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ByNi Ketut Alit A
Faculty Of Nursing Airlangga University Slide 1
Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care. J.B. Lippincott.co.
Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.
Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B. Saunders Company.
Journals and article related to..
Slide 2
REVIEW
Body WeightBody Mass Index ( BMI)Daily Calori Need - Haris Benedict
Current Western beauty standards equate thinness with health and beauty
There has been a rise in eating disorders in the past three decades◦ The core issue is a morbid fear of weight gain
Two main diagnoses:◦ Anorexia nervosa◦ Bulimia nervosa
Slide 4
The main symptoms of anorexia nervosa are:◦ A refusal to maintain more than 85% of normal
body weight◦ Intense fears of becoming overweight◦ A distorted view of body weight and shape◦ Amenorrhea
Slide 5
There are two main subtypes:◦ Restricting type
Lose weight by restricting “bad” foods, eventually restricting nearly all food
Show almost no variability in diet
◦ Binge-eating/purging type Lose weight by vomiting after meals, abusing
laxatives or diuretics, or engaging in excessive exercise Like those with bulimia nervosa, people with this
subtype may engage in eating binges
Slide 6
About 90–95% of cases occur in females The peak age of onset is between 14 and 18
years Around 0.5% of females in Western
countries develop the disorder◦ Many more display some symptoms
Slide 7
The “typical” case:◦ A normal to slightly overweight female has
been on a diet◦ Escalation to anorexia nervosa may follow a
stressful event Separation of parents Move or life transition Experience of personal failure
◦ Most patients recover However, about 2 to 6% become seriously ill and die as
a result of medical complications or suicide
Slide 8
The key goal for people with anorexia nervosa is thinness◦ The driving motivation is FEAR:
Of becoming obese Of losing control of body shape and weight
Slide 9
Despite their dietary restrictions, people with anorexia are extremely preoccupied with food◦ This includes thinking and reading about food and
planning for meals◦ This relationship is not necessarily causal
It may be the result of food deprivation, as evidenced by the famous.
Slide 10
People with anorexia nervosa also demonstrate distorted thinking:◦ Often have a low opinion of their body shape◦ Tend to overestimate their actual proportions
Adjustable lens assessment technique – overestimate size by 20%
◦ Hold maladaptive attitudes and beliefs “I must be perfect in every way” “I will be a better person if I deprive myself” “I can avoid guilt by not eating”
Slide 11
People with anorexia may also display certain psychological problems:
◦ Depression (usually mild)◦ Anxiety◦ Low self-esteem◦ Insomnia or other sleep disturbances◦ Obsessive-compulsive patterns◦ Perfectionism
Slide 12
Caused by starvation:◦ Amenorrhea◦ Low body temperature◦ Low blood pressure◦ Body swelling◦ Reduced bone density
◦ Slow heart rate◦ Metabolic and
electrolyte imbalance
◦ Dry skin, brittle nails◦ Poor circulation◦ Lanugo
Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:◦ Bouts of uncontrolled overeating during a limited
period of time Often objectively more than most people
would/could eat in a similar period
Slide 14
The disorder is also characterized by compensatory behaviors, which mark the subtype of the condition:◦ Purging-type bulimia nervosa
Vomiting Misusing laxatives, diuretics, or enemas
◦ Nonpurging-type bulimia nervosa Fasting Exercising excessively
Slide 15
Like anorexia nervosa, about 90–95% of bulimia nervosa cases occur in females
The peak age of onset is between 15 and 21 years
Symptoms may last for several years with periodic letup
Slide 16
Patients are generally of normal weight◦ May be slightly overweight◦ Often experience weight fluctuations
“Binge-eating disorder” may be a related diagnosis◦ Symptoms include a pattern of binge eating with
NO compensatory behaviors (such as vomiting)◦ This condition is not yet listed in the DSM
Slide 17
Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia from friends or the media
In one study:◦ 50% of college students reported periodic binges◦ 6% tried vomiting◦ 8% experimented with laxatives at least once
Slide 18
For people with bulimia nervosa, the number of binges per week can range from 2 to 40◦ Average: 10 per week
