EATING DISORDERS themselves

- Family Factor- some people with eating disorder belong to

 Severe disturbance in eating behaviors
HISTORY:
- middle ages indicates willful dieting leading to
self starvation in the female saints who fasted to
achieve purity
- late 1980’s doctors in England and France
describe young woman who apparently use self
starvation to avoid obesity
- 1960’s Anorexia was established as a mental NURSING DIAGNOSIS:
disorder
- 1970 Bulimia was described as a distinct
syndrome
INCIDENCE:
- Bulimia 3%- 5% of woman from puberty to 30 years old
- Anorexia 1%
- 10% are male
- 25%-50% suffers from depressive disorder
- 15%-20% die because of the disorder
- affects more WOMEN
- 56% of women between 25-35 y/o are dieting ANOREXIA NERVOSA
- 80% of the 4th grade are dieting
ETIOLOGY:
- Biologic Factor – personality type OCD, sensitive-avoidant Characteristics:
- mother or sister who has eating disorder
* Lateral hypothalamus- disruption results in decrease
eating and decrease response to sensory stimuli that
are important to eating
* Ventromedial hypothalamus- disruption results to
excessive eating, weight gain and decrease response
to satiety effects of glucose
* Norepinephrine low during periods of restricted dieting
* Serotonin low found in client with Bulimia and Binge
Purge type of anorexia
- Psychological Factor – people with eating disorder tend to Types:
be perfectionist, they have unrealistic perception of
an Overprotective family
- Social- Life style Factor – some people with eating disorder
are into relationship(sorority, dance companies,
cheerleaders that encourage eating disorders.
- Cultural Factor – in Westernized countries woman are
pressured to be thin to develop a self esteem
- Media Factor
- Physical and Sexual Abuse
 Alteration in health maintenance
 Altered nutrition less/more than body requirement
 Anxiety
 Body image disturbance
 Ineffective family coping
 Ineffective individual coping
 Self Esteem disturbance
2 MAJOR TYPE OF EATING DISORDER
“ A rentless Pursuit of thinness”
- eating disorder with insidious onset that often affect
adolescent girls
- sufferers are typically high achievers with good grades and
describe by their parents as good child
- Denies that they have a problem
- 10%-20% died due to suicide
- socially isolated
- personality are perfectionist and introvert with low level of
self esteem, they era conscientious, hard working and ideal
students and people pleasers
- they have fear of growing up and assuming adult
responsibilities
 1. Restricting – weight loss by dieting , acting and excessive approach to patient, assist to find positive qualities
exercise about self
2. Binge eating/Purging type – use self induce vomiting, abuse - teach about their disorder
diuretics, laxatives and enema - monitor weight 3x/week, facing away from the weighing
Assessment: scale make sure that they are not hiding any heavy object
- behavior directed toward weight loss and using hospital gown
- distorted body image - matter of fact attitude
- intense fear of becoming fat - setting limits to avoid manipulative behavior
- preoccupation with food * restrict bathroom use 2 hrs. after eating
- depressed * accompany them to the bathroom
- compulsive rituals * stay with the client during meal
- amenorrhea (3 cycles) due to decrease body fats * Do Not accept excuses to leave eating areas
- lacks interest in sexual activity - help patient identify and express feelings and do not be
- Physical symptoms judgmental
* 85% less than IBW - identify the patient non weight related interest
* bradycardia - avoid being confrontational and avoid long discussion or
* lanugo (fine downy hair) explanation about food or body
* hypothermia - Individual Psychotherapy
* dehydration - Self help group
* dependent edema
* hypotension BULIMIA NERVOSA
* decrease metabolic rate “ A diet-binge purge disorder”
- deceitful, stubborn, hostile and manipulative - disorder characterized by alternating dieting, binging and
Implementation: purging through vomiting enema and laxatives
- medical management focuses of weight restoration, Characteristics:
nutritional rehabilitation, rehydration and electrolyte - a cycle of binge eating about 8OOO Kcal/2 hrs and 5O,OOO
imbalance Kcal/day then they terminates it by purging happening in 2
* high caloric and protein diet weeks for 3 mos.
* hyperalimentation - weight fluctuation
* parenteral nutrition - usually manifest during the late adolescent period around
- Psychopharmacology given for 28 days 15-24 y/o
* Antidepressants (prozac) - they are extrovert, low self esteem, depressed and has fear
* Antipsychotic (periactin) of loosing control
* Antihistaminic (zyprexa) - they are lonely ashamed and empty inside but outside they
- Cognitive behavioral therapy- by positive and negative are competent and fun to be with
reinforcement - they are impulsive (shoplifting, sexually adventurous,
* privileges are gain when weight are gain alcohol and drug abuse and other risk taking behaviors )
* privileges are loss when weight are loss - they are aware of the behavior but are unable to stop it
- Increase self Esteem- acceptance and Non-judgmental - Physical complications
 * inflammation of the lining of the esophagus
* electrolyte imbalance causing cardiac arrhythmias
(hypokal/nat/cal/chloremia)
* dehydration
* enlargement of the parotid gland
* irritable bowel syndrome
* rectal prolapsed
* dental erosion
* chronic edema
Implementation:
- create an atmosphere of TRUST
- develop strength to cope with problems
- help patient identify feelings that triggers binge eating
* explore alternative and positive way of coping
* make a journal of incident
* make a contract
- encourage participating in group therapies
- Family therapy
- Cognitive behavioral therapy
- Psychopharmacology
* Antidepressants
Difference Between AN and BN

