EATING DISORDER
➢ Type of mental illness that involves unhealthy
thoughts and behavior towards, weight and
body.
I. Introduction
An eating disorder is more than just about food.
It is a type of mental illness that involves unhealthy
thoughts and behavior towards food, weight and body
shape.
II. Core Content of the Chapter
Terminology:
1. Pica – Ingestion of non-nutritive and non-edible
substances.
2. Ruminating – Repeated regurgitation and
rechewing of food.
3. Feeding disorder – It is the failure to eat
adequately.
4. Binge – Eating of unusual large amount of food
in a relatively short period of time.
5. Purge – To eliminate food by inducing vomiting,
enema, laxative and diuretics.
6. Emaciated – A person made excessively thin by
the lack of nutrition.
7. Bulimia – A disorder characterized by binge
eating, over concerned with body shape and
weight.
8. Anorexia – A disorder characterized by
restrictive eating resulting in emaciation,
disturbance in body image and intense fear of
becoming obese.
9. Obesity – It is the consumption of more calories
than what the body needs.
Etiology:
1. Biological factor – A person with a mother or
sister who has had anorexia nervosa are likely
to develop the disorder.
2. Psychological factor – A person with eating
disorder tends to be perfectionist, with
unrealistic expectation of themselves and
others.
3. Family factor – Some person with eating
disorder belongs to overprotective family
4. Social factor – A person who are into
relationship that they need to be thin to be
continually accepted.
5. Cultural pressures – In westernized country
where female are pressured to be thin to be
accepted.
6. Media factor – People who are happy and
successful are almost always portrayed by
actors or models who are young, thin and toned.
7. Lifestyle – People who are socialites, dancers,
models, gymnast, actress, entertainers and
male homosexuals.
8. Physical and sexually abused – Person who
usually survived tends to have eating disorders.
NURSING DIAGNOSIS:
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Alteration in health maintenance
Altered nutrition: less than body requirement
Altered nutrition: more than body requirement
Anxiety
Body image disturbances
Ineffective family coping: compromised
Ineffective individual coping
Self-esteem disturbances
ANOREXIA NERVOSA
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Refusal to eat
The relentless pursuit of thinness
Weight phobia
Causes:
➢ Serotonin – something to do in mood; appetite,
pain
➢ Dominant Mother – “Do no”
➢ Disturbances in the hypothalamus – regulate
sexual arrives, eating habits
Characteristics:
➢ Obsessive
➢ Underweight – 15% normal weight; 200 to 400
calorie/day
➢ Adolescent
➢ Introvert/low self esteem
➢ Denies disorder – denial
➢ Deceitful vomiting, enema, diuretics, laxatives –
manipulate induce vomiting
➢ Perfectionist
➢ Suicidal, sleeps 2 – 3 hours
➢ People pleaser – to family “mama”: One need to
please everybody (purge)
➢ Dichotomous thinking – thinking the opposite of
what the look like the think they are fat
Effects:
➢ Emaciated – not enough nutrients
➢ Constipation – not enough water
➢ Decrease libido – no energy
➢ Dry skin/ falling hair – decrease nutrients
➢ Amenorrhea – imbalanced hormone
➢ Electrolyte imbalances – lack of food; decrease
vitamin K so, Check intake before medication;
Correct electrolyte imbalances before
medication.
➢ Susceptible to infection
➢ Death due to cardiac arrest – lack of potassium;
feed first proceeding to any psychotropic drugs;
correct electrolyte imbalances
Behavior:
➢ Adolescent and young est female child are often
affected.
➢ They use denial, don’t accept that they have
problem. They are more difficult to treat.
➢ 10-20% die and half of them are suicidal.
➢ They eat in social functioning but purge
themselves. But avoids social functions
gradually.
➢ As a child, they are chubby or overweight
➢ A perfect girl, ideal, conscientious, hardworking
and people pleasers
➢ A person with low tolerance to changers and
cannot adjust to new situation.
Dependent to family.
➢ Focus in losing weight.
➢ Depress, irritable, withdraws and decrease
libido,
➢ As disorder progresses they become deceitful,
stubborn, hostile and manipulative.
Nursing Care
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Convey warmth sincerity (Trust)
Monitor input and output (Purge)
Listen (Afraid to show emotions)
Be honest (Distrustful)
Set Limits (manipulative)
Teach patient about the disorder (Denial)
Avoid long science (Rejection)
Be consistent (Trust)
Daily height taking (not facing the scale)
Involve family treatment
Positive reinforcement (weight gained)
Nursing management:
1.
2.
3.
4.
Use reinforcement to help patient gain weight.
Acceptance and nonjudgmental
Listen to the patient
Be honest
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Avoid long silence
Close observation
Weigh patient not facing the weighing scale.
Set limits
Let them participate in the planning process.
Teach them about their illness.
Be consistent
Involve family in the treatment
How to establish eating pattern:
1.
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Sit with the patient during meals and snack time
Offer CHON and CHO food patient prefers
Adhere to the treatment program
Observe patient after meals/snacks
Be aware they hide or discard food
Medication: Antidepressant after electrolyte imbalance is
corrected.
