Parent guide. Healthcare Response. Health, Medicine, Nursing Essay

Respond two other groups by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.
INCLUDED ARE THE 2 PARENT GUIDES PLEASE WRITE ONE PARAGRATH ON EACH
Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by weight loss (or the lack of appropriate weight gain in growing children), including difficulties maintaining an appropriate body weight for height, age, and stature; and, and a distorted body image in many individuals (National Eating Disorders Association [NEDA], 2018. Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Anorexia nervosa results in the individual restricting their caloric intake and the types of food they eat. Some individuals with the disorder may exercise compulsively, binge eats, or purge via vomiting and laxatives.

“I am Fat”
Signs and Symptoms
Emotional and behavioral
• Dramatic weight loss
• Dressing in layers to hide weight loss or stay warm
• Preoccupation with weight, food, calories, fat grams, and dieting
• Refuses to eat certain foods or food categories
• Denies feeling hungry, skipping meals, or hides food (to discard later), may feed their food to their pet
• Develops food rituals (e.g., eating foods in specific orders, excessive chewing, rearranging food on a plate)
• Regularly makes excuses to avoid mealtimes or situations involving food
• Seems concerned about eating in public
• Has problems maintaining a bodyweight appropriate for their age, height, and build
• Has an intense fear of weight gain or being “fat,” even though underweight
• Menstrual period cessation in post-puberty females
• Has a strong need for control
• Exhibit rigid thinking patterns
• Has overly restrained initiative and emotional expression

Physical
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin
• Dry and brittle nails
• Swelling around salivary glands
• Fine hair on the skin (lanugo)
• Thinning, dry and brittle hair
• Cavities or teeth discoloration (as a result of vomiting)
• Muscle weakness
• Impaired immune functioning


Pathophysiology
Anorexia nervosa is an eating disorder characterized by self-starvation due to a person’s fear or obsession of being fat, and thus attempt to change that self-image (Lewis, Bucher, Heitkemper & Harding, 2017). It is one of the three most common types of eating disorders. Anorexia nervosa manifests clinically as severe thinness and the patient’s unwillingness to eat, gain or maintain a healthy weight, lanugo (soft, downy hair on the body), continuous dieting, sensitivity to cold, compulsive exercise, dry-yellowish skin appearance, and constipation. Patients with anorexia nervosa are so fixated on the prevention of weight gain that they restrict their amount of food intake. They can control their calorie intake by inducing vomiting or by misusing diuretics and laxatives such as enema, to create diarrhea (Mayo Clinic, 2018.).
Diagnosis
Anorexia is diagnosed by a specific set of criteria that is present along with other physiological and laboratory diagnostic markers.
Criteria Include:
• Restricting food and energy intake to extremes causing low body weight.
• Extreme fear of gaining weight or being fat.
• Behaviors that prevent weight gain.
• Disturbance in body perception
• Indifference to dangerously low body weight.
Laboratory Tests:
• Weight, Height, and Body Mass Index
• Complete Blood Count-Leukopenia, anemia, and thrombocytopenia can be present
• Comprehensive Metabolic Panel, elevated hepatic enzymes, blood urea nitrogen levels, magnesium, phosphorus, zinc, and amylase is usually low.
• Urinalysis
• Thyroid Function Tests
• Bone Density Test-Low bone mineral density is seen with increased risk for fractures.
• Electrocardiogram-Arrhythmias can be present along with prolonged QTc levels.
• Electroencephalogram-Fluid and electrolyte imbalances can be severe.
Treatment of anorexia
Anorexia Nervosa is complex; treatment requires a multidisciplinary approach. A priority of treatment is to address and identify any serious health problems caused by malnutrition. Sadock, Sadock, & Ruiz, (2014) note a treatment plan may include hospitalization (when necessary), individual and family therapy, behavioral, interpersonal, and cognitive approaches are used. (p. 514). Medications may be indicated for persons with underlying depression or mood disorders (Sadock et al., 2014).
Hospitalization:
Less than 75% of ideal body weight, ongoing weight loss despite intensive management
Heart rate < 50 bpm daytime;< 45 bpm nighttime
SBP <90 mmHg
Hypothermia T <96 F
Arrhythmia; prolonged QTc
Electrolyte abnormalities
Intractable vomiting
During hospitalization, daily monitoring of weight, intake, and recording of output, and monitoring electrolytes when vomiting occurs (Sadock et al. 2014). To prevent regurgitation following meal measures such as no entry into the restroom for two hours post meals or having an attendant in the bathroom (Sadock et al. ,2014). Re-introduction of food occurs gradually, six small feedings throughout the day, so the client doesn’t eat a large amount of food at one sitting. To reduce apprehension related to eating, an introduction of liquid supplements (Sadock et al., 2014).
Psychotherapy
Cognitive- Behavioral Therapy
CBT used in inpatient and outpatient settings. Monitoring is a vital component of CBT. Clients learn to cope with their feelings, understand nutrition and starvation, and aid in making healthy food choices while managing what they are eating.
Dynamic Psychotherapy
This approach uncovers the feelings or thoughts that interfere with a client’s relationships, communication, and daily functioning. For this method to be effective, the therapist must gain the trust of the client within a short period and engage the client in the therapeutic process (Sadock et al., 2014)

Family therapy
A careful assessment of the entire family, including the identified patient, parents, siblings, the child’s emotional, social, and physical development, developmental stages, and communication pattern is vital in establishing a treatment plan. Family therapy is an attempt to reducing potentially life-threatening symptoms and begin a therapeutic change process within the family.
Medications
There are no medications approved specifically for Anorexia Nervosa. SSRIs (Selective Serotonin Reuptake Inhibitors) can help treat co-morbidities such as depression, anxiety, and OCD.


