Eating Disorders – Treatment and Diagnosis (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:02 So, what do we do for patients who have these three types of eating disorders? Well, there's medical treatments.

    00:10 And the first medical treatment I'm going to talk about is behavior modification.

    00:15 That can be in the hospital, Milieu treatment with behavioral reward systems.

    00:20 So as we set small goals for the patient, as they achieve that goal, there's some sort of behavioral reward system, so that they feel good about achieving those goals.

    00:35 There's also individual therapy.

    00:38 You want to make sure that a patient who has an eating disorder is with a therapist, who is specifically trained to work with patients who have eating disorders.

    00:50 Cognitive behavioral therapy has been demonstrated to be very effective with eating disorders.

    00:57 Again, you need to be trained in cognitive behavioral therapy in order to conduct that kind of psychotherapy.

    01:07 Group therapy is also used for patients with eating disorders.

    01:14 We want to include the family.

    01:18 One of the things with any psychiatric disorder, whether it's a substance use disorder, an eating disorder, or a psychiatric disorder.

    01:29 It's never one person who has this disorder.

    01:32 We come from our family.

    01:34 Our family requires treatment in order to support recovery.

    01:38 So talk to the patient's family, see if the patient's family is willing to go into family therapy, so that the whole environment starts becoming safe for that patient to return.

    01:53 There's also psychopharmacology.

    01:56 There are medications that we are able to give to the patient.

    02:00 So, we want to find out, what is the underlying psychiatric problem that is affecting the patient to the point where they will starve themselves, or will they will binge until they are sick? For the most part, when we commonly see a medication being prescribed.

    02:24 For a person with an eating disorder, it's usually Prozac. Also, it's called fluoxetine.

    02:31 One of the things that we know about antidepressants is that most of them come with a 7 to 10 pound weight gain.

    02:41 For a person who has a binging disorder, the Prozac also works.

    02:47 We have to work with them to make sure that they don't have the full 10 pounds of weight gain.

    02:53 But it helps them to start gauging their eating and reducing the binging which in fact causes weight loss, despite the fact that they are on an anti-depressant like Prozac.

    03:07 What kind of nursing diagnoses do we see in eating disorders? Again, we're going to be listening and watching our patient.

    03:15 Our nursing diagnosis starts with the patient.

    03:20 So we're going to see a person in front of us who is either not eating at all, eating and vomiting, or unable to stop eating.

    03:30 So we know just by their behavior, our first nursing diagnosis must be imbalanced nutrition.

    03:39 We also know that these are the patients who when they look in the mirror, they don't like what they see whether they are thin or heavy, they have a perception of a disturbed body image.

    03:53 And so that could be another nursing diagnosis specific to eating disorders.

    04:00 As we talk to our patients, we might find that they say, "Nobody cares anyway. Why should I care about myself? I'm not worth it." And we start thinking about the fact that they have low self worth, and they have low self esteem.

    04:17 And so that could be another nursing diagnosis.

    04:22 "I don't have an eating problem.

    04:25 I'm very happy with the way I'm eating.

    04:28 It's not a problem.

    04:30 I don't know why everyone's making such a big deal of it." they'll say.

    04:34 And what nursing diagnosis is that? So those of you who said denial, you're right.

    04:44 It is very likely that the person will deny that their eating disorder is a disorder.

    04:52 They like who they are. Leave me alone.

    04:56 All of these lead us to the biggest one, which is risk for injury.

    05:03 Because of the loss of calcium, because of the orthostatic hypotension, because of the cholesterolemia.

    05:11 Because we have high cholesterol, increase heart attack, these are patients who are at very high risk for injury.

    05:20 And so we have to be aware of that as well.

    05:27 What is the first thing that we must be in looking around us and making sure that we are doing? We want to keep our patients safe.

    05:37 We want to help them through to and through recovery.

    05:42 We want to make sure that there is a diet plan that comes from a dietitian, who is a specialist in this area that can provide the adequate nutrition and we'll have a realistic plan for weight gain.

    05:59 We also want to make sure that we are working with our clients and our patients, for them to explore their feelings, for them to look into what they are afraid of.

    06:11 Because that fear, and those feelings are part of their disorder.

