eating disorder west coast university nurs 204. sociocultural factors cultural stereotypes...
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Eating Disorder
West Coast University
NURS 204
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Sociocultural Factors Cultural stereotypes Preoccupation with the body Cultural ideal of thinness Identity and self-esteem are dependent
on physical appearance
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Female Attractiveness Equated with thinness, physical fitness Media glamorizes thinness Thinness equated with success and
happiness Prejudice against overweight Self-esteem enhanced for those
considered attractive
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Male Attractiveness
Ideal body type is lean and muscular Emphasis on strength and athleticism Less popular if they do not have the ideal
body type
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Biologic Theory There may be a genetic predisposition
for anorexia. Relatives of clients with eating disorders
are 5 to 10 times more likely to develop an eating disorder.
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Psychological Factors Perfectionism Social and affective insecurities Low self-esteem Immaturity Sense of ineffectiveness Interpersonal distrust Poor conflict resolution Depression Obsessive-compulsive disorder
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Psychosocial Pressures Frequent exposure to articles about
dieting is significantly associated with lower self-esteem, depressed mood, and lower levels of body satisfaction.
Occupations, such as modeling or ballet dancers
Athletes, gymnastics
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Psychosocial Considerations Use of anabolic steroids Predominately an issue in industrialized,
developed countries Not solely a problem of specific cultural
groups
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Neurotransmitters affect eating disorders Serotonin
Low levels: increase food intake High levels: decrease food intake
Increase eating behavior: Norepinephrine Neuropeptide Y
Suppresses food intake: Dopamine
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Eating Disorders Anorexia nervosa and bulimia
nervosa are not single diseases, but syndromes with multiple predisposing factors and a variety of characteristics.
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Characteristics ofAnorexia Nervosa Extreme perfectionism Fear of gaining weight Significant weight loss Body image disturbance Strenuous exercising Peculiar food handling practices Rigidity and control
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Physical Manifestation of Anorexia Nervosa Reduction in the following:
Heart rate Blood pressure Metabolic rate Production of estrogen or testosterone Body temperature
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Physical Symptoms of Anorexia Nervosa Weight loss 15% below ideal Amenorrhea Cachexia Sunken eyes Dry skin Lanugo on face Constipation Cold sensitivity
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Psychological Symptoms of Anorexia Nervosa
Denial of low weight Body image disturbance Irrational fear of weight gain Preoccupied with food and cooking Delayed psychosexual development
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Bulimia Nervosa Cyclical condition Episodes of binge-eating and purging Skipping meals sporadically Strict dieting or fasting
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Physical Symptoms of Bulimia Nervosa Fluid and electrolyte imbalances Cardiovascular Symptoms Endocrine Symptoms Gastrointestinal Symptoms
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Psychological Symptoms of Bulimia Nervosa Body image disturbance Persistent over concern with weight,
shape and proportions Mood swings, irritability Self-concept influenced by weight
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Binge-Eating Disorder Eating significantly larger-than-normal
amounts in a discrete time period, until uncomfortably full
Sense of lack of control No compensatory purging Frequently symptoms of an affective disorder
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Assessing Clients Willingness for treatment Treatment history Dramatic weight loss or gain Medical history and physical examination Patterns and perceptions regarding weight Body dissatisfaction and image distortion Physical symptoms Denial
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Assessment Continued Assess:
Dieting history Binge eating Feeling regarding binge behavior Food cravings Purging behaviors Menstrual history Medical side effects Co-morbidity factors
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Nursing Diagnosis: NANDA Anorexia:
Imbalance nutrition: Less than body requirements Disturbed body image Chronic low self-esteem Anxiety
Bulimia Nervosa: Ineffective coping Deficient fluid volume Chronic low self-esteem
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Outcome Identification: NOC Be free of self-harm Adequate nutrients taken into the body for
height, frame, gender, and activity level Manage stressors, ability to self-restrain
compulsive or impulsive behavior, ability to acquire, organize and use information
Positive perception of own appearance and ability to self-restrain altered perception
Verbalize understanding of underlying psychological issues
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Goals
The goal of nursing interventions with anxious clients with bulimia is to help them: Recognize events that create anxiety Avoid binge eating and purging in
response to anxiety Verbalize acceptance of normal body
weight without intense anxiety
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Goals - continued The overall goal of treatment for the individual
with anorexia nervosa is gradual weight restoration/
A target weight is usually chosen by the treatment team in collaboration with a dietitian.
Target weight for discharge from treatment is usually 90% of average for age and height.
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Planning and Implementing: NIC Manage nutrition
Establish adequate eating patterns and fluid and electrolyte balance
Assume a calm, matter-of-fact attitude Gradual weight restoration
Tube feeding or intravenous therapy Weigh the client daily Record intake and output Observe client during meals Observe bathroom behavior
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Nursing Interventions Help increase client understanding of treatment plan. Emphasize client capability to eat small portions
without binging. Avoid power struggles. Intervene with anxiety. Give positive feedback for adherence to plan. Engage in group therapy. Assist to identify issues (e.g., esteem, identity
disturbance). Collaborate with dietician to teach nutrition. Collaborate with interdisciplinary staff.
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Goals - continued Providing basic nutritional education is
the goal of interventions with clients that have a knowledge deficit in this area.
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Nursing Interventions: Client with Anorexia Nervosa
Establish Trust Tube feeding Intravenous therapy Avoid weighing the client daily Observing bathroom behavior Recording intake and output Observing the client during meals
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Nursing Interventions: Client with Bulimia Nervosa Managing medications Reducing anxiety Managing fluids and electrolytes Facilitating coping Mobilizing the family Health Teaching and Promotion
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Pharmacologic
SSRIs Reduce binge
eating and vomiting
Symptom control Anxiety Depression Obsessions Impulse control
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Psychotherapeutic Treatment Modalities Individual Psychotherapy Family Therapy Group Therapy Behavioral
Contracts Exposure and response prevention
Cognitive Reframing Cognitive restructuring
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Adjunctive Therapy
Occupational therapy Nutrition education and counseling Interdisciplinary treatment team Community support groups
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Prevention Nurses in community-based settings
can play a valuable role in: Education Support Referral
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Screening and Education Nurses can provide screening and
education in schools, clinics, homes, health fairs, health clubs
Individuals at risk: low self-esteem, irrational behavior related to food, excessive exercise, and other factors
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Prevention and Screening Important to understand cultural factors
contributing to eating disorders Nurses can implement primary
prevention and secondary screening measures