East Los Angeles College Char

  • Discussion POST
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating
  • Pica
  • Rumination disorder

Develop a substantial initial post addressing all the points on the chosen disorder:

  • Discuss the characteristics of the disorder.
  • What symptoms should the nurse expect to see for the disorder?
  • After watching the videos on Total Parenteral Nutrition and Enteral Nutrition in ATI, how would these nutritional treatments be used in the care of these patients?

Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source.

reply 1

Develop a substantial initial post addressing all the points on the chosen disorder: Bulimia Nervosa

  • Discuss the characteristics of the disorder. Bulimia nervosa which is referred to as the “binge-purge” disorder, involves repeated episodes of excessive eating (bingeing) followed by attempts to rid the body of the food by vomiting, using laxatives or enemas (purging), or exercising excessively. It is characterized by abnormal eating patterns and distorted perceptions of food and their own body weight. When bingeing, people with bulimia often feel as if they have little control over their behavior. After a binge, they feel guilty and fearful of becoming fat, so they try to rid, or purge, their body of the food by vomiting or using laxatives or enemas. They may use diet pills or take diuretics, which are medications used to reduce the volume of fluids in the body. Some people with bulimia also exercise excessively in order to burn some of the calories eaten during binges. People with bulimia have a distorted body image. Even though many people with bulimia stay at a fairly healthy weight, they are fixated on their body shape and weight and feel as if they are fat.
  • What symptoms should the nurse expect to see for the disorder? Symptoms of bulimia nervosa would include: tooth and other dental problems caused by stomach acids damaging the tooth enamel, rips or tears in the esophagus from frequent vomiting; these tears in the esophagus may result in the appearance of blood in the vomited stomach contents, other gastrointestinal problems such as bowel irregularities and bloating, electrolyte imbalances, missed menstrual cycles, low energy levels, sore throat as a result of vomiting, the Russell sign, which is evidence of scars, calluses, and scratches on the knuckles caused by repeated attempts to self-induce vomiting, feelings of loss of control, shame, depression, irritability, withdrawal, and secretiveness, and low self-esteem, thoughts of committing suicide, and increased risk of suicide attempts
  • After watching the videos on Total Parenteral Nutrition and Enteral Nutrition in ATI, how would these nutritional treatments be used in the care of these patients? TPN is a form of intravenous nutrional support if they are unable to use their GI system in an extended period of time. TPN helps by providing the patient with an IV mixture of dextrose, amino acids, lipids, electrolytes, vitamins, trace elements and water. Enteral nutrition is used for patients who have at least have a partially functional GI system but are unable to consume adequate nutrients orally. When patient’s condition is considered to be life-threatening or when they are lacking the necessary nutrients or if they can’t handle consuming foods orally, TPN and Enteral nutrition would be the best option for them. It will help provide the necessary nutrients they need in their body.

References:

Bulimia nervosa and binge eating disorder. (2017). In Gale (Ed.), Human diseases and conditions (3rd ed.). Gale. Credo Reference: https://westcoastuniversity.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/galehuman/bulimia_nervosa_and_binge_eating_disorder/0?institutionId=8049

reply 2

Greetings Classmates:

For week five’s discussion, I have chosen to address the rare behavioral syndrome called Rumination. A condition where a person spits up food from the stomach rechews it, and either swallows it again or spits it out. It tends to occur within 30 minutes of every meal. The cause is unknown.

Characteristics of the disorder.

Rumination syndrome is a rare condition. It is often underdiagnosed or mistaken for another problem such as vomiting, gastroparesis (delayed digestion), or gastroesophageal reflux disease (GERD). The syndrome is most often diagnosed in children but not uncommonly diagnosed in adults (Rumination syndrome, 2019).

The precise cause is not clear, but it appears to be triggered by an increase in abdominal pressure. Rumination syndrome is regularly confused with bulimia nervosa, gastroesophageal reflux disease (GERD), and gastroparesis. Several individuals have rumination syndrome linked to a rectal evacuation condition, in which poor coordination of pelvic floor muscles often preceding recurring, or chronic, constipation.

