Ch. 20 Anorexia Nervosa, Bulimia Nervosa

Ppl at increased risk for developing an eating disorder

-Minority women who are younger -Better educated -More closely identified with middle class values

genetic vulnerability

-disorders tend to run in families -result from a particular personality type or a general susceptibility to psychiatric disorders -Family hx of mood or anxiety disorders (OCD) places ppl at risk for eating disorder

childhood adversity

-phys neglect, sexual abuse, parental maltreatment -Risk factor in dvlpment of eat/weight problems in adolescence

Neurochemical Changes

=not known if they cause or result from eating disorders · NE normally rises after eating to metabolize nutrients -------Low NE seen during periods of restricted food intake bc no nutrients to metabolize · Increase in Serotonin = increase in satiety -------Low Serotonin and Monoamine Oxidase found in bulimia and binge/purge AN

a. Ask the client to write about all feelings and experiences related to food.

A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? a. Ask the client to write about all feelings and experiences related to food. b. Assist the client in making daily meal plans for 1 week. c. Encourage the client to ignore feelings and impulses related to food. d. Teach the client about nutrition content and calories of various foods.

a. Belief that dieting behavior is not a problem c. History of dieting at a young age d. Performance of rituals or compulsive behavior f. View of self as overweight or obese

A nurse doing an assessment with a client with anorexia nervosa would expect which findings? a. Belief that dieting behavior is not a problem b. Feelings of guilt and shame about eating behavior c. History of dieting at a young age d. Performance of rituals or compulsive behavior e. Strong desire to get treatment f. View of self as overweight or obese

b. Dissatisfaction with body shape and size c. Feelings of guilt and shame about eating behavior d. Near-normal body weight for height and age f. Strong desire to please others

A nurse doing an assessment with a client with bulimia would expect which findings? a. Compensatory behaviors limited to purging b. Dissatisfaction with body shape and size c. Feelings of guilt and shame about eating behavior d. Near-normal body weight for height and age e. Performance of rituals or compulsive behavior f. Strong desire to please others

d. Unrealistic perception of body size

A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? a. Guilt and shame about eating patterns b. Lack of knowledge about food and nutrition c. Refusal to talk about food-related topics d. Unrealistic perception of body size

judgment and insight

AN - DO NOT believe they have health problems; DO believe that others are trying to interfere w/ their ability to lose weight and achieve desired body · Continue to restrict food intake or engage in purging despite neg effects on health Bulimia - ashamed of binge/purge, feel out of control, unable to change · Recognize beh as abnormal and try to hide from others

roles and relationships

AN - begin to fail in school, even though they used to be successful; withdraw from friends & family Bulimia = feel shame about binge/purge, which leads to binge/purge in secret

general appearance and behavior

AN - slow, lethargic, fatigue, emaciated depending on amount of weight loss · Slow to respond to questions, difficulty in deciding what to say = unwilling to admit / discuss problems · Wear loose-fitting clothes in layers = to hide weight loss and to keep warm Bulimia - generally normal body weight; appear open and willing to talk

14, 18

AN typically begins between _______ & _______ years of age

Neuropsychiatric complications r/t weight loss

Abnormal taste sensation apathetic depression mild organic mental symptoms sleep disturbances

sensorium and intellectual functions

Alert, Oriented, Intact intellectual f(x)s; unless med complications exist

Reproductive complications r/t weight loss

Amenorrhea low levels of LH and FSH

Pt has less than the minimal expected weight considering their age, height, and overall physical health.

Anorexia nervosa

18, 19

BN usually begins in late adolescence or early adulthood; ________ or _______ years of age of onset

cardiac complications r/t weight loss

Bradycardia hypotension loss of cardiac muscle small heart cardiac arrhythmias (including atrial and ventricular premature contractions, prolonged QT level, ventricular tachycardia) sudden death

Client and Family Education: For Eating Disorders

Client •Basic nutritional needs •Harmful effects of restrictive eating, dieting, and purging •Realistic goals for eating throughout the day •Acceptance of healthy body image Family and Friends •Provide emotional support, love, attention •Express concern about the client's health. •Encourage the client to seek professional help. •Avoid talking only about weight, food intake, and calories. •Become informed about eating disorders. •It is not possible for family and friends to force the client to eat. The client needs professional help from a therapist or psychiatrist.

