Gail Notes

Anorexia nervosa - characterized by a voluntary refusal to eat. The client has a distorted body image and vigorous physical activity is often obsessively pursued. Extreme weight loss, amenorrhea, lanugo hair, hypotension, bradycardia, hypothermia, constipation, polyuria, and electrolyte imbalances.

BULUMIA:

Characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with anorexia. They compensate for excess food intake by obsessive exercise, vomiting, laxative and diuretic use. They may develop dental caries as a result of vomiting so much. They may have ECG changes, electrolyte imbalances, parotid gland enlargement, esophagitis, gastric dilatation, and menstrual irregularities. MOST BULIMICS DO NOT HAVE A DISTORTED BODY IMAGE

PSYCHODYNAMIC THEORY:

Stems from unresolved conflicts in childhood. The child develops into a person with strong needs to please others.

BIOLOGICAL THEORY:

Believe there is a genetic link. There is an association between depression and eating disorders. Hormonal and biochemical disturbances.

BEHAVIORAL AND SOCIOCULTURAL THEORIES:

Behavior theory: believe that the person initially looses weight to gain approval. As the weight, loss continues the approval turns to concern. The client continues to receive attention and it reinforces her behavior.

Sociocultural theory: anorexia is rarely found in countries without an abundant food supply. America places a heavy emphasis on thin women.

Family systems theory: passive father, controlling mother and dependent child.

The three interaction patterns found in families with anorexic children:

1.Enmeshment: lack of clear boundaries between family subsystems and between individual family members. "We this…" and "we that." No individuality

2. Over protectiveness

3. Rigidity and conflict avoidance

ASSESSMENT:

FORMING AN ALLIENCE WITH THE CLIENT IS CRUCIAL!!! The clients are so secretive about their problem. Obtain an accurate current weight; find out about previous high and low weights, and the chronology of current weight loss episode. How fast did the weight loss occur?

ELIMINATION PATTERN

ACTIVITY AND REST/SLEEP PATTERNS

COGNITIVE/PERCEPTUAL PATTERN- give the client information about eating disorders it may help them acknowledge that they have a problem.

The client may intellectualize with all or none reasoning.

They need to learn that strong feelings (esp. neg. ones) are acceptable and that you can express feelings without losing control.

They have perfectionist personalities.

SELF PERCEPTION AND SELF CONCEPT PATTERNS:

Low self esteem unrealistically high expectations.

Ask the following questions:

What do you like best about your body and worst

If you could change the way you look, how would you be different?

What do you like best about yourself and least

How would you describe yourself to others?

How would others describe you?

What are your strengths and weaknesses?

ROLE RELATIONSHIPS:

Assess their roles and their relationships with others

COPING AND STRESS TOLERANCE:

1. inability to ask for help
2. inability to make decisions
3. inability to meet role expectations
4. perceived powerlessness

SEXUALITY-REPRODUCTION:

Anorexic clients tend to be sexually inactive while bulimic client tend to exhibit impulsive sexual behaviors

VALUES AND BELIEF PATTERN

SoutheasternNurse