愛華網(wǎng)文章取自丁香園，感謝作者……希望對大家有幫助……
EATING DISORDERS
(進食障礙)
Anorexia Nervosa神經(jīng)性厭食癥
Bulimia Nervosa 神經(jīng)性貪食癥
一、Introduction 概念簡介
一項關(guān)于人們對自我形象（體形）的調(diào)查指出：
We are healthier than ever, fitter than ever, but less satisfiedwith how we look.
我們比以往更健康，身體更壯，但是我們卻越來越不滿意自己的外表。
據(jù)報道:
3-5% 女大學(xué)生服用瀉藥 purge, laxatives
56% 25-34歲的女性在節(jié)食 on diet
69% 的肥胖人群是由于暴飲暴食造成的binge eating
20% 的肥胖人群死于肥胖帶來的疾病
（一） 神經(jīng)性厭食癥：
Anorexia nervosa is an illness ofstarvation related to a severe disturbance紊亂 of body image and amorbid fear of obesity; It is an eating disorder, usually seen inadolescence, when a person is under-weight and emaciated andrefuses to eat. It can result in death due to irreversiblemetabolic process.
是指人不滿意自己的外表，懼怕長胖而拒絕正常進食，長期饑餓導(dǎo)致營養(yǎng)缺乏的一種進食障礙，常見于年輕女性，患者體重明顯下降，消瘦，拒絕進食， 最終可因不可逆的代謝紊亂導(dǎo)致死亡。
注意：
l排除下丘腦進食中樞病變導(dǎo)致的食欲減退Not due tolack of appetite or problem with appetite center inhypothalamus.
l好發(fā)于青年女性：90-95%是女性adolescence
l嚴重的自我形象的紊亂severe disturbanceof body image
l沒有確定的“瘦”的標準 no desiredweight
l懼怕長胖morbid fear ofobesity;
l否認、壓抑、強制性的抵制-正常的胃的饑餓感Normalstomach hunger is repressed, denied, depersonalized; no consciousawareness of hunger sensation.
l10-20%神經(jīng)性厭食癥的患者死亡，其中50%死于自殺。Commit suicide
（二）神經(jīng)性貪食癥：
Bulimia nervosa is another type ofeating disorder (binge-purge syndrome) also encountered, primarilyamong older women and younger men.
神經(jīng)性貪食癥是另一種進食障礙，它是一種暴飲暴食狂瀉的綜合癥狀，在年輕女性多見，也見于男性。
The person is aware that the behavior is abnormal, fears theinability to stop eating, is self-critical, and may experiencedepression after each episode.
神經(jīng)性貪食癥的患者能夠意識到自己的行為是不正常的，他們沒有辦法讓自己停止進食，并因此而擔(dān)憂、自責(zé)，許多人發(fā)作后都很沮喪。
The person may stop eating because of abdominal pain.
他們停下來進食可能是由于腹痛。
Repeat attempts are made to lose weight by fasting ordieting;
他們可能反復(fù)禁食或節(jié)食來減輕體重。
by abusing laxatives, enemas, or diuretics;
by self-induced vomiting;
也可能過量應(yīng)用瀉藥、灌腸、利尿劑，或誘發(fā)嘔吐等方法。
They decrease physical pain of abdominal distention may reducepost-binge anguish, and may provide a method ofself-control.這些方法也可以減輕暴飲暴食后的腹脹和腹痛，也可以減輕患者對暴飲暴食的自責(zé)，使患者有自制感。
Bulimia nervosa may develop into a chronic disorder and occurintermittently over several years. Bulimic episodes may occur aspart of anorexia nervosa, but these clients rarely becomeemaciated, and not all have a body-imagedisturbance.神經(jīng)性貪食可以發(fā)展為慢性的進食障礙，或間接發(fā)作。神經(jīng)性厭食癥也可以使神經(jīng)性貪食癥的表現(xiàn)之一，但是譚氏癥的患者很少表現(xiàn)為消瘦，沒有自我形象的紊亂。
二、對神經(jīng)性厭食癥患者的護理評估
（心理、行為、生理三個方面的異常表現(xiàn)）
心理方面：
1、自我形象評價紊亂Body-image disturbance
產(chǎn)生錯覺---幻想癥delusional
強迫性思維obsessive
e.g., does not see self as thin and is bewildered by others’concern，
2、過分關(guān)注食物preoccupied with food
回避食物avoids food
藏覓食物hoards.儲藏food
3、擔(dān)心懷孕Pregnancy fears
錯誤地認為進食會導(dǎo)致懷孕misconceptions of oral impregnation through food
4、身體感覺遲鈍Feels ineffectual
性欲降低low sex drive
批判與性有關(guān)的事情Repudiation.批判of sexuality.