References
National Eating Disorder Association [NEDA]. (2018). Anorexia Nervosa. Retrieved from https://www(dot)nationaleatingdisorders(dot)org/learn/by-eating-disorder/anorexia
Khalifa, I., & Goldman, R. D. (2019). Anorexia nervosa requiring admission in adolescents. Canadian family physician Medecin de famille canadien, 65(2), 107–108.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Lewis, S. L., Butcher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems. (10th ed.). St. Louis, MO: Elsevier.
Mayoclinic.org. (2018). Anorexia nervosa. Retrieved from https://www(dot)mayoclinic(dot)org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591


RUMINATION DISORDER
WHAT IS RUMINATION DISORDER (RD)?
RD is an eating disorder characterized by repeated and effortless regurgitation of food that is ongoing for at least a month in absence of gastroenteritis or other explanatory medical conditions. In one study of over 2,000 children between the ages of 10 and 16 years, rumination behaviors were found in approximately 5% of boys and girls.

PATHOPHYSIOLOGY
RD is associated with elevated pressure within the stomach and the ability to contract the abdominal muscles, causing food to move from the stomach back up the esophagus. The squeezing of stomach muscles may be either voluntary or unintentional. Overstimulation and tension may also contribute to rumination.

SIGNS AND SYMPTOMS
 Abdominal pains or pressure relieved by regurgitation
 A feeling of fullness
 Bad breath
 Unintentional weight loss

DIAGNOSIS
The diagnosis of RD is often difficult due to the similarity of symptoms with other gastrointestinal issues. In many cases, rumination disorder can be misdiagnosed as delayed gastric emptying, vomiting disorder or gastroesophageal reflux disease (GERD). For an accurate diagnosis, a detailed symptom history is required. The provider may ask the following questions to identify the likelihood of RD:
• How long after eating does the regurgitation start?
• Can you hear retching or see that your child is about to vomit the food or is about to regurgitate?
• Has your child taken any medicine to treat reflux and was this medicine helpful?
Although the diagnosis is made based on signs and symptoms, blood tests and other diagnostic tests are still needed to rule out other causes of regurgitation, dehydration, and malnutrition.

TREATMENT
In many patients, recognition and explanation of the diagnosis of rumination disorder and reassurance may be all that is required as treatment. However, behavioral therapies, biofeedback, and diaphragmatic breathing are the mainstays of treatment. These therapies work by aiding in the relaxation of the abdominal wall and reduction of abdominal wall contractions, which may induce symptoms. Even a single, brief intervention can help suppress ruminating events. Such interventions can result in significant improvements in symptoms, with up to 43% of children reporting complete symptom resolution and an additional 28-55% reporting partial improvement.
Diaphragmatic breathing: One hand is placed on the chest and the other on the abdomen just below the rib cage at the bottom of the sternum. The aim is to keep the hand on the chest almost still while the hand on the abdomen rises and falls with the breath. Each breath should last at least three seconds.
Behavioral strategies: aversion training and distraction (e.g., gum chewing after meals has been shown to reduce rumination).
Medications: Baclofen has been effective in reducing symptoms of RD. Medications such as proton pump inhibitors (e.g., Prilosec) and antiemetics aren’t clearly beneficial in improving symptoms. Low dose tricyclic antidepressants have been used to reduce gastric hypersensitivity when pain is a significant symptom in combination with rumination.
Surgery: When children don’t respond to medication and behavioral therapy, Nissen fundoplication has been reported to be an effective treatment for RD.

REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bryant-Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22. The International Journal of Eating Disorders, 52(4), 378–387. https://doi-org(dot)ezp(dot)waldenulibrary(dot)org/10.1002/eat.22958
Disney, B., & Trudgill, N. (2013). Managing a patient with rumination. Frontline gastroenterology, 4(3), 232–236. https://doi(dot)org/10.1136/flgastro-2013-100321
Mayo clinic. (2018). Rumination syndrome - Symptoms and causes. Retrieved from https://www(dot)mayoclinic(dot)org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330
Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and Treatment of Rumination Syndrome: A Critical Review. The American journal of gastroenterology, 114(4), 562–578. https://doi(dot)org/10.14309/ajg.0000000000000060
Rajindrajith, S., Devanarayana, N. M., & Perera, B. J. (2012). Rumination syndrome in children and adolescents: A school survey assessing prevalence and symptomatology. BMC Gastroenterology, 12(1), 163-168. 10.1186/1471-230X-12-163.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.