• Demographics: 20-year-old female sent to inpatient mental health unit with an admitting diagnosis of bulimia nervosa.
• Reason for admission: Patient would binge eat at each meal, and was purging up to 35 times a week. She was recently diagnosed with Cushing’s Syndrome, type 2 diabetes, reoccurring mononucleosis, and kidney issues. She has been admitted to the hospital over 5 times because of pyelonephritis and reoccurring kidney stones. Patient refers to her purging episodes as “getting sick” and wants to stop her impulsive eating behaviors. Sometimes she feels guilty, and occasionally cuts her wrists.
• Psychosocial information: Before college, she had a gastric lap band surgery to help her lose weight, since she borderline obese. After
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She needs to be educated about bulimia nervosa and the complications of the disorder. She needs to be informed the negative consequences of binging and purging, and that these are maladaptive coping mechanisms. She needs to find healthier alternatives, so that she will not further destroy her body. She is started to cut herself, so working through her emotions would greatly benefit her safety.
• Nursing interventions for imbalanced nutrition – less than the body requirements/deficient fluid volume:
1) Patient will consume a certain amount of calories in order to get necessary nutrition and gain weight realistically. Rationale: “Adequate calories are required to allow a weight gain of 2-3 pounds per week” (Townsend, 2014, pg. 592).
2) Daily assessment of weight, skin turgor, monitor I/O’s, and mucous membranes. Rationale: “These assessments are important measurements of nutritional status and provide guidelines for treatment” (Townsend, 2014, pg. 592).
3) Nurse or other assistive personnel with stay will patient during and after meals. Rationale: “Lengthy mealtimes put excessive focus on food and eating and provide client with attention and reinforcement” (Townsend, 2014, pg. 593). Also, staying with the patient after the meal ensures that they do not try to puke up or stash away the
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Rationale: “Emotional issues must be resolved if these maladaptive responses are to be eliminated” (Townsend, 2014, pg. 593).
• Anxiety and psychotropic medications: Since there are no medications specifically for eating disorders, these medications will help treat the symptoms of anxiety and depression (Townsend, 2014, pg. 601). However, Fluoxetine has been successful in bulimia clients because it “may decrease the craving for carbohydrates, thereby decreasing the incidence of binge eating” (Townsend, 2014, pg. 602). Also, antidepressant drugs have aided treatment for bulimia nervosa.
• Treatment modalities: the most beneficial form of treatment for this patient would be psychotherapy, specifically individual therapy. The other treatment options were good too, but this one is needed because her case is more severe. According to Townsend (2014), “in supportive psychotherapy, the therapist encourages the client to explore unresolved conflicts and to recognize the maladaptive eating disorders as defense mechanisms used to ease the emotional pain” (Townsend, 2014, pg. 601). Since her life experiences have been rough, she needs to discuss them and stop pretending these events that happened to her are alright. She deserves to feel better as a person, so that she can live a successful
On assessment, Anne’s reported height is 5’1” and weighs one hundred ninety one pounds. Based on Anne’s BMI, Anne is obese. Anne reports difficulty to adhere to a low carbohydrate diet and previous unsuccessful attempts at weight loss due to impaired physical mobility.
An average client that attends this facility is someone suffering with an eating disorder. An average client might be someone who is having trouble having a healthy relationship with food and needs others to intervene. An average client that is attending the Laureate Eating Disorders Program, may have one or more of these common eating disorders: anorexia, bulimia, avoidant/restrictive food intake disorder, and binge eating disorder. The Laureate Eating Disorders Program offers inpatient, outpatient, intensive outpatient, partial hospitalization, and residential treatment to adolescents and adults. The facility not only addresses the fact that the client has an eating disorder, but goes deeper to try to help the client understand why.
This interview should consist of open-ended questions to make Sara feel she is able to express herself in a manner she sees fit. To help a client, a clinician needs to be able to create rapport with a patient and creating an open conversation for Sara to express herself will help her let go of the refrigerator and have someone to confide in. As well this interview should include questions about how Sara feels about herself personally, how she feels about her body image, experiences or trauma she may have had pertaining to her body image and size, and her perceptions on the importance of being “skinny”. This interview will be the last factor determining whether Sara has Bulimia Nervosa. Bulimia Nervosa is linked to psychosis so more questions would need to be asked to see if Sara feels as if she is mentally flawed and she blames others for her flaws (Miotto et al., 2010). A test of Sara’s DNA would also be helpful in this case. Sara states that she was always large, in a taller sense, but given her obsession with bingeing and purging and possible weight size that has not been revealed, a simple thyroid test could determine whether issues with weight are possibly thyroidal and/or from bad lifestyle habits such as overeating. Current research has been done on the link between genetics and Bulimia Nervosa. Lewin and Carter (2014), state that neurotrophic factors are a group of proteins that supplement the growth and
Thompson-Brenner, Heather, Dana A. Satir, Debra L. Franko, and David B. Herzog. "Clinician Reactions to Patients With Eating Disorders: A Review of the Literature." Psychiatric Services 63.01 (2012): 73-78. Print.
Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., Mitchell, J.E. (2009) Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry 166, 1342-1346.