BN

Clients with ______ appear initially pleasant and cheerful as though nothing is wrong. The pleasant façade usually disappears when they begin describing binge eating and purging; may express intense guilt, shame, and embarrassment.

AN

Clients with ______ maybe slow to respond to questions and have difficulty deciding what to say, Often reluctant to answer questions fully because they do not want to acknowledge the problem. I contact maybe limited. May turn away from the nurse, indicating their unwillingness to discuss problems or to enter treatment

BN

Clients with ______ maybe underweight or overweight are generally close to the accepted bodyweight agent size. Generally appearance is not unusual, and they appear open and willing to talk

AN

Clients with ______ seldom smile, laugh, or enjoy any attempts at humor; They are somber and serious most of the time

AN

Clients with ______ wear loose fitting clothes and layers, regardless of the weather, both to hide the weight loss and to keep warm (clients with anorexia are generally cold)

AN

Clients with ________ appear slow, lethargic, and fatigued; They may be emaciated, depending on the amount of weight loss.

BN

Clients with ________ often have a history of impulsive behaviors such as substance abuse and shoplifting as well as anxiety, depression, personality disorders. Clients are focused on pleasing others and avoiding conflict.

GI complications r/t weight loss

Delayed gastric emptying bloating, constipation abdominal pain gas diarrhea

AN

Developmental risk factors include: - issues of developing autonomy and having control over self and environment - developing a unique identity - dissatisfaction with body image

BN

Developmental risk include: - self-perceptions of being overweight, fat, unattractive, and undesirable - dissatisfaction with body image

AN treatment

Difficult as pt is resistant, uninterested, denies problem Treatment Settings - specialty eating disorder units, partial hospitalization, day programs, outpatient therapy · Setting depends on severity of illness (duration of binge/purge, phys s/s, comorbid psych conditions) · Life-threatening conditions may require hospital admission (F&E imbalances, severe weight loss, risk for suicide, CV complications)

struggle for autonomy autonomy

Difficult to have autonomy in families that are overprotective or exhibit "Enmeshment" (role boundaries are unclear like child/parent role reversal) · Teens may feel they have no control over their lives= begin to control their eating through dieting & thus gain control of their weight = losing weight becomes reinforcing bc they can control that 1 aspect

Dermatologic complications r/t weight loss

Dry, cracking skin due to dehydration lanugo (i.e.. fine, baby-like hair over body) edema acrocyanosis (i.e.. blue hands and feet)

Metabolic complications r/t purging: vomiting & laxative abuse

Electrolyte abnormalities, particularly hypokalemia, hypochloremia alkalosis, hypomagnesemia, and elevated blood urea nitrogen

NURSING INTERVENTIONS

Establishing nutritional eating patterns •Sit with the client during meals and snacks. •Offer liquid protein supplement if client is unable to complete meal. •Adhere to treatment program guidelines regarding restrictions. •Observe the client following meals and snacks for 1 to 2 hours. •Weigh the client daily in uniform clothing. •Be alert for attempts to hide or discard food or inflate weight. Helping the client identify emotions and develop non-food-related coping strategies •Ask the client to identify feelings. •Self-monitoring using a journal •Relaxation techniques •Distraction •Assist the client in changing stereotypical beliefs. Helping the client deal with body image issues •Recognize benefits of a more near-normal weight. •Assist in viewing self in ways not related to body image. •Identify personal strengths, interests, and talents. Providing client and family education (see "Client and Family Education: For Eating Disorders")

Treatment Settings - outpatient therapy, hospital admission if binge/purge beh is out of control CBT - most effective treatment; Requires detailed manual to guide treatment · Strategies to change pt's thinking (cognition) and actions (beh) about food o Interrupt cycle of diet, binge, purge o Alter dysf(x)al thoughts and beliefs about food, weight, body image, overall self-concept Psychopharmacology = antidepressants; shown to improve mood, reduce preoccupation w/ weight & body

Explain the different treatments for bulimia

AN

Family members often described clients with ________ as perfectionist with above average intelligence, achievement oriented, dependable, eager to please, seeking approval before their condition beginning

BN

Family risk factors include: - chaotic family w/ lose boundaries - parental maltreatment including possible phys or sexual abuse

