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1.

Anorexia
Nervosa
2. Bulimia Nervosa

Facts About
Anorexia Nervosa
1.Intense fear of
gaining weight or
becoming fat
(even if under
weight)
2.Amenorrhea of 3
cycles
3.Refusal to
maintain body
weight
4.Main sign: fear of
gaining weight

5. The parents are


typical overprotective
to their children.
6. Agouti-related protein
(AGRP) (chemical that
stimulates appetite)
are frequent among
anorexic patients.
7. High levels of
enkephalins and
endorphins influence
eating disorders.
8. Birth trauma
(cephalohematoma)

Psychological
Presentation:
1.Terrified of
gaining weight
2.Pre-occupied
with thoughts
of food
3.See
themselves as
fat even when
emaciated
4.Peculiar
handling of
food

6. Pushing pieces of
food around the table
7. May develop rigorous
exercise program.
8. Self-induced
vomiting, laxatives
and diuretics.
9. Cognition so
disturbed that they
judge their self-worth
by their weight
10.Cutting
Cutting food into
small bits

Clinical
Presentation:
1.Low weight
2.Amenorrhea
3.Yellow skin
4.Cold extremities
5.Peripheral edema
6.Muscle weakening
7.Constipation
8.Low T3 and T4

9. Hypotension
10.Bradycardia
11.Hypokalemia
12.Anemia
13.Pancytopenia
14.Decreased
bone density

Signs and Symptoms:


a.Refuses to eat
b.Plays with food and
eats in very small
amounts
c.Perceives body or body
parts as being fat even
if not
d.Dry skin, fine downy
hair
e.Absent menses
f. Hypothermia,
hypotension,
bradycardia

Signs Related to Purging Behaviors :


a.Gastrointestinal parotid gland
tenderness, pancreatitis,
esophageal and gastric erosion or
rupture.
b.Metabolic electrolyte imbalance
hypokalemia
c.Dental erosion of dental enamel
of the front teeth.

a. Increasing
body weight
to at least 90
% of average
weight for
age and
height
b. Reestablishing
good eating
behavior.
c. Increasing
self-esteem

Nursing Management
a.Monitor daily caloric
intake, activity level and
weight and electrolyte
status
b.Establish nutritional
eating patterns
1. Sit with client during
meals
2. Offer liquid protein
supplement if unable
to complete a meal
3. Observe signs of
purging 1 2 hours
after meals

c. Provide accurate information on


nutrition and discuss realistic and
healthy diet
d. Help client identify emotions and
develop non-food related strategies
1. Convey warmth and sincerity
2. Ask the client to identify feelings

e. Assist in identifying
at least three
positive
characteristics
f. Teach patient about
their illness
g. Behavior
modification: reward
increase in weight
with meaningful
privileges
h. Identify patients
non-weight related
interests to reduce
anxiety and refocus
attention

Important Facts:
1.Binge eating eating
a large amount of
food, rapidly and
discretely, in a given
time.
2.Compensatory
behavior to prevent
weight gain
3.Twice a week
episode for 3 months

Clinical
Presentation:
1.Binge and
purging behavior
2.Have depressive
signs and
symptoms
3.Disturbed home
life
a. Interpersonal
b. Self-concept
c. Impulsive
behavior

4. Chemical dependence
is also common
5. Normally to slightly
low weight
6. Dental carries
7. Parotid swelling
8. Gastric swelling and
rupture
9. Calluses or scars on
the hand
10.Peripheral edema
11.Hypokalemia,
hyponatremia

Nursing Management:
1.Trust
2.Help patient identify feelings associated
binge-purge behavior.
3.Accept patient as worthwhile human
beings because they are ashamed of
their behavior

4. Encourage patient
to discuss positive
qualities about
themselves.
5. Teach about bulimia
nervosa
6. Encourage to
explore
interpersonal
relationships
7. Encourage patients
to adhere to meal
and snack
schedules.

8. Encourage patient
to approach the
staff if she feels like
binging or purging
9. Encourage to attend
group sessions.
10.Encourage family
therapy.
11.Encourage
participation in art,
recreation and
occupational
therapy.

The
DOs

1. Small frequent feedings


2. Monitor I and O and small bowel
functions.
3. Monitor weight gain and lab results
4. Encourage expression of feelings
5. Set realistic expectations of self
6. Encourage participation in activities
7. Stay with client during meal time
and at least 1 hour after eating.
8. Accompany to bathroom.

The DONTs
1. Indicate feelings of shock,
disbelief or disgust at eating
disorder
2. Confront and judge hostilities,
anger, should they occur.
3. Discuss and explain food, diet
or body (unless linked with
feelings).
4. Compare clients behavior and
appearance with others.
5. Allow long meal time (30
minutes meal time)