CATEROGIES BULIMIA
ANOREXIA
< 85% OF THE IBW WEIGHT NORMAL

DIET!DIET! DIET! EATING PATTERN BINGE-PURGE

AMENORRHEA 3
MENSTRATION IRREGULAR
CYCLES
FEMALE GENDER FEMALE
EGO SYNTONIC
ATTITUDE EGO DYSTONIC
(DENIAL)
EARLY 13-15 Y/O ONSET LATE 15-19 Y/O
 SUBSTANCE ABUSE AND DEPENDENCE DSM-IV-TR List of 11 cause of substance abuse
1. Alcohol
2. Amphetamines
ABUSE – misuse of substance with significant and recurrent 3. caffeine
adverse consequences related to repeated use. 4. cannabis
DEPENDENCE – cluster of cognitive behavioral and physiologic 5. Cocaine
symptoms indicating continued use of substance 6. Hallucinogens
despite problems related to use with 3 or more of the 7. Inhalants
following symptoms for 12 months. 8. Opiates
* Tolerance – increase amount of substance is required to 9. Nicotine
achieve desired effects, and markedly diminished 10. Phencyclidine PCP
effect with continued use of the same dose 11. Sedative, Hypnotics or anxiolytic
* Withdrawal – reduction or cessation of intake of the ALCOHOLISM
substance experience a substance specific syndrome - is a legal substance classified as CNS depressant
(physiologic and psychologic) Incidence:
* Compulsive drug taking behavior - 1 of 10 Americans who drinks alcohol is alcoholics
* Inability to reduce substance use - 1 out of 10 alcoholics is diagnosed and treated
* excess time spent in obtaining drugs - male:female ratio is about 1:4
* Impairment in social and occupational functioning or Symptoms of Dependence:
recreational activity - ingestion - of large amount over a long period of time
* Continued substance use despite of negative - inability to control or cut down drinking
consequences - frequent intoxication
OTHER TERMINOLOGIES: - withdrawal from social and occupational activities
Polysubstance Abuse – use of more than one abusive - marked tolerance
Substance - withdrawal symptoms
Intoxication- development of substance specific syndrome - persistence of use for at least one month
induce by ingestion or exposure to substance which * Episodic Excessive Drinking – intoxication more than 4x/year
produces physiologic effect on the CNS * Habitual Excessive Drinking – intoxication 12x/year
Dual Diagnosis- presence of another psychiatric diagnosis in Characteristics:
an individual with a substance specific disorder - dependent personality
Cross Tolerance – persons dependent on one substance - Early onset (adolescent antisocial personality)
requires higher dose of another substance in the - Late onset (developed after 25 y/o passive dependent
general categories personality)
Detoxification – controlled withdrawal from abusive substance - fixated at the oral stage
in a medically assisted program - under-report amount of alcohol consumed
Codependence – persons who enable behavior of individual in - signs of impaired judgment and motor skills
the family or social system of a person who is a Etiology:
substance dependent - Individual Factor- genetic predisposition and weak
dependent personality
 - Environmental Factor – family and sociocultural - Uric Acid – rise and return to normal after 1 week of
environment norms that condone alcoholic drinking abstinence
* Inhuman - Triglyceride and Cholesterol – increase
* Rigid - Thrombocytopenia
* Closed
Stages of Alcohol Addiction:
- pre-addiction (experimental use)
- responsible use * H2 receptor (ZANTAC,TAGMET) can raise blood alcohol
- occasional misuse , addiction concentration resulting in increase intoxication effect
- early phase (regular misuse) * Taking Acetaminophen causes severe hepatic injury when
- Middle phase (dependency) taken with alcohol
- Late phase (complete dependency)
Diagnosis:
- CAGE questionnaires 2 positive response are indicative of
diagnosis for Alcoholism
* Have you ever felt of CUT down your drinking? EFFECTS:
* Have people ANNOYED by criticizing your drinking? - initial effects - are relaxation and loss of inhibitions
* Have you ever felt a bad or GUILT about your drinking? - intoxication – slurred speech,
* Have ever had a drink first day in the morning as an EYE unsteady gait
OPENER? lack of coordination
- BAL (blood alcohol level is the best evidence drawn within impaired concentration or memory and
the first 24 to 36 hrs) judgment
