June 2020

Eating Disorder

Types of Eating Disorder

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge Eating Disorder

Etiology

• Biological factors
  • Genetics
  • Neurobiological (neurotransmitters- serotonin and norepinephrine)
• Psychological factors- suggestions that development of an eating disorder is rooted in an unfulfilled sense of separation-individuation (events occur that threaten the vulnerable ego, feelings of lack of control over one’s body (self) emerge)
• Environmental factors- such as family influence

Anorexia Nervosa

• Intense & irrational beliefs about one’s shape and weight, including fear of gaining weight

General signs and symptoms

Psychological Signs and Symptoms

Bulimia Nervosa

• Eating binges typically followed by efforts to purge calories

General signs and symptoms

Psychological signs and symptoms

Gambling Disorder

• Persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress.
• As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction.
• Gambling behavior usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood.
• The disorder usually runs a chronic course, with periods of waxing and waning.
• The disorder interferes with interpersonal relationships, social, academic, or
  occupational functioning.

Predisposing factors to Gambling Disorder

• Biological influences
  • Genetic: Increased incidence among family members
  • Physiological: Abnormalities in neurotransmitter systems
  • Dopaminergic neurotransmitter systems.
  • Biochemical theories suggest that both winning and losing may stimulate the reward and pleasure centers of the brain, which could contribute to a persistent and repeated desire to gamble even though one is not winning.
• Psychosocial influences
  • Loss of a parent before age 15
  • Inappropriate parental discipline
  • Exposure to gambling activities as an adolescent
  • Family emphasis on material and financial symbols
  • Lack of family emphasis on saving, planning, and budgeting

Treatment Modalities for Gambling Disorder

• Behavior therapy
• Cognitive therapy
• Motivational interviewing
• Psychopharmacology
  • S S R I’s
  • Clomipramine
  • Lithium
  • Carbamazepine
  • Naltrexone
• Gamblers Anonymous
  • Organization modeled after A A
  • Only requirement for membership is an expressed desire to stop gambling
  • Reformed gamblers help others resist the urge to gamble.

Codependency

• Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions
• Codependent people sacrifice their own needs for the fulfillment of others to achieve a sense of control.
• Derives self-worth from others
• Feels responsible for the happiness of others
• Commonly denies that problems exist
• Keeps feelings in control, and often releases anxiety in the form of stress-related illnesses, or compulsive behaviors such as eating, spending, working, or use of substances

The Codependent Nurse

• Classic characteristics
  • Caretaking
  • Perfectionism
  • Denial
  • Poor communication

Treating Codependence

• Recovery process
  • Survival stage
  • Re-identification stage
  • Core issues stage
  • Reintegration stage

Chemically Impaired Nurse

• It is estimated that 10% to 15% of nurses suffer from the disease of chemical dependency.
• Alcohol is the most widely abused drug, followed closely by narcotics.
• High absenteeism may be present if the person’s source is outside the work area or, the person may rarely miss work if the substance source is at work.
• Increase in “wasting” of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs for other nurses may be present.
  • Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall
  • Problems with relationships
  • Irritability, tendency to isolate, elaborate excuses for behavior
  • Unkempt appearance, impaired motor coordination, slurred speech, flushed face
  • Patient complaints of inadequate pain control, discrepancies in documentation
• State board response
  • May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse
  • Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
• During the suspension period
  • Successful completion of an inpatient, outpatient, group, or individual counseling treatment program
  • Evidence of regular attendance at nurse support groups or 12-step program
  • Random negative drug screens
  • Employment or volunteer activities
  • Peer assistance programs serve to assist impaired nurses to:
    • Recognize their impairment
    • Obtain necessary treatment
    • Regain accountability within the profession

Planning/Implementation

1. • Risk for injury
     • Provide safe and supportive environment.
     • Administer substitution therapy.
   • Denial
     • Develop trust.
     • Identify maladaptive behaviors or situations.
   • Ineffective coping
     • Establish trust.
     • Set limits.
     • Explore options.
   • Dysfunctional family processes
     • Review history.
     • Provide information.
     • Involve the family.