    06:18 And then we want to help them to develop a positive relationship with food.

    06:25 Right now, while they have this eating disorder, food may be their enemy.

    06:31 And that is if they are binging and purging, or if they are starving themselves, or their relationship with food as their priority.

    06:42 And the only relationship that they want if they are just playing binging.

    06:47 So let's help them to develop a different relationship, a more positive relationship with food, to see it as a way to feed the body just enough so our bodies are healthy.

    07:00 That food is not the purpose.

    07:03 Our body being healthy is the purpose.

    07:06 And then we have to try and help them to achieve a realistic perception of their own body image.

    07:15 We want to encourage their participation in the program.

    07:20 They need to be an active participant.

    07:23 They have to have a capacity to make independent decisions, so that we help them learn how to have a feeling of control of their environment.

    07:34 And what happens next? We don't want to take over.

    07:38 Because oftentimes, when you have a person with an eating disorder, control is really the thing that they are looking to have.

    07:47 Total control.

    07:48 Whether it is total control about not eating anything, or total control, about eating everything, and throwing up, or total control about amassing food and killing themselves by eating too much.

    08:02 So, let's move them back into independent decision making that promote those sense of control of the environment.

    08:11 But without having to have total control.

    08:16 We want to use positive feedback.

    08:18 We want to help these patients understand that they can control their life, instead of maladaptive eating behaviors to establish some sort of control.

    08:31 Although, there are some similarities that we see between substance use disorders and I hope that you've been able to see them, and eating disorders.

    08:41 There are really some important differences that we have to keep ourselves well aware of.

    08:47 Were both of them substance and eating disorders have a main goal to pursue immediate effects.

    08:55 People who have eating disorders have a long range goal.

    09:01 And especially for those with anorexia nervosa, that goal is self-starvation.

    09:10 Where the drug of choice has increased the value to the person who has an STD.

    09:15 So, if it's cigarettes, if it's heroin, if it's anxiolytic, that drug is really the thing that they want more than anything.

    09:27 It is the long term effect of weight loss, not the denial of eating, which is the obsession for the person with the eating disorder.

    09:39 Also, when you're looking at someone who has a substance use disorder, there's a real negative stigma attached to it.

    09:49 Society does not like a person who has a substance use disorder.

    09:56 But there's a real positive consequence for those who are very thin.

    10:01 And society actually strives to make it look better for people to be thin.

    10:08 And to make people who are not thin feel as though they're overweight.

    10:15 If a person is struggling and trying desperately to recover from their substance use disorder, and they want to stop using, or misusing, or abusing that substance.

    10:27 They have a real fear of relapsing.

    10:31 They don't, once they start in recovery, the idea of going back out and smoking again or having that drink, it's frightening because they know if I have one, it won't be enough.

    10:44 This is a real difference from those people who have eating disorders, because they love being thin.

    10:51 And when they start gaining weight, they often are very ambivalent.

    10:56 They can't weigh whether or not this is a good new look for them.

    11:01 And so they are ambivalent about slipping and going back to the eating disorder.

    About the Lecture

    The lecture Eating Disorders – Treatment and Diagnosis (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Eating Disorders (Nursing).

    Included Quiz Questions

    1. Behavior modification
    2. Individual therapy
    3. Family therapy
    4. Psychopharmacology
    5. Health coaching
    1. Safety
    2. Clinician control
    3. Meal planning
    4. Medication compliance
    1. Denial
    2. Risk for injury
    3. Imbalanced nutrition
    4. Low self-esteem
    1. Have the client choose what they want to eat from a list of pre-approved meal options
    2. Have the client eat only at the nursing station so that staff can monitor their intake
    3. Have a dietician choose each meal for the client and inform the client they must eat the entire portion
    4. Encourage the client to only consume liquids so they feel less full
    1. There is positive reinforcement from society.
    2. There is negative reinforcement from society.
    3. There is nothing wrong with the client's diet.
    4. The client can continue suffering from an eating disorder without other health ramifications.
    1. Group therapy
    2. Family therapy
    3. Cognitive behavioral therapy
    4. Cryotherapy
    5. Cleanse

    Author of lecture Eating Disorders – Treatment and Diagnosis (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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