Refeeding syndrome occurs when “patients that have been starved begin to eat and metabolize calories. The body shifts from a catabolic state (a state of breaking down tissues for nutrients) to an anabolic state (a state of rebuilding tissues/ growth)” (Eating Disorder Hope, 2018d). This change in metabolism leads to secretion of multiple hormones that trigger shifts in salts and fluids in the body. The body is in such need of nutrients that it moves various salts from the plasma to the growing cells. Low levels of potassium, phosphorus, and magnesium can lead to a number of complications, including heart failure, arrhythmias, respiratory failure, muscle breakdown, or death (Eating Disorder Hope, 2018d). No current specific guidelines are in place on how to refeed patients once the process is started. Treatment must still be tailored to the individual client's needs. Historically, the process focused on gradual increase of caloric intake and close monitoring of weight, vital signs, fluid shifts, and serum electrolytes. Recent research findings have suggested that a more aggressive approach to refeeding is safe, reduces complications, prevents fatalities, and reduces hospital length of stay. The scientific literature seems to be moving from a slow, gradual caloric increase to more aggressive approaches of higher calories with the amount more rapidly increased. Not enough data exist to establish specific recommendations, however (Eating Disorder Hope, 2018d). Intake, output, and weight are assessed daily before breakfast. Clients must be monitored so that they do not add weight to their clothing or take other actions to appear to have gained weight when, in reality, they have not (Gersch et al., 2016; Videbeck, 2017). No FDA-approved medications exist for the specific treatment of anorexia. However, antidepressants or antianxiety medications are sometimes used to treat coexisting disorders such as depression or anxiety (Mayo Clinic, 2018c). Various classes of drugs are under investigation, but few have demonstrated clinical success. The following drugs have shown some clinical success (Videbeck, 2017): ● Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses up to 28 mg/day have been shown to promote weight gain in some inpatients with anorexia nervosa. ● Olanzapine (Zyprexa) has been prescribed because of its antipsychotic effect on bizarre body image distortions as well as associated weight gain. ● Some effectiveness has been shown with the use of fluoxetine (Prozac) or sertraline (Zoloft) to prevent relapse in clients whose weight has been partially or completely restored. It is essential that clients be closely monitored because weight gain can be a side effect of this medication. 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 (Mayo Clinic, 2018c). Family therapy can also be helpful for all members of the family. Healthcare Interventions Healthcare professionals could find it not only challenging but also 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 (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017). Mistaken beliefs can interfere with effective healthcare interventions. Healthcare professionals might not understand how someone can willingly starve themselves, some to the point of death. Others view eating disorders not as diseases but as lifestyle choices. Indeed, some healthcare professionals believe that clients are not sick but simply choosing to be thin (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017).
Issues that may be evident among family members are conflict, difficulty handling emotions, unclear boundaries, and controlling behaviors. Therapy is usually not a short-term process and could take years of work (Gersch et al., 2016; Videbeck, 2017). CBT-E, short for “enhanced cognitive behavior therapy,” is a highly effective treatment for eating disorders. IT was initially designed for adult outpatient treatment but has since been adapted for day patients, inpatients and younger individuals. Each treatment plan is tailored to address the specific eating problem of the individual, making it highly personalized therapy (CBT-E, 2022). The treatment process involves four stages (CBT-E, 2022): Stage One: the focus is on understanding the person’s eating issues and stabilizing their eating patterns while providing personalized education about weight concerns. Stage Two: involves reviewing progress and planning for the main treatment in Stage three. Stage Three: Weekly sessions are dedicated to addressing the factors that maintain the eating disorder, such as body image concerns, emotional regulation and extreme dietary restraint. Stage Four: The focus shifts to preparing for the future, dealing with setbacks and maintaining the progress achieved during therapy. For individuals who are underweight, the treatment duration is typically longer, which is around 40 sessions over 40 weeks. This version of CBT-E integrates weight regain with addressing eating disorder issues. Patients and therapist work together to carefully consider the reasons for and against weight regain, empowering patients to make this decision themselves. The goal is for patients to become proficient at maintaining their weight as they progress through the therapy. After treatment, a review session is often held to assess progress and address any remaining challenges (CBT-E, 2022). Alternative medicine initiatives have not been well researched for persons suffering from eating disorders. Vitamin and mineral supplements could be needed if clients are not getting adequate amounts of nutrients. However, no vitamins, supplements, or herbal preparations should be consumed without the knowledge and approval of the client’s healthcare provider (Mayo Clinic, 2018c). Healthcare consideration : Dietary supplements and herbal preparations that suppress appetite or facilitate weight loss may be abused by clients with anorexia nervosa (Mayo Clinic, 2018c). It is very important that nurses monitor clients for such abuse, discuss it with clients, and teach families, as appropriate, to monitor for it. Clients and families should be cautioned that any treatment interventions could take months or even years to achieve success. Dealing with anorexia can be a lifelong struggle, and some clients remain vulnerable to relapses, especially during periods of stress. Ongoing monitoring and, during times of stress, psychotherapy can be helpful (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017). Healthcare settings must change not only to provide the best possible care for persons with anorexia nervosa but also to educate colleagues (as well as clients and families) about the disease and the need for ongoing treatment. Healthcare professionals can help colleagues and others to understand the disease and its ramifications by educating them on the following key points (Gersch et al., 2016; Mayo Clinic, 2018c; Videbeck, 2017): ● Reiterate that anorexia nervosa is a serious illness, not a lifestyle choice. Treatment requires that clients adhere to their individualized treatment plans.
Page 125
Book Code: PYMA2024
EliteLearning.com/Psychology
Powered by FlippingBook