Nursing care for patients with eating disorders

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Nursing care for patients with eating disorders

• Rebecca Sposato MS, RN

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Eating Disorders
A collection of psychiatric conditions that
manifest psychological illness through abnormal
eating habits and body image Includes anorexia
nervosa, bulimia nervosa, binge eating,
orthorexia nervosa, pica and selective eating
disorder

http//vimeo.com/user638254/videos/sortdate
(www.nationaleating disorder.org, 2011)
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Statistics

• Eating disorders are grossly under diagnosed due
  to the surrounding secretive and resistant habits
• 90 of cases are female U.S. prevalence 10
  million women and 1 million men
• 40 of new diagnoses occur in females 15-19 years
  old
• Only 1/3 of people with anorexia nervosa and 6
  of people with bulimia receive mental health
  services
• (www.nationaleating disorder.org, 2011)

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Eating Disorders Comorbid Diagnoses

• Borderline Personality Disorder
• Obsessive Compulsive Disorder and Obsessive
  Personality Disorder
• Depression
• Anxiety
• Body Dysmorphic Disorder
• Narcissistic Personality Disorder
• Addiction and Substance abuse
• Victim of Abuse or trauma

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Methods of Eating Disorders

• Persons with eating disorders may utilize
  different methods as their illness evolves
• Calorie reduction
• Excessive exercise
• Induced vomiting (mechanical or chemical)
• Misuse of laxatives, dieting pills, enemas,
  diuretics
• Insulin misuse

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• What does 300 calories look like?

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Anorexia Nervosa

• Seek to maintain a BMI lt18, most often with
  calorie reduction
• Ritualistic /analytical eating habits
• Preoccupation with weight/size and anxiety with
  weight gain
• Lifetime prevalence of 1 in women, 90 of cases
  are female
• Anorexia nervosa has a mortality rate of 20,
  giving it the highest mortality rate of all
  psychiatric disorders
• 10 die within 10 years of diagnosis
• 35 fully recover
• (www.state.sc.us/dmh/anorexia/statistics.htm,
  2011)

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Body Mass index
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Bulimia Nervosa

• Engage in compulsory consumption of high calorie
  foods during binge episodes often followed by
  purging
• Cyclic pattern of calorie restraint, excessive
  intake and purging
• Binge on high calorie, high sugar and high fat
  foods
• Binge-purge twice/week x 3 months per DSM 4
• Episodes occur in private, beyond volitional
  control
• Usually have a BMI gt18
• Episodes are often triggered by stressful events
  and changes
• (www.womenshealth.gov/faq/bulimia-nervosa.cfma,
  2011)

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Pro-Ana, Pro-Mia and Pro-Ed

• A n eating disorder community who collectively
  deny the pathology of their habits, defend their
  condition as a lifestyle choice and maintain
  extreme thinness as a form of beauty
• Thinspiration pictures
• http//www.bukisa.com/articles/381852_45-pro-ana-t
  ips-and-tricks

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Assessment

• What would you include in your assessment?
• Questions?
• Measurements?
• Labs?
• Diagnostics?

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Medical Treatments

• Standard
• History height/weight, eating/dieting habits ,
  body image, menstrual habits, stressors/coping
• Labs CBC, chem panel, thyroid levels, estrogen,
  albumin/prealbumin, urinanalysis, ABG
• Diagnostics VS, EKG
• gt20 below BMI chest x-ray, 24hr creatinine
  clearance, bone density scan, echocardiogram
  (mitral valve prolapse) EEG, brain imaging
• (www.nationaleatingdisorders.org/uploads/file/Scre
  ening20for20Eating20Disorders20by20Primary20
  Care20Physicians-2.pdf, 2011)

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Recovery Team

• Medical MD, psychiatrist
• Clinical psychologist/therapist, expressive
  therapist
• Social worker, case manager
• Nurse
• Dietician
• Teachers/School Liaison

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Recovery Environments

• Hospital Inpatient Acute physical problems
• Mental Health Inpatient Facility unstable
  psychiatric problems, suicidal
• Residential Facility structured living
  environment
• Intensive Outpatient several hours on most
  weekdays
• Outpatient weekly sessions
• Telehealth technology and telephone resources
• (www.eatingdisorderrecovery.com. 2011)

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Recovery Interventions

• Tube Feeding with consent
• Treat the compounding psychiatric condition
• Individual counseling, psychotherapy
• Group Therapy
• Family Therapy
• Support Groups
• Art/Expression Therapy, Culinary/Nutrition
  Sessions
• (www.eatingdisorderrecovery.com. 2011)

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References

• Eating Disorder Recovery (2011). Retrieved from
  www.eatingdisorderrecovery.com.
• National Eating Disorders Association (2011).
  Retrieved from www.nationaleating disorder.org
• Womens Health Information Center (2011)
  Retrieved from www.womenshealth.gov