Malnutrition_Secondary_to_Eating_Disorder

Malnutrition Secondary to Eating Disorders a. Physiological Process Anorexia nervosa has an effect of practically every organ in the body especially in the major body systems including the endocrine system, reproduction, renal, gastro intestinal cardiovascular and the neurologic systems (Miller & Golden, 2010, p. 111). Anorexia nervosa causes the body to starve and therefore suffer deficient of nutrients that are important for cell function. These nutrients are divided into two categories; the micro-nutrients which include minerals and vitamins and the macronutrients that include fats, proteins and carbohydrates. Human body cells functionality at the molecular level relies on foods that are rich in micro- and macronutrients. The basic formation of the cell membrane where the basic life functions of the cell take place like enhance of gases, nutrients and growth and developments. Micronutrients enhance generation of energy in the mitochondria, help in development of new DNA and repair worn out cells. Deficient in these nutrients starve the cell and the process of making DNA is alter, repair of old worn out cell and generation of new ones will malfunction and the cell cannot produce enough energy as well cells. Cells are entirely made up of lipids and fats plus other constituents majorly obtained from nutrition (Fichner et al, 2008, p. 578). Deficient in these nutrients causes cells to lose their function and to die and the body starts to be emaciated since as cell are destroyed no new ones and formed to replace them. This is severe malnutrition and the patient has no energy even to work normally. Karen Carpenter’s death was as a result of cardiac dysfunction and congestive heart failure which is the commonest cause of death in such conditions. As the body gets less and lesser nutrients, it begins to utilize those that were initially stored in the liver and other location even muscles. This is now the extreme pathology of the diseases (Miller & Golden, 2010, p. 111). After extreme starvation, the body turns to the muscle cell where it destroys the myocytes (cell of the heart) as well. As a result of this process, referred to as proteolytic destruction, the myocardial muscles begin to reduce in size because of myofibrillar atrophy (Fichner et al, 2008, p. 578). This is the wasting of heart muscles because of starvation and the myocardial mass decreased critically and the contractility is impaired. Such cardiac dysfunction is common in anorexic patients and causes congestive heart failure. This condition in manageable when directed early and therapy initiated immediately. On assessment by echocardiography, anorexic patients are observed to have significantly reduced mass of their heart’s left ventricle and even the stroke volume (Fichner et al, 2008, p. 578). There is also increased size of the heart during refeeding and this clearly shows that the heart is overloaded as a result of the myocardial wasting and fibrosis. A very high output failure results from the augmented cardiac demand caused by the anabolic condition of refeeding plus deficiencies in micronutrients including thiamine, potassium, phosphates and anemia (Miller & Golden, 2010, p. 112). Furthermore, there is also retention of fluid in extracellular compartments as the renal system becomes more sensitive to aldosterone and oncotic pressure falls because of hypoalbuminemia. Such function impairement are the main reason that the casues to become more vulnerable to development of overt CHF which is potentially fatal (Miller & Golden, 2010, p. 113). Other possible heart conditions that are may develop and potentially fatal are dysrrhythmias induced by electrolyte imbalance fallowing refeeding on high calorie food like carbohydrates. b. Physical Assessment and Pathophysiology Anorexia nervosa can be fatal if not intervened in time. This condition develops as a result of eating disorder whereby the patients develop irrational fear of gaining weight or becoming obese and as s result, the patient starves him or herself and at times they induce vomiting (Fichner et al, 2008, p. 579). Karen Carpenter is one such patient who induced vomiting after binge eating and time used laxatives. As a consequence her body function was disturbed and she eventually died. Beside the fatal physiological effects of anorexia nervosa, there is usually psychological suffering. Physical assessments of patient with anorexia show signs of hypotension which is reduced blood pressure (Fichner et al, 2008, p. 583). The reduction is as a result of reduced heart rate because the myocardial muscles are wasted. This is also the same reason why bradycardia is observed. Hypothermia on the other hand is caused by the problem is slowed circulation resulting from slowed heart rate. As a result, the body extremities to do not get enough warm blood flow making them cold and as a result, the general body temperature falls (Miller & Golden, 2010, p. 114). The physical changes in anorexia are wide spectrum. There