* Legal level 0.8-0.10mg/100cc of bld. - overdose – vomiting,
* Intoxication – 0.15(150mg of alcohol/100cc of bld.) unconsciousness and
- Elevated Bal without intoxication respiratory depression
- GGT (gamma-glutamyl transferase)- liver function test that COMPLICATIONS:
rise during habitual drinking, this is the first enzyme to - cardiac myophaties
rise after heavy drinking and the first to return to normal - Wernicke’s psychosis – inflammatory, hemorrhagic
(half life 5to17 days) degenerative condition of the brain due to thiamine
- CDT (carbohydrate –deficient transferrin)- more accurate deficiency and B12
than GGT because it is independent concomitant to liver - s/s – Confusion
dse - Opthalmoplegia
- MCV (mean capsular volume) elevated MCV without anemia, - Ataxia
due to bone marrow depression - Thiamine deficiency
- Magnesium Level – hypomagnesemia is common in
alcoholics - Korsakoff’s psychosis sometime preceded by Wernicks
- AST/ALT – greater than 1:1 indicate hepatic damage due to - thiamine and niacin
alcohol., This should return to baseline within 4 weeks of deficiency
abstinence - s/s – memory disturbance
 - Retrograde amnesia * Vit. B1
- Anterograde amnesia - dehydrate patient by D5NSS
- Confabulation - elevate the head of the bed 60 degrees
- Korsakoff”s psychosis II. Hallucinosis (occurs 8-10 hrs after the last drink)
- Pancreatitis s/s: Delusion/disorientation
- Esophagitis Anorexia
- Hepatitis/ Cirrhosis Hallucination
- Leukopenia Hyperactivity
- Thrombocytopenia Mgt: remain with the client and orient to reality
- Ascites - monitor V/S every 2 hrs.
COMMON BEHAVIOAL CHANGES: - avoid television
* Denial - use restraint as the last resort
* Dependency III. Stage 3 occurs 12 to 48 hrs after the last drink
* Demanding s/s: Persistent hallucination
* Destructive - seizure occurs
* Domineering mgt: institute seizure precaution
DM: - anticonvulsant
* Denial - offer oral fluids and light meals
* Rationalization - maintain peaceful environment
* Isolation IV. Delirium Tremens
* Projection s/s: uncontrollable body shaking
- heavy sweating
STAGES and ONSET OF DETOXIFICATION - convulsion
I. Shakes and Tremulous (symptoms occurs 8hrs. after the - extreme restlessness
last drink and may last for 36 hrs) mgt: remain with the client
s/s: Diaphoresis - monitor the clients V/S
Increase V/S V. Occurs 3-5 days after drinking
Nausea s/s: seizure and worsening agitation
Tremors
Flushed face Implementation:
Agitation - Aversion Therapy (Antabuse DISULFIRAM)
Nervousness * it inhibits the breakdown of Acetaldehyde by the enzyme
Mgt: monitor clients behavior Acetaldehyde Dehydrogenase, causing Acetaldehyde to
- relieve withdrawal symptoms accumulate in the blood, producing a toxic symptom
*Librium for convulsion making the patient feel very ill
* Valium to decrease anxiety * it potentate anti-anxiety and anticoagulants
* Ativan to sedate patient * contraindicated with pregnancy and cardiac
* Dialantin (Phenytoin) preferred over barbiturates decompensation.
because it has less respiratory depression effect * Nursing Responsibilities
 - teach the client to avoid intake of alcohol or any
product or food containing alcohol - slurred speech
- Naltrexone – an opium antagonist that has been use - lacks coordination
successfully for the treatment of alcoholism - labile mood
- Family and Marital therapy - stupor – coma
- Self Help Group W/D
* AA (Alcoholic Anonymous) - opposite of the acute effect of the drug
* 12 Steps to AA - autonomic hyperactivity
1. We know that we are powerless over alcohol that life - hand tremors
has become unmanageable - insomnia
2. Came to believe that the power greater than our self - anxiety
can restore our sanity - nausea
3. Make a decision to make our will and our lives over - psychomotor agitation
the care of God, as we understood him - “ tapering “ 10 mg/day
4. made a stretching and moral inventory of ourselves TX
5. Admitted to God, to our selves and other human - gastric lavage
being the exact nature of our wrong - ingestion of activated charcoal
6. We are entirely ready to have God to move this - saline chatartics
defects of character - dialysis
7. Humbly ask him to remove all may shortcomings