AN

Family risk factors include: - Family lacks emotional support - parental maltreatment - cannot deal with conflict

self-awareness for eating disorders

Feelings of frustration and incompetence when pt rejects help Being seen as "the enemy" if you must ensure that the pt eats Pt may become hostile as anxiety about eating increases, but nurse must remember that pt's beh is symptom of anxiety and fear about gaining weight and not personally directed towards the nurse Dealing with own issues about body image, dieting

Use assessment tools to detect improvement like the Eating Attitudes Test Treatment successful if pt maintains body weight w/i 5-10% of normal w/ no medical complications For AN, Weight gain & adequate food intake = determine effectiveness of treatment

How can we evaluate treatment?

metabolic complications r/t weight loss

Hypothyroidism (symptoms include lack of energy, weakness, intolerance to cold, and bradycardia) hypoglycemia decreased insulin sensitivity

· Happens in pts w/ AN bc they have problems w/ self-awareness o Express feelings through somatic complaints à "I feel fat or bloated" · RN should ask pt to describe how they are feeling and allow adequate time for response o DO NOT ask "Are you sad/anxious?"

In what patients is Alexithymia common? What can the nurse do to help this?

used in pts w/ bulimia · Raises pt's awareness about beh patterns & helps to regain a sense of control by implementing techniques to avoid or replace beh · RN encourages pt to keep a diary of all foods eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, interactions surrounding eating & binge/purge episodes · Client makes connections b/w emotions, situations, & eating beh · RN helps pt dvlp ways to manage emotions using relaxation techniques, distraction, etc

In what patients is Self-monitoring used? What can the nurse do to help this?

where food is abundant concept of beauty = thinness Most common in US, Canada, Europe, Australia, Japan, New Zealand, South Africa

In what type of countries are eating disorders more common?

establish nutritional eating patterns

Initially, 1200-1500 cal diet when pt can eat Gradual increase to adequate amount of cal for pt's height, activity level, growth needs Allotted cal are divided in 3 meals & 3 snacks Liquid protein supplement given to replace food not eaten = Ensures consumption of total # of prescribed cal Initially, RN will sit w/ pt during meals or snacks v Enforce meal / snack times v Discourage food rituals (cutting food into small pieces, mixing food in unusual combos) v Monitor for attempts to hide or discard food To ensure no purging = · Client may be required to remain in view of staff 1-2 hours after meals · Limit access to bathrooms w/o supervision Daily weight in hospital gown after emptying bladder

mood and affect

Labile moods that correspond to their eating and dieting beh · Avoiding bad foods = gives them power and control over their bodies · Eat, Binge, Purge = anxiety, depression, feeling out of control AN - seldom smile or laugh; mostly somber and serious Bulimia - initially pleasant and cheerful; good mood disappears when they discuss binge/purge beh and express intense guilt, shame, and embarrassment IMPORTANT: Ask pts w/ eating disorders about self-harm or suicide = not uncommon in these pts

Hematologic complications r/t weight loss

Leukopenia anemia thrombocytopenia hypercholesterolemia hypercarotenemia

o Weight Restoration o Rehydration o Correction of F&E Imbalances o Nutritional Rehab - nutritionally balanced meals / snacks, TPN, tube feedings, hyperalimentation

List the 4 parts of medical management of AN

self-concept

Low self-esteem, helpless, powerless, ineffective, lack of control, judge themselves harshly See themselves in terms of ability to control food intake and weight Overlook other achievements as less important than being thin

AN

Often express there feeling in terms of somatic complaints such as feeling fat or bloated. Nurse can help them begin to recognize emotions such as anxiety or guilt by asking them to describe how they are feeling and allowing adequate time for response. Nurse encourages client to describe feelings. This approach can eventually help clients to recognize their emotions and to connect them to their eating behaviors.

1200 to 1500 calories

Once clients can eat a diet of ___________ to ______________ calories per day is ordered with gradual increases in calories until clients are ingesting adequate amounts for height, activity level, and growth needs.

