Anorexia Nervosa
-
body weight <85%
normal
-
fear of being fat
-
distorted body image
-
two types: refusal to eat or binging/purging
-
denial of problem
-
need for control,
inflexible
-
can be life
threatening
o
the lower the
weight and longer the duration, the poorer the prognosis
- physical s/s:
amenorrhea, dry skin, brittle hair, lanugo,
constipation, abd pain,
lethargy, emaciation, cold intolerance, hypotension, bradycardia, hypothermia,
elevated BUN and liver enzymes, electrolyte imbalances, mild anemia, salivary
gland hypertrophy
- psychosocial s/s:
fear of weight gain, preoccupation c food,
depression, insomnia, irritability, social withdrawal,
flattened affect, paranoia
Bulimia Nervosa
-
recurrent binging followed
by purging
o
feelings of
guilt or remorse
- aware of problem & try to hide it
-
near normal weight
-
physical s/s: tooth enamel loss, dental caries, electrolyte
imbalance, esophageal tears, menstrual irregularities
-
psychosocial s/s: depression, anxiety, poor body image & selef esteem, substance abuse
Binging - eating excessive amounts
Purging - induced vomiting, laxative or diuretic
use, excessive exercise
Possible Etiologies
- Nature:
may be some genetic factors
- Nurture:
overprotective & controlling parents (anorexia),
childhood sexual/physical abuse (bulimia), parental neglect,
cultural emphasis on slim ideal body type
Treatment
- limited
effectiveness with meds (antidepressants, antipsychotics)
- psychotherapy
including family counseling (anorexia) and
cognitive behavioral (bulimia)
Nursing Interventions (Review Box on pg 446):
-
nonjudgemental, empathetic attitude
-
restore nutritional
homeostasis - may require parenteral
feedings, establish good eating habits
-
help to express
feelings, develop coping skills
-
improve concept of
body image
-
patient & family
education