8. Make a list of all people we had harm, and make NARCOTICS/OPIOIDS
willing to make amends to them all - group of drug generally used as pain reliever
9. Make direct amend to such people whenever possible, - the most common abused Opioids are
except when to do so would injure them or others * Heroin
10. continue to take personal inventory and when we * Morphine
were wrong we promptly admitted it * Codeine
11. Sought through prayer and medication to improve * Demerol
our conscious contact with God as we understood * Paregoric
him , praying only for knowledge and will and the * Opium
power to carry that out - Also called “whit stuff”, “hard Stuff” and Junk
12. Having had a spiritual awakening as the result of - administer by IV or snorted
this step, we tried to carry is massage to alcoholics , EFFECTS: improve self confidence and productivity
and to practice all this principles to all our affairs - causes euphoria (better than sex)
- reduce feeling of hunger and sexual desire
CNS DEPRESSANT - distorted perception
BARBITURATES (sedative Hypnotics) - constricted pupils
- acts as a CNS depressant - impaired memory and judgment
- causes psychological dependence WITHDRAWAL SYMPTOMS: (occurs within 12 to 16 hrs.)
INTOXICATION: - N ausea and vomiting, anorexia
 A abdominal cramps - respiratory collapse
R estlessness - severe hypertension
C oryza: watery eyes, rhinitis and sneezing - seizure and coma
O on the 2nd to 3rd day, violent, hysterical, destructive, patient mgt: treatment is acidification of urine
may attempt to escape from the hospital - induce vomiting and diuresis
T remors, convulsion coma - cholpromazine given for paranoia
I ratability - ammonium cl given to acidify the urine
C cold and hot flushes with PILO errection Cocaine – comes from the coca plat found in Andres mountain
S weating - causes physiologic dependence
Implementation: - users inject it IV or smoke every 10-15 min. to sustain
- reassure patient that signs and symptoms will disappear high and prevent crashing
after several days EFFECTS:- euphoria
- institute seizure precaution, and limit patients stimulation - dilated pupils
- give antidote NALOXONE (nacan) - increase mental alertness
- secure physical restraint before giving the antagonist - increase and sexually stimulated
- observed patient closely for the 1st 24 hrs. due to the - paranoia
possibility of having coma and respiratory depression OVERDOSE: tachycardia, hypertension
- observed for severe pulmonary edema - mydriasis, muscle twitching
DETOXIFICATION: - sleeplessness and extreme nervousness
- terminate the use of the drug mgt: no treatment is required because the effect is very short
- METHADONE substitution decreases the withdrawal signs acting, they maybe given Barbiturate (diazepam)
and symptoms over the period of 3 to 7 days
- Morphine is given for 2 days to counter act the symptoms of CANABIS (marijuana) – pot or hashish
withdrawal (withdrawal occurs in 5 to 7days) - acts in < 1min
- Phenothiazine may be given to relieve anxiety - peaks at 20-30 mins.
- self help group - last at 2-3 hrs
- lowers inhibition
CNS STIMULANTS - can cause possible psychosis
Amphetamine – use medically against obesity, ADHD and - relaxation
Narcolepsy - euphoria
- produces longer high than cocaine and less - increase appetite
expensive INTOXICATION
- can be taken IV, orally and the most recent - impaired motor activity
smoking also known as CRANK or SPEED - inappropriate laughter
EFFECTS: euphoria - impaired judgment
- increase alertness and wakefulness - shorterm memory
- increase ability to concentrate and energy - blood shot eye
- improved performance and mood -dry mouth
OVERDOSE: arrhythmia - hypotension
 * overdose do no occur

HALLUCINIGENS
- cause psychosis with distorted perception, heightened sense
of awareness, gradiosity and mystical experience
- dilated pupils
- hyperreflexia
INTOXICATION
- anxiety
- paranoid ideation
- fear of losing ones mind
- potentially dangerous behavior
* No withdrawal symptoms

INHALANTS
- can cause significant brain damage, peripheral nervous
system damage and liver damage
INTOXICATION
- dizziness
- nystagmus
- lacks coordination
- slurred speech
-unsteady gait
* there’s no withdrawal symptoms and Tx is symptomatic