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Anorexia Nervosa |
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Definition |
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說明 |
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Anorexia nervosa is an eating disorder characterized by refusal to maintain body weight that is within the minimal range of normal. The affected individual has a distorted body image, perceiving self as globally overweight or obsessing about shape and size of particular body parts. |
神經(jīng)性厭食癥屬于進(jìn)食障礙病，特點(diǎn)是拒絕體胖，盡管它已經(jīng)是最低限度的正常體重�；颊邔�(duì)體形看法偏執(zhí)，認(rèn)為自己總體超重或沉迷于身體特定部位的形狀和尺寸。 | |
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There are two subtypes of anorexia nervosa. One is the restricting type, wherein the individual severely restricts food intake and compulsively exercises. The other is the binge eating and purging type marked by restricted dietary intake coupled with intermittent episodes of binge eating, followed by purging through self-induced vomiting or use of ipecac, laxatives, diuretics, or enemas. |
神經(jīng)性厭食癥分兩種。一是限制型的，患者嚴(yán)格限制食物攝入并強(qiáng)迫自己運(yùn)動(dòng)。另一種是狂飲狂瀉型的，其特點(diǎn)是在限制飲食的同時(shí)又伴有間歇性暴飲，接著又通過自我誘導(dǎo)式嘔吐或使用吐根、緩瀉劑、利尿劑和灌腸劑等催瀉。 | |
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Pathophysiology |
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A variety of psychologic factors are associated with the development of behaviors characteristic of anorexia nervosa. Low self-esteem often plays a significant role. Weight loss is viewed as an achievement, and self-esteem becomes dependent on body size and weight. There is also a relationship between eating disorders and mood disorders. In some cases, major depression may result from nutritional deprivation. Individuals with anorexia nervosa may lack spontaneity in social situations and may be emotionally restrained. The excess use of appetite suppressants or diet pills is seen in both types. |
很 多病因素都與一些神經(jīng)性厭食癥特有的行為有關(guān)。缺乏自尊常常起著很重要的作用。減肥使其產(chǎn)生一種成就感，自尊依賴于體形和體重。飲食障礙與心境障礙也有關(guān) 系。有些病人嚴(yán)重抑郁，這通常是營養(yǎng)不足引起的，厭食癥患者在社交場(chǎng)合缺乏自發(fā)性，在情感上會(huì)很拘束。這兩類厭食癥都會(huì)發(fā)生過度使用食欲抑制劑或節(jié)食丸這 種情況。 | |
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Family dynamics may play a role in development of symptoms. Parents may be controlling and overly protective. Eating behaviors may emerge in an unconscious attempt to gain control over the environment. Also contributing to this eating disorder is a societal ideal slimness that the adolescent strives to emulate. In some cases, diminished weight and loss of secondary sexual characteristics may be related to difficulty in accepting maturation into adulthood. |
家族情況對(duì)癥狀出現(xiàn)也有一定影響。父母對(duì)小孩控制過嚴(yán)，保護(hù)過度。有意無意地想要控制環(huán)境，從而形成了不良飲食習(xí)慣。造成飲食障礙的另一個(gè)因素是社會(huì)對(duì)所謂的理想的苗條的追求，青少年努力想要效法這種苗條。在有些病例中，體重減輕，失去第二性征可能也與難以接受成年有關(guān)。 | |
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Clinical Manifestations |
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臨床表現(xiàn) |
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Sudden, unexplained weight loss |
體重突然下降，原因不明 | |
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Emaciated appearance, loss of subcutaneous fat |
瘦弱，在下脂肪丟失 | |
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Changes in eating habits, unusual eating times |
飲食習(xí)慣改變，飲食時(shí)間異常 | |
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Excessive exercise and physical activity |
運(yùn)動(dòng)和體力活動(dòng)過度 | |
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Amenorrhea |
無月經(jīng) | |
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Dry, scaly skin |
皮膚干燥、脫皮 | |
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Lanugo on extremities, back, and face |
四肢、背部和臉部長(zhǎng)出毳毛 | |
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Yellowish discoloration of skin |
皮膚微黃褪色 | |
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Sleep disturbances |
睡眠障礙 | |
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Chronic constipation or diarrhea, abdominal pain, bloating |
