Eating disorders

• Eating Disorders


  • Severe disruptions in normal eating patterns
  • High levels of anxiety around eating
  • Altered perception of body shape and weight
• Cognitive Distortions


  • Overgeneralization
  • All-or-nothing thinking
  • Catastrophizing
  • Personalization
  • Emotional reasoning
• Overgeneralization


  • A single event affects unrelated situations
• All-or-nothing thinking


  • Absolute and extreme reasoning
  • Black or white; good or bad
• Catastrophizing


  • Consequences are magnified
• Personalization


  • Events are overinterpreted as having personal significance
• Emotional Reasoning


  • Subjective emotions determine reality
• Causes of Eating Disorders

  • Neurobiological/Neuroendocrine Models
  • Dysfunctional family
  • Trauma
  • Participation in activity requiring thinness
  • Culture/peer pressures
  • Stressful life transitions
  • Comorbid anxiety disorder
• Physical Criteria for Hospital Admission


  • 30% weight loss over 6 months
  • Inability to gain weight outpatient
  • Severe hypothermia
  • HR<40
  • SBP<70mm Hg
  • K+ < 3 mEq/L
  • EKG changes
• Psychiatric Criteria for Hospital Admission


  • Suicide or self-mutilation
  • Laxatives, emetics, diuretics, street drugs
  • Failure to adhere to treatment
  • Severe depression
  • Psychosis
  • Family Crisis
• Anorexia Nervosa


  • Terror of gaining weight
  • Preoccupied with food
  • Views self as fat
  • Handles food peculiarly
  • Rigorous exercise regimen
  • Self-induced vomiting; laxatives, diuretics
  • Cognitive distortions
• Physical Symptoms of Anorexia Nervosa


  • Poor circulation
  • Pallor
  • Palpitations
  • Fainting
  • Dizziness
  • Menstrual disturbances
  • Unexplained GI symptoms
  • Cachectic
  • Lanugo
• Nursing Process - Assessment for Eating Disorders


  • Sick
  • Control
  • One stone
  • Fat
  • Food
• Nursing Process - Assessment Priorities


  • Safety
  • Level of insight
  • Understanding of disease
• Nursing Process - Outcomes


  • The patient will refrain from self-harm
  • The patient will eat 75% of three meals per day + 2 snacks
  • Patient will achieve 85-90% of IBW
  • Patient will participate in treatment
  • Patient will demonstrate one coping behavior
• Nursing Process - Implementation


  • Weight patient regularly
  • Observe patient while eating
  • Give patient time frame to eat meal
  • Consult nutritionist for choice of foods
  • Monitor physiological parameters
  • Assess for suicide
  • Work with patient to identify strengths
• Interdisciplinary Treatments for Eating Disorders


  • Cognitive-behavioral therapy
  • Enhanced CBT
  • Dialectical behavioral therapy
  • Interpersonal psychotherapy
  • Maudsely anorexia nervosa tx for adults
  • Specialist supportive clinical mgmt
  • Group therapy
• Pharmacological Treatments


  • Olanzipine
  • Fluoxetine
• Bulimia Nervosa


  • Binge-eating
  • Binging occurs after fasting
  • Compensatory behavior
  • Hx of anorexia nervosa
  • Depression, anxiety, compulsivity
  • Problems with interpersonal relationships, self-concept, impulsive behaviors
• Physical Symptoms of Bulimia Nervosa


  • At or above IBW
  • Enlargement of parotid glands
  • Dental erosion
  • Skin problems
• Nursing Process - Assessment for Bulimia Nervosa


  • Medical stabilization
  • Physical exam/Laboratory testing
  • Use of medications, herbs, drugs
  • Psychiatric evaluation
  • Suicide risk
• Nursing Process - Outcomes for Bulimia Nervosa


  • Patient will obtain and maintain normal electrolytes and stable VS
  • Patient will refrain from binge-purge behaviors
  • Patient will be free from self-harm
  • Patient will demonstrate 2 anxiety reduction techniques
  • Patient will name 2 personal strengths
• Nursing Process - Implementation for Bulimia Nervosa


  • Weight patient regularly
  • Observe patient while eating AND 1-3 hours after
  • Observe for compensatory behavior
  • Encourage patient to keep a journal
  • Assess for suicide
• Interdisciplinary Treatments for Bulimia Nervosa


  • Psychotherapy
• Binge-Eating Disorder


  • Similar to bulimia nervosa, but no compensatory mechanisms used
  • Eat large amount of food in a short period
  • Feel guilty after bingeing
• Nursing Process - Evaluation is a constant process of revising goals
• Delirium is a secondary condition that can occur due to factors like medications, infections, or age
• Cognitive Domains Affected in Delirium


  • Complex attention
  • Executive functioning
  • Learning and memory
  • Language
  • Perceptual-motor abilities
  • Social cognition
• Risk Factors for Delirium


  • Medications
  • Infections/Illness
  • Number of co-occurring conditions
  • Disorders of substance or alcohol
  • Surgery
  • Pain
  • Age
  • Cognitive impairment
  • Emotional or mental illness
  • Sleep disturbances
• Delirium features include symptoms that develop rapidly and fluctuate
• Delirium involves decreased ability to focus, pay attention, or switch attention
• Delirium - Risk Factors

  • Medications
  • Infections/Illness
  • Number of co-occurring conditions
  • Disorders of substance or alcohol
  • Surgery
  • Pain
  • Age
  • Cognitive impairment
  • Emotional or mental illness
  • Sleep disturbances
• Delirium features


  • Symptoms develop rapidly and fluctuate
• Delirium features - Cognition


  • Decreased inability to focus
  • Decreased orientation to environment
  • Memory impairment
  • Unable to calculate
• Delirium features - Behaviors


  • Restless
  • Anxious
  • Motor agitation
  • Labile
• Delirium features - Perception


  • Hallucinations
  • Illusions
  • Decreased visuospatial ability
• Types of Delirium


  • Hyperactive
  • Hypoactive
  • Mixed
• Delirium - Outcomes


  • Cognitive and perceptual disturbances
  • Safety
  • Mood and behaviors
• Interventions


  • Provide a safe and therapeutic environment
• Mild vs. Major Neurocognitive Disorder


  Mild: Modest impairment, symptoms do not interfere

  Major: Substantial impairment, symptoms interfere with independence