First is to correct electrolyte imbalances
Then give “Anti-depressant” (SSRI [BECAUSE
SHOWS LESS SIDE EFFECTS] or mood
elevators) 1st line of meds to give because the
show less effects; if not progressing; TCA
tricyclic anti-depressant; MAO Inhibitors
Prozac, Zoloft, Paxil – (2 to 4 weeks’ full effect)
(2 weeks, wash out period)
If pregnant, start with lowest milligram – causes
cleft palate
Do not overlap drugs (can cause death)
Wait for wash out period before starting another
meds
Side Effect
➢ Nausea (Administer w/ meals)
➢ Diarrhea (low dosage/ hydration) – how many
times
➢ Insomnia (adjust time of intake) – not to disturb
sleep – check patter of sleep
➢ Dry mouth (Waller/candy) - let the doctor know
Drug Interaction
1. TCA – toxic sa blood
2. MAO – fatal
3. Lithium – increase serotonergic effect (check
lithium average first before and it should be
normal)
Side Effect: drooling, slow movement
- check for lithium level if abnormal don’t give.
4. Antipsychotic – increase EPS abnormal
involuntary movement scales (AIMS)
Therapy:
➢ Individual Therapy – denial
➢ Family Therapy – Strict mother
➢ Group Therapy – 10 or less person
BULIMIA NERVOSA
“diet- binge- purge disorder”
Effect:
➢ Eating a large amount of food in a short period
of time
➢ A binge – purge eating disorder – continue
eating even mot hungry
Tension
and
Cravings
Binge
Eating
Purging
to avoid
weight
gain
Cause:
➢ Increase Serotonin
➢ Lack of care from family (Rebelling from family)
Characteristics:
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Dental Problem
Vomiting
Use and abuse of laxatives, pills and diuretics
Increase peristalsis
Rectal bleeding
Constipation
Nursing care:
Strict
Diet
Shame
and
Disgust
➢ Hoarding
➢ Binge can be controlled at times by the patient.
➢ After an episode they become guilty for
uncontrolled urge and purges by cleansing.
➢ Aware of the disorder and ashamed
➢ 8,000 calories in 2 hours or 50, 000 calories in a
day
➢ Russell’s sig- old and new scars (knuckles)
Obsessive compulsive
Normal/over weight
Late adolescent, earl adulthood
Extrovert/low self esteem
Behavior:
➢ Late adolescent and early adulthood
➢ Occurs after a period of dieting.
➢ Belongs to a family that places great value on
one’s appearance
➢ They try to be thin to be accepted.
➢ Extrovert, low self-esteem and self-destructive.
➢ Depress, perfectionist, ashamed, feeling of
emptiness, highly dependent on the approval of
others to maintain self-esteem.
➢ They feel unworthy, cannot talk about their
feelings, with deeply buried anger
➢ Uncontrolled impulses.
1. Accept patient as worthwhile person
2. Encourage patient to discuss positive qualities
about themselves
3. Inform patient to approach a nurse when they
feel urge to binge
4. Encourage group activity
Nursing management:
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12.
Use reinforcement to help patient gain weight.
Acceptance and nonjudgmental
Listen to the patient
Be honest
Avoid long silence
Close observation
Weigh patient not facing the weighing scale.
Set limits
Let them participate in the planning process.
Teach them about their illness.
Be consistent
Involve family in the treatment
Medications:
Antidepressant
➢ Selective Serotonin Reuptake Inhibitors (SSRI),
less side effect
- Mood elevators
- Tofranil or Prozac
- Note: 2-4 weeks full effect
Therapy:
➢ Family Therapy
➢ Behavioral Therapy
Patient with this kind oof disorder is willing to be treated
so they cooperate
CHARACTERISTIS OF ANOREXIC FROM THE
BOLIMIC CLIENT:
Appearance
Age
Family
Character
Awareness
ANOREXIC:
Decrease
normal weight or
underweight
14-18 years old,
they
are
younger.
Rigid/controlled
BULIMIC:
Normal weight or
overweight
15-25 years old,
they are older
More conflicts,
violent
Introvert/isolates Extrovert/sexually
active/on
drugs/stealing
Denies
Aware of the
disorder
Side Effects of Stabilization:
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abdominal discomfort
edema
constipation
food
swelling of fingers
feels bloated
immediate weight gain
craving for particular
diarrhea
digestive distress
OBESITY
Etiology:
1. Lack of adequate variety of food to eat.
2. Side effects of steroids.
3. Compulsive eating.
Types of obesity:
1. Developmental – obese since childhood.
2. Reactive – maladaptive, occur later, used as
coping styles when in stress.
NURSING MANAGEMENT:
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Assess suicidal thoughts
Assess depression.
Provide one on one session.
Provide activity.
Provide group activity.
Other Eating disorders and related problems:
➢ PICA - behavior occurs between 2-3 yrs. and at
least one month. Possible cause: MR, neglect,
poor family supervision
➢ ANOREXIA ATHLETICA - Obsessed with
exercise and engaged in it beyond the
requirements for good health.
➢ MUSCLE DYSMORPHIA (bigorexia) - a
disorder opposite anorexia. Client worry
excessively that they are too small, undeveloped
and frail muscles.
➢ ORTHOREXIA NERVOSA - a pathological
fixation on eating “proper, pure or superior” food.
➢ NIGHT EATING SYNDROME - lack of appetite
for breakfast because client is preoccupied
eating late in the day or night.
➢ NOCTURNAL SLEEP-RELATED - a client who
eats while asleep.
➢ RUMINATING SYNDROME - a client eats,
swallows and regurgitates food back into the
mouth, chewed and swallowed.
➢ GOURMAND SYNDROME - an obsession with
fine food including its purchase, preparation,
presentation and consumption.
➢ PRADER-WILLI SYNDROME - a congenital
problem usually associated with M.R which
includes incessant eating. Mental- retardation