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Esophageal erosion醫(yī)學(xué)全在線網(wǎng)站www.med126.com |
食管病變 | |
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Depressed mood |
情結(jié)低落 | |
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Excessive focus on high achievement (becomes distressed when performance is not above average) |
過度強(qiáng)調(diào)杰出成就，如表現(xiàn)一般就會(huì)感到痛苦 | |
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Excessive focus on food, eating, and body appearance |
挑剔強(qiáng)調(diào)食物、飲食及體形 | |
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Erosion of tooth enamel and dentin on lingual surfaces (late effects) |
晚期出現(xiàn)牙釉質(zhì)和牙本質(zhì)舌面病變 | |
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Diagnostic Studies |
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診斷檢查 |
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Electrocardiogram (ECG) |
心電圖 | |
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blood pressure |
血壓 | |
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Serum urea, electrolytes, creatinine |
血清尿、電解質(zhì)、肌酐 | |
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Complete blood count (CBC), platelet count |
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全血計(jì)數(shù)，血小板 |
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Thyroid-stimulating hormone (TSH) |
促甲狀腺激素 | |
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Bone density |
骨密度 | |
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Presence of hypercarotenemia |
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Therapeutic Management |
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治療 |
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Treatment is provided on an outpatient basis unless severe medical problems emerge. An interdisciplinary approach is needed to ensure optimal outcomes. Outpatient treatment includes medical monitoring, dietary planning to restore nutritional state, and long-term psychotherapy to work through underlying issues. Psychopharmacologic treatment may be initiated to treat symptoms of depression, anxiety, and obsessive-compulsive behaviors. Hospitalization is indicated if the adolescent weighs less than 20% of ideal body weight or is unable to adhere to the treatment program on an outpatient basis, or when neurologic deficits, hypokalemia, and cardiac arrhythmias exist. |
如無急診情況出現(xiàn)，一般行門診治療。為確保理想治療效果，通常進(jìn)行多科室診治。門診治療包括醫(yī)學(xué)監(jiān)測(cè)、飲食計(jì)劃以恢復(fù)營養(yǎng)、長(zhǎng)期進(jìn)行心理療法解決潛在問題。抑郁癥、焦慮癥和強(qiáng)迫性行為可心通過精神藥理手段進(jìn)行治療。如體重低于理想體重20%或門診治療無法保證治療計(jì)劃落實(shí)，或出現(xiàn)神經(jīng)缺欠、低鉀血及心律失常，這時(shí)就需要住院。 | |
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The following medications may be used: |
使用藥物： | |
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Antidepressants--the selective serotonin reuptake inhibitors (SSRI) are also used, particularly if compulsive exercising is a component of the illness (imipramine, desipramine, fluoxetine, sertraline, paroxetine) |
抗抑郁藥，也可使用選擇性5羥色胺再吸收抑制劑，特別是患有強(qiáng)迫運(yùn)動(dòng)時(shí)，如丙米嗪、地昔帕明、氟西汀、舍曲林、帕羅西丁等。 | |
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Estrogen replacement for amenorrhea |
無月經(jīng)者可補(bǔ)充雌激素。 | |
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Nursing Management |
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護(hù)理 |
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Goals |
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目標(biāo) |
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The individual's physical health status improves without symptoms with steady, reasonable weight gain (about 1lb every 4 days). |
患者身體健康狀況改善，無癥狀，體重穩(wěn)定、合理增加（約每4天1磅) | |
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The individual establishes a healthy pattern of nutritional intake. |
患者確立健康的營養(yǎng)攝取方式 | |
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The individual establishes increased self-esteem and improvement in psychologic functioning. |
患者自尊增強(qiáng)，心理作用改善 | |