Binges are often carried out in secret◦ Binges involve eating massive amounts of food
rapidly with little chewing◦ Binge-eaters commonly consume more than
1500 calories (often more than 3000 calories) per binge episode
Slide 19
Binges are usually preceded by feelings of tension and/or powerlessness
Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and “discovery”
Slide 20
After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects
The most common compensatory behaviors: ◦ Vomiting
Affects ability to feel satiated greater hunger and bingeing
◦ Laxatives and diuretics Almost completely fail to reduce the number of calories
consumed
Slide 21
Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating◦ Over time, however, a cycle develops in which
purging bingeing purging…
Slide 22
The “typical” case:◦ A normal to slightly overweight female has been
on an intense diet◦ Research suggests that even among normal
subjects, bingeing often occurs after strict dieting For example, a study of binge-eating behavior in a
low-calorie weight loss program found that 62% of patients reported binge-eating episodes during treatment
Slide 23
Similarities:◦ Onset after a period of dieting◦ Fear of becoming obese◦ Drive to become thin◦ Preoccupation with food, weight, appearance◦ Elevated risk of self-harm or attempts at suicide◦ Feelings of anxiety, depression, perfectionism◦ Substance abuse◦ Disturbed attitudes toward eating
Slide 24
Differences:◦ People with bulimia are more worried about
pleasing others, being attractive to others, and having intimate relationships
◦ People with bulimia tend to be more sexually experienced
◦ People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia
◦ People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping
Slide 25
Differences:◦ People with bulimia tend to be controlled by
emotion – may change friendships easily◦ People with bulimia are more likely to display
characteristics of a personality disorder◦ Different medical complications:
Only half of women with bulimia experience amenorrhea vs. almost all women with anorexia
People with bulimia suffer damage caused by purging, especially from vomiting and laxatives
Slide 26
Most theorists subscribe to a multidimensional risk perspective:◦ Several key factors place individuals at risk◦ More factors = greater risk◦ Leading factors:
Sociocultural conditions (societal and family pressures) Psychological problems (ego, cognitive, and mood
disturbances) Biological factors
Slide 27
Many theorists argue that current Western standards of female attractiveness have contributed to the rise of eating disorders◦ Standards have changed throughout history
toward a thinner ideal
Slide 28
Certain groups are at greater risk from these pressures:◦ Models, actors, dancers, and certain athletes
Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms
20% of surveyed gymnasts met full criteria for an eating disorder
Slide 29
The socially-accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight◦ About 50% of elementary and 61% of middle
school girls are currently dieting
Slide 30
Families may play a critical role in the development of eating disorders◦ As many as half of the families of those with
eating disorders have a long history of emphasizing thinness, appearance, and dieting
◦ Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves
Slide 31
Abnormal family interactions and forms of communication within a family may also set the stage for an eating disorder◦ Minuchin cites “enmeshed family patterns” as
causal factors of eating disorders These patterns include overinvolvement in, and
overconcern about, family member’s lives Such families can be affectionate and loyal but can also
foster clinginess and dependency Children are allowed little room for individuality and
independence
Slide 32
Bruch : eating disorders are the result of disturbed mother–child interactions which lead to serious ego deficiencies in the child and to severe cognitive disturbances
Slide 33
Bruch : parents may respond to their children either effectively or ineffectively
◦ Effective parents accurately attend to a child’s biological and emotional needs
◦ Ineffective parents fail to attend to child’s internal needs; they feed when the child is anxious, comfort when the child is tired, etc.
