nursing.elitecme.com Page 69 Complete Your CE Test Online - Click Here ● ● Intense fear of gaining weight or becoming overweight or ongoing behaviors that interfere with weight gain. ● ● Disturbance in the way in which one’s weight or shape is experienced. There is undue influence of body weight or shape on self-evaluation, or ongoing lack of recognition of just how serious the client’s low body weight is. The DSM-5 identifies two subtypes of anorexia nervosa. These are[1] : ● ● Restricting type: During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. ● ● Binge-eating/purging type: During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior. Treatment A multidisciplinary clinical approach that includes nurses, physicians, nutritionists, and psychologists is essential for the implementation of a successful treatment program. Client and family involvement in the development, implementation, and evaluation of treatment are also essential if treatment initiatives are to work[2,9,12] . Clients with anorexia nervosa often vigorously resist treatment. They deny they have a problem and are often interested only in continuing to lose weight[12] . There are a variety of treatment settings for clients with anorexia nervosa. Regardless of the setting, treatment should be initiated by healthcare professionals who have knowledge of the disorder and expertise in treating it. Hospitalization is recommended if weight is less than 75% of the normal weight for age and height. Treatment settings include[9,12,15] : ● ● Inpatient settings that specialize in treating eating disorders. ● ● Day treatment programs. ● ● Outpatient therapy. If clients are agreeable to weight gain, gain weight quickly while hospitalized, and are compliant with the treatment regimen, short hospitalization stays are generally effective. However, longer stays are indicated for clients who are resistant to treatment and gain weight slowly[9,12] . The choice of setting depends on the severity of the disorder, complications (i.e. electrolyte imbalance, cardiovascular compromise), and co-existing mental health conditions[12] . The need for immediate hospitalization exists if the client is experiencing severe fluid, metabolic, and/or electrolyte imbalances, cardiovascular complications, and/or suicidal ideation[9,12] . The length of inpatient hospitalization may be as short as two weeks or as long as several months or even years[9] . Clients who benefit most from outpatient therapy are those who have been ill for less than six months, do not binge and purge, and have parents and other family members who actively participate in family therapy[12] . General summary of treatment initiatives Life-threatening complications must be dealt with immediately. Restoration of fluid and electrolyte balance, treatment of metabolic imbalances and restoration of effective cardiovascular functioning are imperative[9,12] . Clients must be assessed for suicidal ideation. Risk level for suicide is evaluated by obtaining an accurate history of any past suicide attempts, recent expression of suicidal thoughts, and current state of suicidal thoughts, including any plans clients may have made to take their own lives. Gather information from clients themselves, as well as from family, friends, and co-workers as indicated. Clients may not always be forthcoming about suicidal ideation. Clients should be monitored for suicide attempts and observed as often as indicated by assessment results. In addition, clients should not have access to sharp objects or other devices that may be used for the purpose of self-harm. It is also important to ensure that clients actually swallow any medications they may be given. Clients may hoard medication for the purpose of self-harm[2] . After life-threatening complications are dealt with and the possibility of death no longer imminent, treatment focus shifts to weight restoration and achievement of appropriate self-image. Dietary modifications are implemented to achieve not only weight gain but normal eating habits. Clients are assisted to develop a dietary plan based on age, height, activity level, lifestyle, and personal food and beverage preferences. Usually, access to a bathroom is supervised to prevent purging[2,9,12] . This is especially important as clients begin to gain weight. As they notice weight gain, they may become more determined to find ways to purge or to “pretend” to eat. Mealtimes must be closely supervised to ensure that clients are actually eating and not hiding food in clothing or “pocketing” food inside their mouths to avoid swallowing[2,9,12] . Intake, output and weight are assessed daily before breakfast. Clients must be monitored so that they are not able to add weight to their clothing (i.e. concealing objects in pockets), or take other actions to appear to have gained weight when, in reality, they have not[2,9,12] . There are no FDA approved medications for the specific treatment of anorexia[15] . However, antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants may be prescribed to help deal with anxiety and depression[9] . Psychotherapy is as important to recovery as the intake of fluids and food. Family therapy is the only evidence-based treatment for teenagers with anorexia[15] . Family therapy may be helpful for all members of the family, as well as for the client. Issues that may be evident among family members include conflict, difficulty handling emotions, unclear boundaries, and controlling behaviors. Therapy is often not a short-term process and may take years of work[2,9,12] . Cognitive behavioral therapy is another form of psychotherapy used as a treatment intervention for clients with anorexia. Many clients use their control of their weight as a means of gaining control over their lives. Clients are taught appropriate problem solving and coping skills and to recognize that the behaviors associated with anorexia nervosa are not only inappropriate but can be life-threatening. They are also taught to improve their self-esteem, assertiveness, life satisfaction, and interpersonal communication[2,9,12] . Alternative medicine initiatives have not been well-researched for persons suffering from eating disorders. However, acupuncture, massage, yoga, and meditation have been found to help reduce anxiety in some clients[15] . Clients and families should be cautioned that any or all treatment interventions may take months or even years to achieve success[2,9,12] . Dealing with anorexia can be a life-long struggle, and clients may remain vulnerable to relapses especially during periods of stress. Ongoing monitoring and, during times of stress, psychotherapy may be helpful[15] . Nursing interventions Healthcare professionals may find it not only challenging but frustrating to provide care to persons suffering from anorexia nervosa. These clients often find it difficult to adhere to treatment regimens and to participate in psychotherapy. They often go to great lengths to avoid complying with their plans of care. Healthcare professionals, including nurses, may have difficulty understanding how someone can willingly starve themselves, some to the point of near death. Others may view eating disorders not as diseases, but as lifestyle choices. Indeed, some clients rationalize their behaviors by proclaiming that they are not sick, but simply making a choice to be thin[9,15] . Nursing practice must change to not only provide the best possible care for persons with anorexia nervosa, but to also educate colleagues (as well as clients and families) about the disease and the need for ongoing treatment. When helping colleagues to understand the disease and its ramifications, it would be helpful to remember the following key points when providing education to clients, families, and professional colleagues[1,9,12,15] :