peripheral edema  Calluses on hands
 Constipation  Electrolyte imbalance
 Cardiac px  failure
 BP
 failure

8.  Client with Anorexia
 Perfectionisn
 Obsessive thoughts and actions relating to food
 Need to control
 Therefore, MUST build a trusting empathetic
relationship

9.  Assessment
 malnourished, underweight,lanugo on face, mottled skin,
dehydration
 Nursing Diagnosis
 Imbalanced Nutrition : less than body requirements…
 Decreased cardiac output
 Disturbed body image
 Planning
 Inpatient vs Outpatient
 Refeeding Syndrome
 Stabilize first if pt is under 75% idea weight or with extreme
electrolyte imbalance
 Outpatient therapy then begins

10.  Acute phase/ basic level
 Milieu therapy (precise meal times, observation,
weigh ins)
 Counseling (to deal with cognitive distortions)
 Health Teaching (self care)
 Coping skills
 Learning to shop and choose food
 Eating forbidden foods

11.  Psychotherapy
 For not only pt but family as well
 Psychopharmology
 Prozac ( increases mood which may directly affect
disorder)
 Zyprexa (decreases agitation and obsessive
behaviors)
 EVALUATION : If weight fails below goal.. Methods
are revised.

12.  Bulimia
 These clients are sensitive to the perceptions of
others
 May feel: shame, low self-esteem, unworthiness
 Must build an empathetic and trusting
relationship to be successful in helping these
clients

13.  Assessment:
 May not appear ill, normal weight
 Dental erosion
 Family relationships may lack nurturing
 May have hx of impulsive behaviors (stealing
etc)
 Electrolyte imbalance
Diagnosis
Risk for injury due to ineffective coping

14.  Outcome Criteria
 Short vs long term: electrolyte / acid base
balance
 Planning: tx life threatening complications
 May be at risk for suicidal tendencies
 Begin treatment to deal with issues leading to
bulimia and prepare for discharge therapies

15.  Acute phase:
 Milieu therapy: interrupt binge/purge cycle
 Counseling
 Health teaching
 Long term treatment:
 Psychotherapy
 Psychopharmacolgy (Prozac)

16.  Normalize eating habits
 Maintain regular exercise plan
 Weight in normal range for height

17.  A different type of compulsive overeating
 Reported in 20-30% obese clients
 Major depression
 Most effective treatment is cognitive-
behavioral therapy
 SSRI’s (Zoloft) used to reduce binging