Eating Disorders

Bulimia Nervosa
Anorexia Nervosa
 Eating Disorders
Significant health problem among children,
adolescents and young WOMEN
1% of young women ages 12 to 25
affected by anorexia nervosa
Eating Disorders: Epidemiology
Affects more women than men
Depression commonly affects the clients
Anorexia= 1%
Bulimia= 3-5%
 Eating Disorders: Etiology
Biological factors= postulated changes in
the neurotransmitters
Psychoanalytical= disturbed
relationships, usually between mother
and child, distorted body image with
misperception of internal needs and
anxiety control is by body control.
 Eating Disorders: Etiology
3. Socio-cultural= thinness is promoted by
media and culture
4. Cognitive-behavioral= obsessive
compulsive behavior and avoidant
behavior are vulnerable to eating
disorders
5. Physical and sexual abuse
 Eating Disorders:
Distortions attributed to eating disorders
Selective abstraction = “I’m still fat”
Superstitious thinking
 Eating Disorders:
Anorexia Bulimia
Weight less than ideal Binge eating and
Intense fear of purging
becoming fat Binges commonly lead
Body image to feelings of loss of
disturbance control, guilt,
Engages in exercise humiliation
and peculiar food
habits
Lack of sense of control
Eating Disorders: Personality traits
Anorexia Bulimia
Resistance to Feeling of helplessness
acknowledging they
have a problem Variable moods=
fatigue, agitation
Hyper-rigid behaviors
Difficulty learning from Sense of loss of control
experience Low self-esteem
Inflexible thinking leading to self doubt
Social introversion Self-conscious
Limited social Sensitive to rejection
spontaneity from others
Eating Disorders: Personality traits
Anorexia Bulimia
Younger (18-20) Older (24-30 yo)
Unable to Weight fluctuates
maintain body considerably
weight at 85%
expected
Amenorrhea Amenorrhea
Starvation Binge eating
Intense fear of Fears loss of control
becoming obese
Eating Disorders: Personality traits
Anorexia Bulimia
Prefers HEALTH Prefers HIGH calorie
food foods
Preoccupation with Repeated CRASH
buying and
preparing foods dieting, use of
laxatives and
Rigorous exercise
diuretics
Views self as
OVERWEIGHT Aware that behavior
is ABNORMAL
 Anorexia Nervosa
A syndrome manifested by self-induced
starvation resulting from FEAR of fatness
rather than from true loss of appetite.
Onset: adolescent years
Female more than male
 Anorexia Nervosa
FEATURES of Anorexia Nervosa
Relentless pursuit of thinness
Amenorrhea
Refusal to maintain ideal weight
Distorted body image
Fear of loss of control
Alexithymia: lack of awareness, mistrust
of others and self, starvation-induced
depression
 Anorexia Nervosa
FEATURES of Anorexia Nervosa
The patient is pre-occupied with foods
that prevent weight gain and is fearful of
foods that increase weight
They are usually the achievers and
perfectionist

Death usually occurs from starvation,

suicide or electrolyte imbalance
 Anorexia Nervosa: FINDINGS
Physical Cold intolerance, constipation, lethargy
Symptoms
Physical Signs Younger, breast atrophy, dry skin, bradycardia,
hypotension, hypokalemia
Cardiovascular ECG abnormalities, Prolonged QT intervals,
complications myocardial damage
Hematologic Anemia and Leukopenia
Gastrointestinal Decreased gastric motility, delayed gastric
emptying
Renal Dehydration, polyuria and peripheral edema
Endocrine Amenorrhea due to starvation
Skeletal Osteopenia and skeletal fractures
Anorexia Nervosa: FINDINGS
Refusal to eat
Loss of appetite
Feelings of lack of control
Excessive exercise
Weight Loss
 Bulimia Nervosa
A syndrome of binge eating followed by
self-induced vomiting or “purging” that is
also accompanied by an excessive pre-
occupation with weight and body shape

More prevalent than AN

Has LATE onset than AN
 Bulimia Nervosa
The client indulges in eating binges followed
by purging behaviors
 Bulimia Nervosa
The measures to gain weight control
include use of laxative, cathartics,
enemas, and diuretics
The patient may resort to periods of strict
dieting, fasting and strenuous exercise
 Bulimia Nervosa
This disorder usually begins in late
adolescence and follows a chronic
course over many years
There is a HIGH rate of depression and the
families of the client may be overly pre-
occupied with food and physical
appearance
They tend to have less SUPEREGO control
 Bulimia Nervosa
Physical Features of the BN
Thin body with swollen cheeks due to
enlarge salivary glands
Signs of fluid retention
Erosion of the tooth enamel
Skin is dry with cuts and abrasions over
the knuckles (Russel’s sign)
Electrolyte imbalances
 Bulimia Nervosa
Features of the BN
Pre-occupied with body shape and weight
Consumes high calorie food in secret with guilt
about secretive eating
Attempts to lose weight through diets,
vomiting, laxatives enemas, cathartics,
amphetamines and diuretics
Low self-esteem and mood swings
Self-mutilating behavior: suicide thoughts and
attempts at suicide
 Other Eating Disorders
1. PICA= persistent eating of a non-nutritive
substance. This is considered acceptable
for children less than 18 months. This is
believed to be due to ZINC and IRON
deficiencies or related to lack of parenteral
supervision
 Other Eating Disorders
2. RUMINATION= eating disorder
characterized by repeated regurgitation of
food with resultant weight loss or failure to
gain weight