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Nursing Diagnoses |
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護(hù)理診斷 |
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Imbalanced nutrition: less than body requirements related to exercise in excess of caloric intake, refusal to eat, self-induced vomiting following eating, or laxative abuse |
營養(yǎng)失調(diào)：低于機(jī)體需要量 與運(yùn)動(dòng)過多、熱量攝入相對(duì)不足、拒絕進(jìn)食、進(jìn)食后自我誘發(fā)嘔吐及濫用瀉藥有關(guān) | |
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Disturbed self-concept related to inaccurate perception of self as obese |
自我概念紊亂 與錯(cuò)誤認(rèn)為自己肥胖有關(guān) | |
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Risk for deficient fluid volume related to vomiting and excessive weight loss |
有體液不足的危險(xiǎn) 與嘔吐及體重丟失過多有關(guān) | |
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Disturbed sleep pattern related to fears and anxiety concerning weight status |
睡眠型態(tài)紊亂 與害怕或擔(dān)心體重增加有關(guān) | |
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Activity intolerance related to fatigue secondary to malnutrition |
活動(dòng)無耐力 與繼發(fā)于營養(yǎng)不良的疲乏有關(guān) | |
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Ineffective individual coping related to self-induced vomiting, denial of hunger, and insufficient food intake secondary to feelings of loss of control and inaccurate perceptions of body states |
個(gè)人應(yīng)對(duì)無效 與自我誘發(fā)性嘔吐、否認(rèn)饑餓、及行為失控感和對(duì)自已身體狀況認(rèn)識(shí)不足引起的食物攝入不足有關(guān) | |
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Nursing Interventions |
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護(hù)理措施 |
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Include family in forming dietary supplementation plan. |
讓家人參與制定食物補(bǔ)充計(jì)劃。 | |
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Provide information about adequate nutritional intake and the impact inadequate intake has on energy level and psychologic well-being. |
提供有關(guān)足夠營養(yǎng)攝入的資訊，使其了解攝入不足對(duì)能量與心理健康的影響 | |
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Initiate specific plan of exercise as reinforcer for positive behavioral outcomes. |
制定具體的鍛煉計(jì)劃，強(qiáng)化積極的行為結(jié)果 | |
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Establish trusting relationship that promotes disclosure of feelings and emotions. |
建立信任關(guān)系，鼓勵(lì)情感和情結(jié)的表達(dá) | |
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Organize eating of meals with others, record amount of food eaten, and monitor activity for 2 hours after eating. |
組織與他人共餐，紀(jì)錄飲食數(shù)量，監(jiān)視飯后2小時(shí)內(nèi)的活動(dòng) | |
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Promote the individual's sense of responsibility and involvement in recovery and treatment. |
增強(qiáng)患者責(zé)任感，鼓勵(lì)其參與恢復(fù)及治療活動(dòng) | |
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Participate on interdisciplinary team that uses multiple modalities such as individual and group psychotherapy, assertiveness training, music and/or art therapy, and nutritional education. |
參加多種形式科室小組活動(dòng)，如個(gè)人和小組精神 療法，表達(dá)訓(xùn)練、音樂和/或藝術(shù)療法及營養(yǎng)教育等。 | |
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Support involvement of family members who are vital to recovery. |
支持重要家族成員的參與。 | |
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Patient Teaching |
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病人宣教 |
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Recommend psychotherapy for treatment of distorted body image and self-concept. |
建議用精神療法治療體像和自我概念的錯(cuò)誤認(rèn)識(shí) | |
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Refer adolescent and family to community resources, that is, support groups and mental health professionals. |
安排社區(qū)資源，如支援小組和心理健康專家。 | |
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Instruct parents to promote the patient’s activities that strengthen the patient’s self-esteem, facilitate the resocialization process and promote social acceptance among peers. |
指導(dǎo)父母鼓勵(lì)病人參加一些有益的活動(dòng)，如增強(qiáng)病人自尊、便于重建社交及促進(jìn)同伴社交接受度的活動(dòng)。 |
