NURSE 2100 Unit 2 TegrityOutline of Tegrity: ‘Eating Disorders’- Continuum of SymptomsI. Normal eatingII. Development of risk factorsa. Low self-esteemb. Dietingi. Parental attitudesii. Body dissatisfaction c. Media ideal bodiesIII. Partial- Syndrome EDa. Binge eatingb. Serious dieting IV. Full- Syndrome EDa. Increase in frequency and severity of:i. Binge eatingii. Purging iii. Starvation V. Treatment Nurse screening in all settings- Are you satisfied with your eating patterns?- Do you ever eat in secret?Diagnostic Criteria: Anorexia Nervosa• Refusal to maintain normal body weight• Intense fear of gaining weight• Disturbance in body image & self evaluation based on body weight to an extreme• Perfectionism & does not recognize seriousness of the condition• Weight loss of 25 pounds and absence of menses for at least 3 consecutive months or periods Two types describe current symptoms not longitudinal course of illness1. Restricting type-Fasting or eating very little food 2. Binging/Purging type- eating excess food all at once followed by purging by vomiting laxatives, diuretics or enemasClinical Course of Anorexia NervosaThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.• Onset in early adolescence• Chronic condition with relapses characterized by significant weight loss• Often continue to be obsessed with food• 10 to 25% go on to develop bulimia nervosa• Poor outcome related to initial lower minimum weight, presence of purging, and later age of onset• May look depressed but that may be secondary to starvationKey Concepts• Body image: discrepancy between self-perception and others• Drive for thinness: an intense physical and emotional process that overrides all physiologic body cues, such as hunger and weakness• Interoceptive awareness: sensory response to emotional and visceral cues, such as hungerInterdisciplinary Treatment• Goals– Initiating nutritional rehabilitation– Resolving conflicts around body image disturbance– Increasing effective coping– Addressing underlying conflicts– Assisting family with healthy functioning Treatment modalities– Hospitalization usually necessary– Intensive therapies• Pharmacologic management: use of SSRIs controversial– Target symptoms of obsessiveness, ritualistic behaviors, and perfectionism Nursing Assessment• Evaluation of body and social systems – School attendance– Family interaction– Careful history (patient and family)• Determine weight with BMI (less than 85% of ideal weight)– Body distortion– Fear of weight gain• Unrealistic expectations and thinking• Ritualistic behaviors• Difficulty expressing negative feelings• Inability to experience visceral cues and emotions• Suicide ideation-50% of deaths are suicideNursing Interventions• Therapeutic relationship– Be firm, accepting, and patient– Provide a rationale for all interventions – Avoid power struggles over eating • Understanding feelings– Challenge cognitive distortions– Imagery and relaxation • Interpersonal therapy– Focus on role transitions, control, and ineffective feelings– Change distortions about food and interactions with others• Education – Clarify misinformation about food with patient– Family education• Weight-increasing protocols – Usually a behavioral plan with positive and negative reinforcements)– Strict monitoring and recording of intake• Exercise – Generally not permitted during refeeding– Any exercise needs to be monitored• Sleep – Structured, healthy routine• Facilitate transition to school• Family therapyDefense Mechanisms Automatic psychological processes protecting the patient from unwanted anxiety, generally the patient is unaware of using them and of the stresses that precipitate their use. Some are adaptive and some maladaptive.• Avoidance-use food to avoid intimacy & other fears• Denial-in AN this gets stronger as others express more concern about the ED• Isolation of affect -inability to recognize their feelingsIntellectualization- use of excessive reasoning or logic to deal with situations rather thanTreating cognitive distortions in maladaptive eating regulation responses• Magnification—Overestimation of the significance of undesirable events (gained 2 pounds can’t wear shorts)• Superstitious thinking —Believing in the cause-effect relationship of noncontingent events (If I eat a sweet it will instantly turn into stomach fat)• Dichotomous or all-or-none thinking —Thinking in extreme or absolute terms such as that events can only be black or white, right or wrong, good or bad (If I eat one piece of candy I blew it and might as well eat all the candy)• Overgeneralization —Extracting a rule on the basis of one event and applying it to other dissimilar situations (I used to be a normal weight & I wasn’t happy so I know gaining weight will not help)• Selective abstraction —Basing a conclusion on isolated details while ignoring contradictory and more important evidence (eating is the only thing that will make me happy)• Personalization and self-reference —Egocentric interpretations of impersonal events or over-interpretation of events related to the self (those people were talking and laughing about how fat I am)Bulimia Nervosa: Diagnostic Criteria A. Recurrent episodes of binge eating1. Rapid, episodic, impulsive, and uncontrollable ingestion of large amounts of food over a short period of time (1 to 2 hours)2. Feelings of lack of control • Restriction of total calories between binges• Undue influence of body weight or shape or denial of current low weight• Recurrent episodes of binge eating & compensatory purging in the form of vomiting or using laxatives, diuretics, or emetics, fasting or over-exercising C. These episodes must occur at least twice a week for a period of at least 3 months D. Eating followed by guilt, remorse, and severe dieting. Self evaluation unduly influenced by weight. Ashamed and often conceal their eating.Key concepts*• Two types of bulimia nervosa– Restricting type: • Similar to anorexia nervosa-restricting is followed by binge eating, which is then followed by another period of restricting– Purging type- vomiting or using laxatives, diuretics, or emetics, fasting or over-exercising • Dietary restraint– Restricting intake is believed to