The disorder has long been known to occur in infants and people with developmental disabilities. Also, Rumination appears not to be correlated to age, as it can appear in children, teens, and adults. Individuals with anxiety, depression, or other psychiatric disorders are more prone to Rumination syndrome (Rumination syndrome, 2019).

To diagnose Rumination, healthcare providers must ask the right questions. For example, asking what the food tastes like when it comes up is critical. If it still tastes good, this implies that the food is undigested, indicating that rumination syndrome is a good possibility. Vomited food has been digested and typically does not remain in the mouth.

In addition to collecting the patient’s (child or adult) current symptoms and medical history, an initial examination and sometimes observation of behavior are included in the assessment. Also, high-resolution esophageal manometry and impedance measurement are used to confirm the diagnosis (Mayo Clinic, 2020). These particular tests reveal whether there is heightened pressure in the abdomen. It can also give an image of the disturbing function for use in behavioral therapy. Other tests utilized to rule out other possible causes of the patient’s symptoms include esophagogastroduodenoscopy and gastric emptying May Clinic, 2020).

What symptoms should the nurse expect to see?

Symptoms of rumination disorder include: Repeated regurgitation of food, repeated rechewing of food, weight loss, bad breath and tooth decay, repeated stomachaches, and indigestion, and raw or chapped lips (Rumination syndrome: Causes, signs & symptoms, treatment, n.d.)

After watching the videos on Total Parenteral Nutrition and Enteral Nutrition in ATI, how would these nutritional treatments be used in the care of these patients?

After viewing the TPN video, in my opinion, Total Parental Nutrition and Enteral Nutrition is not a primary treatment option for rumination syndrome. Rumination is a reflex rather than a conscious action (Rumination syndrome, 2019), as the problem is a psychological disorder, and the immediate treatment is behavioral therapy to stop regurgitation. The behavioral treatment prescribed for rumination syndrome is diaphragmatic breathing (Mayo Clinic, 2020). One of the most successful ways to halt Rumination is to treat the underlying anxiety and depression, causing it to combine medicine and behavioral therapy. Treatment options include psychotherapy and in-person or online counseling (Hvenegaard et al., 2015). Behavioral therapy will help to detect the pattern and work to correct it.

However, TPN/Enteral Nutrition is a viable treatment option for the individual who presents with nutritionally significant weight loss or malnutrition. Continuous nasogastric enteral nutrition support is known to reduce symptoms of rumination syndrome. Continuous tube feeding can reverse symptoms of malnutrition, such as amenorrhea and bradycardia (Becker, 2012). Where there is nutritionally significant weight loss, refeeding syndrome is possible. Medical nutrition therapy for the rehabilitation of malnutrition should include careful monitoring of serum electrolyte levels and supplementation of sodium, potassium, phosphorus, and magnesium when appropriate (Becker, 2012).

References

Becker, P. J. (2012). Rumination Syndrome: A Difficult Diagnosis and Treatment. ICAN: Infant, Child, & Adolescent Nutrition, 4(1), 38–43. https://doi.org/10.1177/1941406411431277

Hvenegaard, M., Watkins, E. R., Poulsen, S., Rosenberg, N. K., Gondan, M., Grafton, B., Austin, S. F., Howard, H., & Moeller, S. B. (2015). Rumination-focused cognitive behavior therapy vs. cognitive behavior therapy for depression: study protocol for a randomized controlled superiority trial. Trials, 16, 344. https://doi.org/10.1186/s13063-015-0875-y

Rumination syndrome: Causes, signs & symptoms, treatment. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/179…

Mayo Clinic. (2020). Rumination syndrome: Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rum…

Rumination syndrome. (2019). A Non-Profit Hospital in Los Angeles. Cedars-Sinai. https://www.cedars-sinai.org/health-library/diseas…

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