5、有自我懲罰的心理和行為Self-punitive behavior
饑餓、壓抑自己starvation; suppression of anger.
行為方面：
1、過分關(guān)注體重 over concern about weight
計算進食的熱量 counting Cal of food
每天稱多次體重 weighing oneself several times daily
在意他人的評價 concern about other’s words
在意 外表 personal appearance
frequent mirror gazing; fear unattractiveness, fear obesity
2、進食習(xí)慣改變 Loss of appetite
Eat less than one supposed to have
Absent in mealtime
Eat very slowly
Give food to others
Hoard food
Refuse to eat
3、通過各種方式減肥
患者可嘗試多種減輕體重的方式：
誘發(fā)嘔吐induced vomiting
服用瀉藥 laxatives
灌腸 enemas
利尿劑 diuretic
減肥藥 diet pills
過度鍛煉 excessive exercise/ hyperactivity (excessive gumchewing)
暴飲暴食狂瀉 binge- purge
絕食 refuse to eat
生理變化
1、體重降低 短時間內(nèi)比以前正常體重下降20%
2、皮膚干燥dry skin，過度角化hyperkeratosis，干癟 poor turgor浮腫
3、毛發(fā)脫落，易折 brittle hair, fall out
4、便秘 constipation
5、月經(jīng)不調(diào)或閉經(jīng)，第二性征萎縮
Menstrual irregularity; Amenorrhea; second sex organ atrophy
6、低血壓、心率，體溫 hypotention, bradycardia, hypothermia
7、血液學(xué)檢查 Blood examinations
白細胞減少Leukopenia
貧血 anemia
低血糖 hypoglycemia
低蛋白hypoproteinemia
低血鉀 hypokalemia
低血鈉 hyponatremia
低血鎂 magnesium
8、ECG：
低電 low voltage
T倒置 T wave inversion
ST壓低 ST depression
三、護理診斷
1、營養(yǎng)改變Altered nutrition, ,and
低于機體需求less than body requirements
體液不足fluid volume deficit
與誘發(fā)嘔吐、過量使用瀉藥、利尿劑、絕食有關(guān)。related to attempts to vomit food aftereating, overuse of laxatives/diuretics and refusal to eat.
2、有生理規(guī)律改變的危險/有體液不足的危險Risk foraltered physical regulation processes/risk for or actual fluidvolume deficit:
饑餓導(dǎo)致閉經(jīng)amenorrhea related to starvation;
與低血壓、心率慢、代謝性鹼中毒有關(guān)hypotension, bradycardia; metabolicalkalosis.
3、有自我傷害的危險Risk forself-inflicted injury
與拒絕進食和對食物的看法有關(guān)related to starvation from refusal to eat orambivalence about food
4、飲食（形態(tài)）改變Altered eating
與有暴飲暴食狂瀉有關(guān)related to altered thought processes: binge-purgesyndrome.
