eating disorders- nursing

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  1. nx dx
    • imbalance nutrition- less than body requirements r/t refusal to eat
    • deficient fluid volume (risk for or actual) r/t decr fluid intake, self induced vomiting and laxative and or diuretic abuse
  2. nx dx
    • ineffective denial r/t delayed ego development and fear of losing the only aspect of life over which he or she perceives some control (eating)
    • imbalance nutrition more than body requirements r/t compulsive eating
  3. nx dx
    • disturbed body image/low self esteem r/t retarded ego development, dysfunctional family system, or feeling of dissatisfication with body appearance
    • anxiety (mod-severe) r/t¬† feelings of helpness and lack of control over life events
  4. Nx intervention 1
    • provide highly structured milieu in an acute care, aid with self care as needed- specialized in eating disorders
    • be aware of your own feelings regarding eating disorders
    • develop therapeutic communication and trusting nurse/pt relationship
    • encourage pt to make decisions, give some control over plan of care
    • establish small realistic goals in concert with therapist
    • monitor vitals, wt (check backwards- so can't see), labs and follow strict protocol
    • monitor pt excercise, use behavioral contract
    • not on psych ward. every staff should understand eating disorder.
  5. nx intervention 2
    • tx is best in specialized setting, difficult to implement on general medical or psych unit
    • provide for access to CBT
    • monitor pt during meals and in batheroom to prevent purging
    • work closely with nutritionist and pt around meal plan
    • help provide diet hight in fiber, low in sodium, restrict caffeine and limit fatty/greasy foods
    • admister vita and supplements
    • encourage fam and spouse in therapy when approriate (mandatory in some settings)
  6. complication of eating tx
    • be aware of the phenomena of refeeding syndrome, which is potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduce to severely malnourish people, must be introduce slowly and labs monitor through out
    • be aware of potential cardiac complications such as dysrhythmias, bradycardia (severe), and hypotension, may need to be a continous cardiac monitor with strictly scheduled vs and protocols to alert MD
    • remember mortality rate for eating disorders is high and suicide is always a high risk
  7. Pt outcome-goals for d/c
    • the patient
    • has achieved and maintained at least 80% of expected body wt*** (when are not eating they are not thinking)
    • has vs, bp, and labs within normal limits
    • verbalize importance of adequate nutrition
    • verbalizes knowledge regarding consequences of fluid loss cause by self induced vomiting (laxative/diurectics) and importance of adequate fluid intake
    • verbalize events that precipate anxiety and demonstrates techniques for it reduction
  8. pt outcomes (continued therapy)
    • the pt
    • verbalizes ways inwhich they can gain more control of the environment and thereby reduce feelings of powerlessnes
    • expresses interest in welfare of tohers and less preoccupation with own appearance
    • verbalize that image of body was fat was misperception and demonstrates ability to take control of own life without resorting to maladaptive eating behavior
  9. pt outcomes for BED
    • the pt
    • has established a healthy pattern of eating for wt control and wt loss toward a desired goal is progressing
    • verbalize plans for future maintenance of wt control
  10. Planning and implementation
    • ** # 1 nursing priority of the patient with eating disordered is aimed at restoring nutritional balance and bring them back to close to norm body wt
    • emphasis is also placed on helping the pt gain control over life situation in ways other than inapproriate eating behaviors
    • self- esteem and positive self-images are promoted in ways that r/t aspects other than appearance
    • monitor safety
    • begin work with family
  11. Key pt/family education
    nature of illness
    • nature of the illness
    • - s/s of aneorexia and bulimia
    • - what constitutes obesity
    • - causes of eating disorders
    • - effects of the illness or condition on the body
  12. Key pt/family education
    management of the illness
    • principles of nutrition
    • ways pt may feel in control of life
    • importance of expressing fears and feelings, rather than holding them inside
    • alternative coping stragtegies
    • use resources from and refer pt to national association of anoerexia and associated disorders and national eating disorder association
  13. Key pt/family education
    management of the illness
    • correct administration of prescribed medication
    • indication for and side effects of prescribed medications
    • ¬†relaxation techniques
    • problem-solving skills
  14. Key pt/family education
    for BED/Obesity
    how to
    • plan a reduced calorie, nutritious diet
    • read food content on labels
    • establish a realistic wt loss plan
    • establish a planned program of physical activity
    • refer to support services
    • - wt watchers international
    • - overeaters anonymous
  15. evaluation
    • evaluation of the pt with an eating disorder requires reassessment of the behaviors for which the pt sought treatment looking for the needed behavioral change required by pt and family members
    • specific for anoerexia and bulimia is pt gains 2-3 lbs per/wk
    • prior d/c, should free of s/s of dehydration and malnutrition, lyte balanced and obtained closer to normal wt
    • can consume adequate food without purging or hoarding food to discard, is discussing tx not engaging in manipulative behaviors, have begun to process body image work and is showing interest in welfare of others
  16. evaluation 2
    • specific to pt with BED/Obesity:
    • has shown steady wt loss, have verbalize plan to continue reduction, have begun to verbalize positive attributes not associated with body size or appearance and is verbalizing ways to adapt to stressors without use of food
  17. tx modalities
    • behavior modifications:
    • success has been observed when the pt
    • - is allowed to contract for privledges based on wt gain or loss
    • - has input into the care plan
    • clearly sees what the tx choices are-
    • - amt of eating, amt of exercise pursued and whether to induce vomiting
    • staff and pt agree about goals and system of rewards
    • the pt has a choice whether to abide by the contract, gain or loss wt and earn the desired priviledge
  18. tx modalities 2
    • behavior modification
    • - issues of control are central to the etiology of these disorders
    • - for the program to be successful, the pt must perceive that they are in control of the tx
  19. tx modalities
    individual therapy
    • both inpatient and long term outpt
    • helpful when underlying psychological problems are contributing to the maladaptive behaviors
    • the goal is to resolve the issues and establish a more adaptive coping strategy to deal with stress and conflict
  20. tx modalities
    family therapy
    • involves educating fam about disorder
    • assess the fam's impact on maintaining the disorder
    • assist in methods to promote adaptive functioning
  21. tx modalities
    • no meds indicated for eating disorders
    • various meds rx for associated symptoms
    • - anxiety
    • - depression
  22. tx modalities
    pharm- tried with some success
    • fluoxetine (prozac)- depression/anxiety
    • cyproheptadine (pariactin)- appetite stimulant
    • chlorpromazine (thorazine)- thought process/body image
    • olanzapine (zyprexa)- thought process,/body image
    • avoid TCA- cardiac issue
  23. tx modalities
    pharm- bulimia
    • fluoxetine (prozac)- decrease cravings for carbs- binge
    • imipramine (togranil)- same along with depression
    • desipramine (norpramine)- depression
    • amitriptyline (elavil)- depression
    • nortriptyline (aventyl)- depression
    • phenelzine (nardil)- MAIO (tyramine)- depression
  24. tx modalities
    pharm- BED/obesity
    • topiramate (topamax)- binging reduction and wt loss- seizure med- mood stabilizer
    • fluoxetine-depression- binge reduction like bulimia
  25. tx modalities
    • various anoerexiants (CNS stimulants)- use only short term- rebound weight gain, abuse potental
    • lorcaserin (belviq)- appetitite suppressants
    • phentermine/topiramente (Qsymia) combo CNS stimulant suppresses appetite and antidepressants
    • several off market now, such a fenluramine (pondimin or adifax) due to the development of heart valve disease**
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eating disorders- nursing
2016-12-02 02:47:39

eating disorders
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