3. OBESITY
 The Nursing Process for Eating
Disorders
ASSESSMENT
Psychosocial assessment begins when
the nurse establishes a trusting
relationship with the client and
families
The nurse must identify the reason for
hospitalization and a complete family
assessment
 The Nursing Process for Eating
Disorders
ASSESSMENT
Other parts of assessment include a
biological history and medical history
Nutritional assessment is also very
important
PHYSICAL examination and laboratory
exams should be included
 The Nursing Process for Eating
Disorders
ASSESSMENT
Other assessment components:
1. Mental status examination
2. Substance abuse history
3. Family and social history
4. Past and present psychiatric treatment
 The Nursing Process for Eating
Disorders
DIAGNOSES
Imbalanced Nutrition: Less than body
requirements related to dysfunctional
eating patterns
Disturbed body image related to fear of
weight gain
Powerlessness related to lack of control
over food avoidance
Anxiety
Constipation/Diarrhea
Decreased cardiac output
Ineffective coping
 The Nursing Process for Eating
Disorders
PLANNING
 To maintain ideal body weight
 To provide insight and teach coping
skills
 The Nursing Process for Eating
Disorders
IMPLEMENTATION for Anorexia Nervosa
Weigh the patient at specific and regular
intervals (About 2x-3x a week) with minimal
clothing (hospital gown), patient facing
away from the weighing scale
Provide for safety and physical needs
STAY with the patient and observe her
within 1 to 2 hours AFTER EATING
Encourage the client to share feelings to
staff
 The Nursing Process for Eating
Disorders
IMPLEMENTATION for Anorexia Nervosa
Teach relaxation techniques
Discuss factors interfering with client’s
inability to eat
Document intake and output
Educate the client about the negative
effects of dietary restriction and LOW
weight and the rationale for normal weight
Instruct the client on how to increase
caloric intake and developing strategies for
coping with anxiety
 The Nursing Process for Eating
Disorders
IMPLEMENTATION for Bulimia
1. Encourage development of behavioral
diary
2. Encourage expression of feelings
3. Educate about the physical
consequences of binging, self-
induced vomiting and use of drugs
4. Limit exercising, frequent weighing
and obsessive caloric counting
 The Nursing Process for Eating
Disorders
IMPLEMENTATION for Bulimia
5. Stay with client after eating for 1-2
hours
7. Reinforce healthy coping
8. Monitor F and E status
 General Interventions
Assess the client’s nutritional status
Establish a CONTRACT with the client
concerning the diet plan for the day
Assist the client in identifying
precipitators of the eating disorder
Encourage the client to state feelings
about the eating behavior
Encourage behavior modification
 General Interventions
Convey an accepting and non-
judgmental attitude
Provide POSITIVE reinforcement for
accomplishments
SUPERVISE client during mealtimes
and few hours after
SET A TIME LIMIT FOR EACH MEAL
Provide a pleasant atmosphere for
eating
 General Interventions
Monitor for signs of physical
complications related to the eating
disorder
WEIGH client daily with same scale,
same time, same clothing (hospital
gown) and AFTER VOIDING
Encourage participation in diversional
activities
ASSESS AND MANAGE SUICIDAL
BEHAVIORS
 General Interventions
LIMIT SETTING:
 Restrict use of bathroom for 2 hours after
eating
 Accompany to bathroom to ensure that
they will not self-induce vomiting
 Stay with client during meals
 DO NOT accept excuses to leaving the
area
 Limit Eating to 20 minutes
 General Interventions
DIET
 HIGH protein
 HIGH carbohydrates
 Serve foods preferred by patient

Small frequent feedings
 NGT if patient refuses to eat
 General Interventions
DRUG
 Antidepressant drugs may be given after
correcting the electrolyte and nutritional
imbalances
Treatment modalities for Eating
disorders
PSYCHOTHERAPY
 Individual psychotherapy= anorexia is
considered food phobia. Goal of therapy is
to remove the phobia, restore weight and
restructure cognitive process

FAMILY therapy
 Helping family define the problem in the
context of eating behaviors
 Treatment modalities for Eating
disorders

GROUP THERAPY
 The group composed of patient and a
nurse talk openly about their concerns
Treatment modalities for Eating
disorders
BEHAVIORAL THERAPY

PHARMACOTHERAPY
 Fluoxetine (Prozac)

NUTRITIONAL THERAPY
 Dietician should be consulted
 The Nursing Process for Eating
Disorders
EVALUATION
Evaluate response to treatment
Bulimia should have abstained from
purging and decrease time to count
the calories of food
Anorexia nervosa should stabilize her
weight without loss and able to ingest
food