Slide 34
There is some empirical support for Bruch’s theory from clinical sources◦ People with bulimia eat in response to emotions;
many mistakenly think they are also hungry◦ People with eating disorders rely excessively on
the opinions, wishes, and views of others They are more likely to worry about how they are
viewed, to seek approval, to be conforming, and to feel a lack of life control
Slide 35
Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depression◦ Theorists believe mood disorders may “set the
stage” for eating disorders
Slide 36
There is some empirical support for the claim that mood disorders set the stage for eating disorders
◦ Many more people with an eating disorder qualify for a clinical diagnosis of major depressive disorder than do people in the general population
◦ Close relatives of those with eating disorders seem to have higher rates of mood disorders
Slide 37
Biological theorists suspect that some people inherit a genetic tendency to develop an eating disorder◦ Consistent with this model:
Relatives of people with eating disorders are 6 times more likely to develop the disorder themselves
◦ These findings may be related to low serotonin
Slide 38
Other theorists believe that eating disorders may be related to dysfunction of the hypothalamus◦ Researchers have identified two separate areas
that control eating: Lateral hypothalamus (LH) Ventromedial hypothalamus (VMH)
Slide 39
Some theorists believe that the LH and VMH are responsible for weight set point – a “weight thermostat” of sorts
◦ Set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a particular weight level
Slide 40
Eating disorder treatments have two main goals:◦ Correct abnormal eating patterns◦ Address broader psychological and situational
factors that have led to and are maintaining the eating problem This often requires the participation of family and
friends
Slide 41
The initial aims of treatment for anorexia nervosa are to:◦ Restore proper weight◦ Recover from malnourishment◦ Restore proper eating
Slide 42
In the past, treatment took place in a hospital setting; it is now often offered in an outpatient setting.
In life-threatening cases, clinicians may force tube and intravenous feeding
Most common technique now is the use of supportive nursing care and high calorie diets
Slide 43
Therapists use a mixture of therapy and education to achieve this broader goal◦ One focus of treatment is building autonomy
and self-awareness
Therapists help patients recognize their need for independence and control
Slide 44
Another focus of treatment is correcting disturbed cognitions, especially client misperceptions and attitudes about eating and weight◦ Using cognitive approaches, therapists correct
disturbed cognitions and educate about body distortions
Slide 45
Another focus of treatment is changing family interactions◦ Family therapy is important for anorexia◦ The main issues are often separation and
boundaries
Slide 46
The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa◦ But even with combined treatment, recovery is
difficult The course and outcome of the disorder
vary from person to person
Slide 47
Positives of treatment:◦ Weight gain is often quickly restored 83% of patients still showed
improvements after several years◦ Menstruation often returns with return to normal
weight
Slide 48
Negatives of treatment:◦ Close to 20% of patients remain troubled for
years◦ Even when it occurs, recovery is not always
permanent Relapses are usually triggered by stress Many patients still express concerns about body
shape and weight
Slide 49
Treatment programs are relatively new but have risen in popularity
Treatment is frequently offered in specialized eating disorder clinics
Slide 50
The initial aims of treatment for bulimia nervosa are to:◦ Eliminate binge-purge patterns◦ Establish good eating habits◦ Eliminate the underlying cause of bulimic patterns
Programs emphasize education as much as therapy
Slide 51
Several treatment strategies:◦ Individual insight therapy
The insight approach receiving the most attention is cognitive therapy, which helps clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape As many as 65% stop their binge-purge cycle
If cognitive therapy isn’t effective, interpersonal therapy (IPT), a treatment that seeks to improve interpersonal functioning, may be tried
A number of clinicians also suggest self-help groups or self-care manuals
Slide 52
Several treatment strategies:◦ Behavioral therapy
Behavioral techniques are often included in treatment as a supplement to cognitive therapy Diaries are often a useful component of
treatment Exposure and response prevention (ERP) is used to
break the binge-purge cycle
Slide 53
Several treatment strategies:◦ Antidepressant medications
During the past decade, antidepressant drugs have been used in bulimia treatment Most common is fluoxetine (Prozac), an SSRI Drugs help 25 to 40% of patients
Medications are best when used in combination with other forms of therapy
Slide 54
Several treatment strategies:◦ Group therapy
Provides an opportunity for patients to express their thoughts, concerns, and experiences with one another
Helpful in as many as 75% of cases, especially when combined with individual insight therapy
Slide 55
Left untreated, bulimia can last for years Treatment provides immediate, significant
improvement in about 40% of cases◦ An additional 40% show moderate improvement
Follow-up studies suggest that 10 years after treatment, about 90% of patients have fully or partially recovered
Slide 56
Relapse can be a significant problem, even among those who respond successfully to treatment◦ Relapses are usually triggered by stress◦ Relapses are more likely among persons who:
Had a longer history of symptoms Vomited frequently Had histories of substance use Have lingering interpersonal problems
Finally, treatment may also help improve overall psychological and social functioning
Slide 57
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