is also evidence peripheral edema; renal failure and malfunctioned absorption are complications of anorexia leading to edema. As already highlighted earlier, the body tends to retain body fluids because of the reduced heart beat and hence low blood pressure (Fichner et al, 2008, p. 583). When the heart does not have enough energy to pump blood and cause proper circulation of all bodily fluids, edema sets in. . Signs that the heart is severely affected by anorexia include dizziness, fatigue, bluish and splotchy hands and legs and to the extreme ends, the patient experiences breathlessness, rapid breathing, feeling of congestion and pain to the chest, irregular pulse and pain in the legs. These signs are caused by the fact that these signs are caused by lack of enough nutrition to the brain and body tissues, lack of enough oxygen in the blood causing the bluish coloration and splotchy legs (Fichner et al, 2008, p. 585). Heart palpitations and chest pain are often experienced during sleep at night and the patient feels like they are dying. These symptoms are accompanied with bradycardia and severe hypotension. Unless rectified this posses greatest risk of CHF. This is what killed Karen. If an EKG could have been obtained from her before death, it could clearly reveal that she had a critically slowed heart rate or experienced arrhythmias since anorexia had wasted the size of her heart muscles to a dangerous extent to cause cardiac dysfunction and CHF (Miller & Golden, 2010, p. 114). The cause of the cardiac problems is as already mentioned due to myocardial muscle atrophy. Malnutrition also causes lanugo and alopecia whereby the hair does not get enough nutrients for growth. Enlargement of salivary glands is caused by starvation and induced vomiting after binge eating and this makes the face appear swollen. c. Possible interventions Due to the weighty effects of physiological and psychological developments of anorexia, it’s widely accepted that intervention of the condition should aim at restoring about 90% of body weight (Birmingham & Treasure, 2010, p. 44). Unfortunately, this is very hard to achieve because the patients, feel ‘fat’ and are afraid of getting obsess therefore there is usually so much resistance causing frustration to the doctors, patient and their families (Sim et al, 2010, p. 747). The first intervention is refeeding and is mostly attained by oral feeding or through parenteral means (Sim et al, 2010, p. 749). Patients with less than 70% of normal weigh or Body mass index less than 16 should be considered first. Medical intervention can also be given when the doctor diagnosis indicates that the patient is seriously affected and needs hospitalization. Upon hospitalization, the physicians try to the health of the patient medically including proper heart function by replenish electrolyte balance and use of multivitamins (Sim et al, 2010, p. 751). Criteria for hospitalization pulse less than 45/minute, hypothermia, depleted K, Mg and PO, mental problem and elevated AST or ALT double the normal (Birmingham & Treasure, 2010, p. 44). Feeding and weight are monitored by the physician in this case. Psychiatric intervention includes providing emotional support when refeeding is started. Psychological support should also aim at building the patients’ self esteem so that the patient can develop a satisfying feeling of herself despite the weight (Sim et al, 2010, p. 751). This is necessary because of misery and obsessive compulsive character most anorexia patients suffer from. Psychosocial intervention is designed to build the individual’s personal relationship and reasonable life goals. This is because anorexia is more like a developmental problem. Family history can affect its occurrence and therefore families often interfere with patient life and dietary decision (Sim et al, 2010, p. 753). This intervention will treat patients’ personality and behavior so that they can develop independence, self esteem and adequate problems solving skills. Hormonal balancing: due to the habit of anorexic patients of vomiting and use of laxative, the endocrine system is affect and hormone function is affected. Some are extremely lowered while others are elevated (Birmingham & Treasure, 2010, p. 47). This is why the normal process of growth, bone formation, amenorrhea and stress (mood) are affected. Reference List Birmingham, C.L & Treasure, J. (2010). “Medical Management of Eating Disorders,” Cambridge; Cambridge university press Fichner, M., Quadflieng, N., & Hedlund, S. (2008). “Long-Term Course Of Binge Eating Disorder And Bulimia Nervosa: Relevance For Nosology And Diagnostic Criteria,” International Journal Of Eating Disorders, Vol. 41, Issue 7, pp. 577–586, Miller, C.A & Golden, N.H. (2010). “An Introduction to Eating Disorders: Clinical Presentation, Epidemiology, and Prognosis,” Nutr Clin Pract; Vol. 25 No. pp. 110 - 115. Sim, L.A., et al. (2010). “Identification and Treatment of Eating Disorders in the Primary Care Setting,” Mayo Clin. Proc., 85(8): 746 - 751.