AN onset and clinical course

Onset = Begins b/w 14-18 years Early Stage = deny having neg body image or anxiety about appearance Progression = depression, labile mood, isolate themselves as diet and compulsive beh increase 6x more likely to die from medical complications or suicide

bulimia onset and clinical course

Onset = late adolescence or early adulthood; average age is 18-19 years Binge eating begins during or after dieting episode In b/w binges, restrictive eating or consumption of low-cal foods Recognizes beh as abnormal so hides beh from others Secretive consumption & storage of food (cars, desks, orders food from multiple fastfood places in 1-2 hours) Patterns may exist for years before anyone finds out

thought processes and content

Preoccupied w/ not eating or eating "bad" or "wrong" foods Cannot think about themselves w/o thinking about weight & food Body image disturbance can be almost delusional à severely underweight pts point to areas on their body that are "still fat," which fuels their need to keep dieting AN - paranoid ideas about family / HCW = believe they are "enemies" who are trying to fatten the pt

physical and self care considerations

SEE TABLE 20.2 Excessive exercise to the point of exhaustion Insomnia, reduced sleep time, early-morning awakening Loss of tooth enamel, chipped / ragged teeth, dental caries, mouth sores

GI complications r/t purging: vomiting & laxative abuse

Salivary gland in pancreas inflammation and enlargement with an increase in serum amylase esophageal and gastric erosion or rupture dysfunctional bowel superior mesenteric artery syndrome

Neuropsychiatric complications r/t purging: vomiting & laxative abuse

Seizures (r/t large fluid shifts and electrolyte disturbances) mild neuropathy fatigue weakness mild organic mental symptoms

b. The client identifies healthy ways of coping with anxiety.

The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? a. The client can identify calorie content for each meal. b. The client identifies healthy ways of coping with anxiety. c. The client spends time resting in her room after meals. d. The client verbalizes knowledge of former eating patterns as unhealthy.

a. Supervise the client closely for 2 hours after meals and snacks.

The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? a. Supervise the client closely for 2 hours after meals and snacks. b. Increase the daily caloric intake from 1,500 to 2,000 calories. c. Increase the client's fluid intake. d. Request an order from the physician for fluoxetine.

b. Fluoxetine can cause appetite suppression and weight loss.

Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which problem? a. Clients object to the side effect of weight gain. b. Fluoxetine can cause appetite suppression and weight loss. c. Fluoxetine can cause clients to become giddy and silly. d. Clients with anorexia get no benefit from fluoxetine.

sociocultural factors

Western countries = "ideal woman" is thin; being overweight is lazy Adolescents idealize celebrities who may use techniques to appear thinner; Weight loss programs; Plastic surgery ads; Dietary supplements Pressure from parents, coaches, peers to have ideal body form for sports Teasing, bullying, harassment, parental concern over pt weight

Eating disorders linked to history of sexual abuse, childhood neglect (phys & emotional) May contribute to problems w/ intimacy, body satisfaction, sexual attractiveness, and low interest in sexual activity

What are eating disorders link to? Explain

2 subgroups depending on how weight is controlled 1. Restricting = lose weight by dieting, fasting, excessive exercise 2. Binge Eating and Purging = a. Binge Eating = consuming a large amount of food (far greater than most ppl eat at 1 time) in a discrete period of usually 2 hours or less b. Purging = compensatory beh designed to eliminate food by self-induced vomiting or misuse of laxatives, enemas, diuretics

What are the 2 subtypes of anorexia nervosa and what are they based on?

· client's restriction of nutritional intake necessary to maintain a minimally normal body weight · intense fear of gaining weight or becoming fat · significantly disturbed perception of body shape or size · steadfast inability or refusal to acknowledge seriousness of the problem or even that one exists

What are the 4 parts of anorexia nervosa?

Help pt recognize benefits of near-normal body weight Assist pt in viewing self in ways not r/t body image, weight, size, shape ID pt's strengths, interests, talents not r/t to food

What can the nurse do to Deal w/ Body Image Issues?

Mood / Anxiety Disorders & Substance Abuse / Dependence Most common = Depression, OCD

What comorbid conditions are frequently seen in clients w/ eating disorders?

AN - patient has distorted body image and limits food intake to prevent getting fat -----does not recognize that their beh has neg health effects Bulimia - patient has distorted body image, eats a lot of food in secret, compensates with inappropriate beh ----recognizes that beh is abnormal

What differentiates bulimia from AN?

· Amitriptyline & Cyproheptadine - promote weight gain · Olanzapine - antipsychotic effect on distorted body image, weight gain · Fluoxetine - prevent relapse, but side effect of weight loss

Which drugs can be used to treat AN?

c. Self-monitoring

Which is an example of a cognitive-behavioral technique? a. Distraction b. Relaxation c. Self-monitoring d. Verbalization of emotions

a. Correction of body image disturbance

Which is not a goal for treating the severely malnourished client with anorexia nervosa? a. Correction of body image disturbance b. Correction of electrolyte imbalances c. Nutritional rehabilitation d. Weight restoration

b. Cultures in which beauty is linked to thinness have an increased risk for eating disorders.

