Eating disorders and nursing care

Eating disorders and nursing management

1. EATING DISORDERS AND NURSING MANAGEMENT Dr. Muhammad Arsyad Subu Assistant Professor in Nursing

2. Objectives Define eating disorders Identify different types of eating disorders Identify different forms of eating disorders Apply nursing assessment and history taking of clients with eating disorders Apply nursing care plans for clients with eating disorders

3. INTRODUCTION In the brain, the hypothalamus contains the appetite regulation center. It regulates the body’s ability to recognize when it is hungry, when it is not hungry, and when it has been sated (satisfied). Eating behaviors are influenced by society, culture, and religion Society & culture also have influenced what is considered desirable in the female body.

4. Eating Disorders A collection of psychiatric conditions that manifest psychological illness through abnormal eating habits & body image that includes: Pica Anorexia nervosa & bulimia nervosa Binge eating Orthorexia nervosa , selective eating disorder.

5. DSM-V: CLASSIFICATION Neurodevelopmental disorders Schizophrenia spectrum & other psychotic disorders Bipolar & related disorders Depressive disorders Anxiety disorders Obsessive-compulsive & related disorders Trauma- & stressor-related disorders Dissociative disorders Somatic symptom & related disorders Feeding & eating disorders Sleep–wake disorders Sexual dysfunctions Gender dysphoria DIC Disruptive, impulse-control, & conduct disorders Substance-related & addictive disorders Neurocognitive disorders Paraphilic disorders Personality disorders

6. Feeding & Eating Disorders - DSM-5 Pica: eating of substances such as dirt or paint

7. Feeding & Eating Disorders - DSM-5… Rumination Disorder: A client brings back up and re-chews partially digested food that has already been swallowed.

8. Feeding & Eating Disorders - DSM-5 (cont.) Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa - a psychological disorder defined by extremes in low body weight relative to stature which is apart from low Body Mass Index

9. Feeding & Eating Disorders - DSM-5 (cont.) Bulimia Nervosa Binge-Eating Disorder

10. Feeding & Eating Disorders - DSM-5 Other Specified Feeding or Eating Disorder Unspecified Feeding or Eating Disorder

11. Person with Eating Disorders They may utilize different methods: Calorie reduction Excessive exercise Induced vomiting (mechanical or chemical) Misuse of laxatives, dieting pills, enemas, diuretics Insulin misuse

12. Recovery Environments Hospital Inpatient: Acute physical problems Mental Health Inpatient Facility: unstable psychiatric problems, suicidal Residential Facility: structured living environment

13. Recovery Environments (cont.) Intensive Outpatient: several hours on most weekdays Outpatient: weekly sessions Telehealth : technology and telephone resources

14. 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

15. NURSING CARE PLANS FOR EATING DISORDERS Assessment Diagnosis Planning Implementation Evaluation

16. NURSING ASSESMENT CLIENT ASSESMENT Identifying data Reliability of informant/s Present complaints and problems History of present illness Past history of illness Personal history Family history (genogram) Description of premorbid personality Functional history Social history

17. GENOGRAM

18. NURSING ASSESMENT Include at least three to five subjective and/or objective data that lead to the nursing diagnosis ) Subjective data: ( What did patient or family or police say-use direct quotations)? Objective Data: (what did you see, hear, smell, feel – first finding) and measure ? Client lab values, test results: Medications : Doctor’s diagnosis: From this data, the reader must be able to tell that he/she really has a problem

19. ANALYSIS NURSING DIAGNOSIS Two statements are required for each nursing diagnosis. Must be patient and/or family focused; measurable; time-specific; reasonable. Statement of Problem (Nursing diagnosis [NANDA List] plus etiology ) NOT doctor’s diagnosis Only one diagnosis per page

20. SOME NURSING DIAGNOSIS Risk for Imbalanced Nutrition: less than body requirements Low self concept Self-care deficit Impaired communication Sleep disturbance

21. PLANNING PATIENT GOALS / OUTCOME CRITERIA Goal Statement Outcome criteria define goals. They define what will be observed when goal is met Provide time frame Are measurable Both goals and outcome criteria stated as behavioral objective List at least three nursing or collaborative interventions with rationale for each goal & outcome.

22. IMPLEMENTATION NURSING ACTIONS/RATIONAL Nursing actions: Actions to relieve problem and help client achieve goal Each must be specific and complete statements, including who, what, where, when, how, how long, and how often, etc. Label: I/Independent actions nurses can do without doctor’s order D/Dependent – what the doctor orders for this problem C/Collaborative – require knowledge, skill, and expertise of another health care professional

23. IMPLEMENTATION NURSING ACTIONS/RATIONAL Rational: Tells why each action should help achieve the goal Provide reason why intervention is indicated / therapeutic; provide references . Must have statement for each action.

24. TREATMENT MODALITIES

25. Treatment Modalities Behavior Modification: Issues of control are central to the etiology of these disorders. For the program to be successful, the client must perceive that he or she is in control of the treatment. Successes have been observed when the client: Is allowed to contract for privileges based on weight gain Has input into the care plan Clearly sees what the treatment choices are

26. Treatment Modalities The client has control over: Eating Amount of exercise pursued Whether to induce vomiting

27. Treatment Modalities Staff and client agree about: Goals System of rewards

28. Treatment Modalities The client has a choice whether to: Abide by the contract Gain weight Earn the desired privilege

29. Psychopharmacology For anorexia nervosa: Fluoxetine (Prozac) Clomipramine ( Anafranil ) Cyproheptadine ( Periactin ) Chlorpromazine ( Thorazine ) Olanzapine ( Zyprexa )

30. Psychopharmacology (CONT.) For bulimia nervosa: Fluoxetine (Prozac) Imipramine ( Tofranil ) Desipramine ( Norpramine ) Amitriptyline (Elavil) Nortriptyline ( Aventyl ) Phenelzine ( Nardil )

31. Psychopharmacology (cont.) For binge-eating disorder with obesity: Topiramate (Topamax) For obesity: Fluoxetine (Prozac) Sibutramine ( Meridia ) Various anorexiants (CNS stimulants)

32. Recovery Team with Nurse MD, psychiatrist Clinical psychologist/therapist, expressive therapist Social worker, case manager Dietician Teachers/School Liaison

33. Evaluation Have goals been partially or fully met? Describe in terms of the outcome criteria How would you revise the plan of care according the patient’s response to current plan?

34. Youtube site Eating disorders http://www.youtube.com/watch?v=RRseSpdGC2s a norexia and bulimia http://www.youtube.com/watch?v=u7LdEUu4QZE

35. Readings Boyd , M. A. Essentials of Psychiatric Nursing. Philadelphia, PA: Wolters Kluwer; 2017. ISBN: 978-1-4963-3214-1Unit 5, pp. 424-447. Stuart G. Principles and Practice of Psychiatric Nursing. 10 th ed. USA: Mosby; 2013. ISBN-10: 032-3091-148.Unit 3, pp. 477-497. Varcarolis E & Halter M. Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. St. Louis, Missouri: Saunders/Elsevier; 2010. ISBN: 978-1-4160-6667-5.Chapter 16, pp. 344-368. Videbeck, S. L. Psychiatric-mental health nursing (7 th ed.). Philadelphia, PA: Lippincott Williams & Wilkin; 2017. ISBN: 978-1-4963-5703-8. Chapter 20, pp. 393-413.

36. THANK YOU