It is difficult to treat if patients don’t gain weight. This documentary film described that fifty percent of individuals will relapse in the first year if normal weight has not be achieved prior to leaving treatment. Treatment requires a multidisciplinary team approach. In addition to restriction many patients also increase activity levels. The film also examined individuals that have Exercise Anorexia. In conclusion the documentary pointed out the disorders have links to Anxiety. They stated that Prozac and Paxil have been found helpful in treating patients. They noted that Bulimia is linked to depression. The film also described a research study conducted to examine satiety related to food and CCK Cholecystokinin disturbed digestion in individuals with eating disorders. CCK is a digestive hormone that stimulates fat and protein digestion, and promotes the feeling of satiety. The film also stated that it takes years to fully recover from
Through assessment, I have come to the understanding that these symptoms come from an underlying issue of abandonment. She is experiencing a negative cognitive shift where she has trouble seeing anything positive about herself leading to a lack of appetite. She is showing significant symptomology of an eating disorder, this coinciding with her high levels of irrational thoughts and faulty cognition (Lask, 2000). Her eating disorder has led to the problematic behaviors of panic disorder and it has to be dealt
Different forms of treatment are available such as in patient treatments, cell phone apps and therapy to teach how to overcome an eating disorder. Each eating disorder, anorexia nervous, binge eating disorder and bulimia nervosa may respond better to different forms of treatment and each patient is different in what will work best for them to overcome. Support from family and friends is necessary in working with treatment and being strong enough to face an eating disorder once treatment is done. Eating disorders are easy to gain, but with the right treatment can be defeated.
Bulimia nervosa is a slightly less serious version of anorexia, but can lead to some of the same horrible results. Bulimia involves an intense concern about weight (which is generally inaccurate) combined with frequent cycles of binge eating followed by purging, through self-induced vomiting, unwarranted use of laxatives, or excessive exercising. Most bulimics are of normal body weight, but they are preoccupied with their weight, feel extreme shame about their abnormal behavior, and often experience significant depression. The occurrence of bulimia has increased in many Western countries over the past few decades. Numbers are difficult to establish due to the shame of reporting incidences to health care providers (Bee and Boyd, 2001).
There was a secret battle she was handling alone. Something she didn’t want anyone else to find out about. At the age of 11 Lovato had also started cutting herself in order to gain a handle on her emotions. Because she was trying to hold everything in and continue life like there was no problem. She also developed a substance abuse problem. Once in the rehab psychologists identified that she was suffering from bulimia nervosa. Bulimia nervosa is identified by weight fluctuations with in or above normal ranges. This is what made it so easy for Lovato to hide from her family and friends. A U.S national institute of mental health study reported that Americans met the standard for anorexia; studies showed 1 percent for bulimia, and 2.8 percent for binge-eating disorders. It was later discovered at the treatment center that Lovato was diagnosed with bipolar disorder as well. Signs and side effects of bulimia fixate on the distraction with weight and body
Psychotherapy or psychological counseling is an integral part of comprehensive eating disorder treatments. With a trained counselor, the patient can develop ways to cope with the issues that led to the disorder. This is especially important in anorexia nervosa treatments because of the overwhelming fear of becoming overweight. Hopefully a psychotherapist can get to the root of these fears and develop effective measures to take for recovery. Anorexia is considered to be a lifelong illness, and counseling may continue indefinitely. There are no medicines for anorexia, but antidepressants are often prescribed in conjunction with other treatments.
...l, D. M., & Willard, S. G. (2003). When dieting becomes dangerous: A guide to understanding and treating anorexia and bulimia [Ebrary version]. Retrieved from http://libproxy.utdallas.edu/login?url=http://site.ebrary.com/lib/utdallas/Doc?id=10170079&ppg=4
Anorexia nervosa and Bulimia nervosa are described as psychological eating disorders (Keel and Levitt, 1). They are both characterized by an over evaluation of weight. Despite being primarily eating disorders, the manifestations of bulimia and anorexia are different. They both present a very conspicuous example of dangerous psychological disorders, as according to the South Carolina Department of Health, “Eating disorders have the highest mortality rate of any mental illness” (Eating Order Statistics, 1). While Bulimia and anorexia both psychological disorders primarily prevalent in women, anorexia tend to have different diagnostic complexities, symptoms and physiological effects as compared to bulimia.
The patient may no longer be able to orally take in food, and the artificial means of feeding may worsen the patient’s quality of life. The concept of food cessation is often difficult for the patient’s friends and family to understand and accept, especially because food is essential to life, and eating is a sociocultural experience. Family must be reminded that to feed the patient may do more harm than good. However, until the time that oral intake stops, nurses must be providing other ways to increase the patient’s nutrient intake. The performance of symptom assessments and the development of plans of care should begin at the time of diagnosis and continue throughout the remainder of the patient’s life. These assessments and plans of care are both critical to preventing the onset of early malnutrition and to maintaining the patient’s quality of
As is common with other eating disorders, binge eating can be treated with talking therapy and nutritional counselling. Talking therapy addresses dysfunctional behaviours and thoughts involved in the disorder, while nutritional counselling focuses on building strong healthy eating