Eating disorder - treatment in inpatient
- Acute and severe weight loss, ie. BMI 13-14 (loss of> 35% of ideal body weight or> 15 - 25% rapidly and without control).
- Changes in vital signs, Hypo tension <90/60, bradycardia with heart rate <45/min, pulse> 100/min ( threatening circulatory collapse) - arrhythmia, body temperature <35.5.
Electrolyte particularly hypoglycemia Psychiatric:
• Suicide attempt / suicidal thoughts. • self-destructive behavior. • Long disease duration. • Lack of treatment motivation and illness insight. • Crisis in the family or weary family. • Lack of networking.
Planning before admission:
- Inform the patient and relatives about the department's procedures.
- Establish any time a written plan / contract for the purpose and objectives of hospitalization. This increases patient involvement, motivation and compliance. Cooperation between the department and responsible care plan on the design is important.
- If possible, avoid emergency admissions when the structure and clarity must be included from the start.
Overall treatment goals for hospitalization:
- To support the patient to eat regularly, normal diet and normal amount.
- To support patients to manage virtuosity anxiety and risk of compensatory behavior.
- Starting a weight gain treatment. The recommended weight gain in inpatient ½ - 1 kg / week. Weight Curve followed. Weight Stability / normalization on weight.
- Creating trust and alliance of care by following the care plan / PM, in order to minimize the risk of misunderstanding.
- When a patient is admitted to a target weight in consultation with the patient set by doctors, dietitians and therapists in an outpatient setting. Target weight based on BMI. Once the target weight is reached and the psychiatric condition is stable, can the patient be transferred to day care and outpatient care.
- It is mainly the contact persons in the department who is responsible for patient care, but it does not contact people involved at every meal.
- Changes in patient mat schema made always via dietitian with contact persons in outpatient and inpatient care.
- The patient should have single rooms, given that the toilet door sometimes to be locked by the current care plan.
- Inform patrol spirit doctor to food and routines should not be altered, show please PM and agreed to emphasize importance.
Food and eating habits:
- Eat regularly, ie. breakfast, lunch, dinner, three snacks - after the department's time. Completing number of nutritional beverages determined by BMI and finished meal size.
- The main goals should be for the plate model.
- Food design is determined by a nurse / attendant, with excellence eating disorder, along with a dietitian who design meal order for each individual's needs.
- The department's food concern - not your own food . The food should never be negotiable.
- Staff prepares all meals from the kitchen's guidelines on the size of the standard portion. Any deviations in the context of nursing care plan.
- The patient eat all meals together with other patients in the dining room. Deviations from this occurs in the context of nursing care plan.
- A staff eat therapeutic food with the patient at each main objective, ie breakfast, lunch and dinner. The staff eats when a normal portion that the patient does and should eat the same food that the patient eats. All meals are taken on the plate and not in the cup, side plate or the like.
- Staff who eat therapeutically with the patient's task is to support the patient through the meals - without talking about the meal as such. Any reflection after the meal on the patient's thoughts / feelings.
- Main meals are allowed to take 30 minutes, and 15 minutes for snacks. If the patient is unwilling or unable to eat the meal supplemented with nutritional drink, which is set at the direction of a dietitian / doctor. nutritional beverage is allowed to take 15 minutes to drink up.
- Staff sits with when pat eat snacks, but not afterwards.
- If tube feeding occurs, see specific directives from the dietitian / doctor.
- Rest is done together with staff. Staff need not be silent, but the time can be used to perform reflective conversation with the patient that the patient after the meal will have the opportunity to describe their feelings / thoughts after this. Encourage the patient to use Magniloquent.
- Rest is done 30 minutes after the end of each main meal.
- During rest, the patient should be still, no physical activity may occur. Rest can be done both lying in bed or sitting in a sofa / chair in the day room. Encourage the patient to make use of diversionary strategies without physical character, ex. crossword puzzles, reading, playing games, or watching television.
- Toilet door should always be locked 30 minutes after meals. If it helps the patient to the toilet door to be locked up for longer periods. Designed individually after care plan. If you need the toilet opens the door staff. If the toilet must be done during idle time should the door be open toilet. When the toilet outside the rest do not have the staff to be present.
Weighing and weight control:
- Weighing occurs at admission and thereafter by agreement of the care plan.
- Weighing is done after the patient visited the toilet and before breakfast.
- Weighing occurs in lingerie.
- Weight management only as prescribed, and not to the patient's wishes.
- Importance advised not commented upon by staff neutral attitude that is present only in the scale shows. The weight is monitored by the therapist in the Outpatient, possibly with the dietitian and the rounds with physicians.
- The patient should be aware of their current weight unless otherwise agreed in the care plan.
- Physical activity is generally limited. This is done in consultation with the patient and nurse / attendant with excellence eating disorder therapist in outpatient and physician care plan.
- BMI as well as somatic and psychiatric status determines the degree and duration of activity.
- Patient activity program should be low at times that are particularly distressing, as the first hour after eating. Then, one should not add walks, visits to other health care providers, etc.
- Patients should not walk in the hallway or practice room when the aim is to burn calories.
- Clearance individualized according to care plan.
Evaluation is done 1 day / week. Patient contact, dietitian and physician should then be present. This is done to see how the treatment is running and whether there needs to be some changes in the planned care.