5、自我形象紊亂/長期自卑Body-imagedisturbance/chronic low self-esteem
對成熟性別形象的焦慮related to anxiety over assuming an adult role andconcern with sexual identity
依賴感未得到滿足unmet dependency needs
個性脆弱personal vulnerability
對生活的某些方面缺少信心perceived loss of control in some aspect or life;
家庭不完善dysfunctional family system
6、強迫行為Compulsivebehaviors
有想要控制自己的需要related to need to maintain control of self, representedby losing weight.
四、護理計劃及實施
A、幫助患者建立條件反射
即建立饑餓和進食之間的反射
采用條件反射的飲食療法
Help reestablish connections between body sensation(hunger) andresponses(eating). Use stimulus-response conditioning methods toset up eating regimen.
1、Weigh regularly, at same time and with same amount of clothing,with back to scale.定期測體重（在同一時間穿著同樣的衣服，面對著稱）
2、Make sure water drinking is avoided before weighing稱重前不能飲水
3、Give one-to-one supervision during and 30 min after mealtimes toprevent
attempts to vomit food.進食過程中，和30分鐘內(nèi)進行一對一監(jiān)督防止嘔吐
4、Monitor exercise program and set limits in physicalactivity.監(jiān)測患者的鍛煉計劃，限制運動量
B、監(jiān)測癥狀、體征Monitor physiologicalsigns and symptoms
(amenorrhea, constipation, hypoproteinemia, hypoglycemia, anemia,eroded tooth enamel, inflamed buccal cavity, brittle hails, dullhair, secondary sexual organ atrophy, hypothermia, hypotension, legcramps and other signs ofhypokalemia)月經(jīng)、便秘、低血壓、貧血、齲齒、口腔潰瘍，頭發(fā)有，低體溫、低血壓、痙孿等低血鉀的癥狀。
C、健康教育Health teaching:
l解釋正常的性別發(fā)育Explain normal sexualgrowth and development to improve knowledge deficit and confrontsexual fears.
l應(yīng)用行為療法建立起饑餓與時間及進食的規(guī)律Usebehavior modification to reestablish awareness of hunger sensationand to relate it to the clock and regular meal times.
l教育家長與患者的問題方法，滿足其依賴或獨立的心理需求，讓病人關(guān)注節(jié)食、減肥以外的方面自我調(diào)節(jié)（日常生活、工作、休閑等）Teachparents skills in communication related to dependence/independenceneeds of adolescent; allow patient to assume control in areas otherthan dieting, weight loss (e.g., management of daily activities,work, leisure choices).
臨床護理中，面對患者時須注意的幾點：
The nurse plays an important role in the care of individuals witheating disorders. The nurse needs to adjust 調(diào)節(jié)readily to moodswings 情緒波動and changes of behavior.
lBeing friendly and casual ifthe patient is withdrawn性格內(nèi)向 or sullen悶悶不樂(not happy, little bitanger，);
lRemaining uninvolved when thepatient is indecisive or ambivalent;
lAvoiding confrontation whenthe patient exhibits hostility反對，反抗 or anger;
lStating that eating 3nutritional meals a day is necessary to maintain a healthybody;
lAvoiding long discussions orexplanations about food or the body; 注意力
lAllowing the patient tomaintain some control, eg in decision making.
五、護理效果評價標準
A、達到維持與身高、年齡相應(yīng)的最低體重
Attains and maintains minimal normal weight for age andheight.
B、飲食規(guī)律（符合營養(yǎng)標準的）
Eats regular meal (standard nutritional diet).
C、無自己誘導(dǎo)嘔吐、貪食及強迫行為發(fā)生
No incidence of self-induced vomiting, bulimia, or compulsivephysical activity.
D、自我內(nèi)心情緒意識增強，能夠承饑餓（自訴自己餓，餓得心慌、痛）等
Acts on increased internal emotional awareness and recognition ofbody sensation of hunger (i.e., talks about being hungry andfeeling hunger pangs).
E、敘述不斷增強的“不去控制食物攝入的”感覺
Relates increased sense of effectiveness with less need to controlfood intake.