Which statement is true? a. Anorexia nervosa was not recognized as an illness until the 1960s. b. Cultures in which beauty is linked to thinness have an increased risk for eating disorders. c. Eating disorders are a major health problem only in the United States and Europe. d. Individuals with anorexia nervosa are popular with their peers as a result of their thinness.

Family Therapy - for pts < 18 years and for families who demonstrate enmeshment, unclear boundaries among members, difficulty handling emotions and conflict Individual Therapy - indicated if family cannot participate in family therapy; if client is older, separated from family, or has individual issues; Focus on pt's specific issues (coping skills, self-acceptance, assertiveness) Cognitive-Behavioral Therapy (CBT) - for initial treatment, relapse prevention

Which types of therapy are used in AN? Explain all 3.

o Ineffective means of weight control that disrupts neuroendocrine system o Promotes binge eating by decreasing the anxiety that follows binge. If you avoid purging, you will be less likely to engage in binge eating o Distraction and delay techniques - The longer the pt can delay either binging or purging, the less likely they are to carry out that beh

Why does purging need to be stopped ASAP?

CBT

______ has been found to be the most effective treatment for BN

Anorexia nervosa

a life-threatening eating disorder characterized by... · client's restriction of nutritional intake necessary to maintain a minimally normal body weight · intense fear of gaining weight or becoming fat · significantly disturbed perception of body shape or size · steadfast inability or refusal to acknowledge seriousness of the problem or even that one exists

Its important to ask clients with eating disorders?

about thoughts of self-harm or suicide.

Clients with eating disorders are generally

alert and oriented; their intellectual functions are intact. Exception are those with anorexia who are severely malnourished and showing signs of starvation such as mild confusion, slowed mental processes, and difficulty with concentration and attention

history

assessment tools (Eating Attitudes Test) AN - perfectionists above-average intelligence, achievement-oriented, dependable, eager to please, seeks approval = beh BEFORE onset of condition; beh worsens AFTER condition Bulimia - pleasing others, avoid conflict, h/o impulsive beh (à substance abuse, shoplifting), depression, anxiety, personality disorders

AN

biologic risk factors include: -obesity -dieting at an early age

BN

biologic risk factors include: -obesity -early dieting -possible serotonin and NE disturbances -chromosome 1 susceptibility

etiology of eating disorders

biologic, developmental, family influences, sociocultural

AN

clients who are severely underweight may have paranoid ideas about their family and health care professionals Believing they are their "enemies"

self-monitoring

cog-beh technique designed to help pts w/ bulimia

purging

compensatory beh designed to eliminate food by self-induced vomiting or misuse of laxatives, enemas, diuretics

binge eating

consuming a large amount of food (far greater than most ppl eat at 1 time) in a discrete period of usually 2 hours or less

deficits in lateral hypothalamus

decreased eating, decreased responses to sensory stimuli important to eating

Alexithymia

difficulty in IDing and expressing feelings

Dental complications r/t purging: vomiting & laxative abuse

erosion of dental enamel (perimyolysis), particularly front teeth

deficits in ventromedial hypothalamus

excessive eating, weight gain, decreased responsiveness to satiety effects of glucose (seen in bulimia)

characteristics of bulimia

high impulsivity, sensation seeking, novelty seeking, traits r/t borderline personality disorder

body image

how a person perceives his or her body; consistent w/ how others view them

uncommon

it is not __________ for clients with eating disorders to engage in self mutilation behaviors, such as cutting

family discord and abuse

leads to disordered eating, especially in girls -Girls try to escape neg emotions by placing intense focus on something concrete = Phys appearance

AN

limited insight and poor judgment about their health status. They continue to restrict food intake or to engage in purging despite the negative effect on health.