Client/Family Education

• Nature of the illness
• Effects of (substance) on the body
  • Alcohol
  • Other C N S depressants
  • Hallucinogens
  • Inhalants
  • Opioids
  • Cannabis
• Ways in which use of substance affects life
• Management of the illness
  • Activities to substitute for (substance) in times of stress
  • Relaxation techniques
    • Progressive relaxation, tense and relax, deep breathing, autogenics
• Problem-solving skills
• Essentials of good nutrition
• Support services
  • Financial assistance
  • Legal assistance
  • Alcoholics Anonymous (or other support group specific to another substance)
  • One-to-one support person

Evaluation

• Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care.

Nursing Diagnosis/ Outcome identification

Ineffective Denial related to weak, underdeveloped ego

Outcome: Client will demonstrate acceptance of responsibility for own behavior and acknowledge association between personal problems and use of substance(s).

Ineffective Coping related to inadequate coping skills and weak ego

Outcome: Client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances).

Imbalanced nutrition less than body requirements. / Fluid volume deficit related to drinking or taking drugs instead of eating.

Outcome: Client will be free from signs or symptoms of malnutrition/dehydration.

Risk for infection related to malnutrition and altered immune condition

Outcome: Shows no signs or symptoms of infection.

Chronic low self-esteem related to weak ego, lack of positive feedback

Outcome: Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others.

Deficient knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances

Outcome: Verbalizes importance of abstaining from use of substances to maintain optimal wellness.

For the client withdrawing from C N S depressants

Risk for Injury related to C N S agitation

For the client withdrawing from C N S stimulants

Risk for suicide related to intense feelings of lassitude and depression, “crashing,” suicidal ideation

Application of the Nursing Process

• Nurses must begin relationship development with a substance abuser by examining own attitudes and personal experiences with substances.
• It is necessary to use motivational interviewing since it uses skills such as empathy and reflection to explore the client’s motivation, strengths, and readiness for change.

Nursing Process: Assessment

• Various assessment tools are available for determining the extent of the problem a client has with substances.
  • Drug history and assessment
  • Clinical Institute Withdrawal Assessment of Alcohol Scale
  • Michigan Alcoholism Screening Test (M A S T)
  • C A G E Questionnaire
    • Have you ever felt you should Cut down on your drinking?
    • Have people annoyed you by criticizing your drinking?
    • Have you ever felt bad or Guilty about your drinking?
    • Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)?
  • Dual Diagnosis
    • Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis.
    • Program combines special therapies that target both problems.

Cannabis Use Disorder

• Profile of the substance         
  • Marijuana
  • Hashish
• Patterns of use
• Effects on the body
  • Cardiovascular – Induces tachycardia and orthostatic hypotension
  • Respiratory – Production of tar from marijuana that is deposited in the lungs causing bronchodilation and later on lead to obstructive airway disorder
  • Reproductive – decrease in sperm count in men
  • C N S – sensory alterations may occur, including impairment in judgment of time and distance, recent memory, and learning ability.
  • Sexual functioning – Thought to increase sexual satisfaction.

Cannabis-Induced Disorder

• Intoxication
  • Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, and impaired judgment.
  • Physical symptoms include conjunctival injection, increased appetite, dry mouth, and tachycardia.
  • Impairment of motor skills lasts for 8 to 12 hours.
• Withdrawal
  • Occurs upon cessation of cannabis use that has been heavy and prolonged
  • Symptoms occur within a week following cessation of use.
  • Symptoms include irritability, anger, aggression, anxiety, sleep disturbances, decreased appetite, depressed mood, stomach pain, tremors, sweating, fever, chills, or headache.

Hallucinogen use disorder

• Profile of the substance
  • Naturally occurring hallucinogens
  • Synthetic compounds
• Patterns of use
  • Use is usually episodic

Hallucinogens: Effects on the Body

Hallucinogen-induced Disorder

• Intoxication
  • Occurs during or shortly after using the drug
  • Symptoms include perceptual alteration,   depersonalization, derealization, tachycardia, and palpitations.
• Symptoms
  • Belligerence and assaultiveness, and may proceed to seizures or coma