· Body Weight < Normal · Early onset, 90% female · Experience hunger but ignore it bc if they eat anything, they will not be able to stop and become fat · Preoccupied w/ food-related activities (cooking, cal-counting, grocery shopping, collecting recipes) · May engage in unusual or ritualistic food beh (cutting food in small pieces, not letting food touch lips)

list other characteristics of anorexia nervosa

· Body Weight = Near Normal · Later onset · Amount of food consumed during binging is much larger that a person would normally eat · Binge eats in secret; Eats low-cal foods or fasting in b/w binges · Experience feelings of shame, guilt, remorse, or self-contempt regarding their beh · Recurrent vomiting destroys tooth enamel, high incidence of dental caries, ragged / chipped teeth o Dentists are often 1st to ID bulimia

list other characteristics of bulimia nervosa

Musculoskeletal complications r/t weight loss

loss of muscle mass loss of fat osteoporosis Pathologic fractures

night eating syndrome

morning anorexia, evening hyperphagia (eating 50% of daily cal after last evening meal), and nighttime awakenings (at least 1x) to consume snacks

purging; fasting; excessive exercise; use of laxatives, enemas, emetics, diuretics

name examples of inappropriate compensatory beh to avoid weight gain

Orthorexia Nervosa (aka "Orthorexia")

obsession w/ healthful eating; Not formally recognized in DSM-5

body image disturbance

occurs when there is an extreme discrepancy b/w 1's body image and the perceptions of others and extreme dissatisfaction w/ 1's body image

Most treatment facilities weight client

once daily usually upon awakening and after they have emptied bladder. Clients should wear minimal clothing such as hospital gown. Clients should always sit at table in designated eating area.

characteristics of AN and bulimia

perfectionism, obsessive-compulsiveness, neuroticism, neg emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits r/t avoidant personality disorder

pica

persistent ingestion of nonfood substances

Avoiding bad or fattening foods gives ppl with eating disorders a sense of

power and control over their bodies whereas eating, binging, or purging leads to anxiety, depression, and feeling out of control

bulimia nervosa

recurrent episodes of binge eating followed by inappropriate compensatory beh to avoid weight gain (purge; fasting; excessive exercise; use of laxatives, enemas, emetics, diuretics)

Binge-Eating Disorder

recurrent episodes of binge eating w/ no regular use of inappropriate compensatory beh; Affects ppl > 35; Mostly male; More likely to be obese or overweight

rumination

repeated regurgitation of food that is then re-chewed, re-swallowed, or spit out

Liquid protein supplement may be given to

replace any food not eaten to ensure consumption of the total number of prescribed calories.

enmeshment

role boundaries are unclear ----> child/parent role reversal

satiety

satisfaction of hunger

need to develop unique identity

self-doubt / confusion results if adolescent doesn't measure up to person they want to be · Body Image = how a person perceives his or her body; consistent w/ how others view them o AN = not affected by perception of others; believe that they are fat, unattractive, undesirable even if they are malnourished o Cultural belief that slimness is attractive = excessive diet and exercise by adolescent · Body Image Disturbance = occurs when there is an extreme discrepancy b/w 1's body image and the perceptions of others and extreme dissatisfaction w/ 1's body image · Self-Perceptions - influences dvlpt of identity in adolescence and persists into adulthood o Bulimia = Perceives self as fat, unattractive, undesirable = Leads to binge/purge cycle o Perceives self as overweight = leads to belief that diet is necessary to be happy

BN

sociocultural risk factors include: - Weight related teasing - cultural idea of being thin - media focuses on beauty, thinness, fitness - preoccupation with achieving the ideal body

AN

sociocultural risk factors include: - cultural idea of being thin - media focuses on beauty, thinness, fitness - preoccupation with achieving the ideal body

Nurse may request client to sit in view for 1-2 hours to ensure what?

that client doesn't empty stomach by vomiting. Some facilities limit client access to bathroom without supervision.

Clients with eating disorders spend most of their time

thinking about dieting, food and food related behavior. Clients cannot think about themselves without thinking about weight and food. Body image disturbance can be almost delusional

bulimia nursing interventions

· Establish normal eating patterns & Interrupt binge/purge cycle · Eat meals w/ family or friends while sitting at a designated table for all meals · Follow a nutritious meal plan - written in advance and groceries are purchased for planned menus · Avoid buying binge foods

Deficits in 2 nuclei in hypothalamus

·r/t hunger and "Satiety" (satisfaction of appetite) lateral and ventromedial hypothalamus

NURSING DX

Ø Imbalanced nutrition: Less than / more than body requirements Ø Ineffective coping Ø Disturbed body image Ø Chronic low self-esteem Ø Deficient fluid volume Ø Constipation Ø Fatigue Ø Activity intolerance