Advanced nursing practice

Advanced nursing practice

Advanced   nursing practice has greatly brought changes and improved service delivery to the patients (Wade, Davidson, & O’Dea, 2003). This practice is the level where comprehensive skills, experience and knowledge are used in the daily nursing care. These practices are applied depending on the problem addressed where accurate decisions are made. It involves providing preventive care to the patients. Generally, the advanced practice nurses perform the functions of:  obtaining health histories and performing comprehensive physical examinations including psychosocial, functional and developmental assessment, ordering and interpreting laboratory results and other diagnostic studies, developing differential diagnoses,   developing therapeutic plan of care,  maintaining patient records, evaluating patient’s response to plan of care and modifying as needed ,  providing patients/family counseling and education ,  arranging for patient referrals/consultations and  finally participating in research studies (Becker, Smith, & Ciao, 2005). The nurses have a big role in preventing and controlling the eating disorders which is one of the problems affecting the people. They are supposed to be aware of the ways of prevention and should have the skill to counsel patients who have that problem. These nurses are entrusted in their profession and through the advanced nursing practice their work will be of more quality.                                                                           Eating disorders has been a major problem facing the human race. Most people do not know the diet which is good for their health. This has contributed to negative results in the environment within which these people live in. With advanced nursing practices the problems which affect human beings have been addressed to reduce the effects which result from feeding disorders (Wade,  Davidson, & O’Dea, 2003) .                                                              The affected people are mostly the elderly and the children and especially those at the adolescent stage. It can cause effects such as a dramatic weight changes. The normal daily life is interfered with generally (Becker, Smith, & Ciao, 2005. The people who are commonly affected among the adolescents are girls but boys are also affected. People who have got anorexia normally have the fear of gaining a lot of weight which may end up altering their shape and size. Some of them restrict themselves food through dieting, excess exercise and fasting. These people normally try to eat as little as possible and take in very few calories. Bulimia on the other side is associated with habitual binge eating and purging (Becker, Smith, & Ciao, 2005. When someone has bulimia, he/she may undergo weight fractuations but they rarely experience low weight as it is the case with anorexia. The people suffering from anorexia are normally very thin and are underweight whereas those who are suffering from bulimia may have overweight or even normal weight.  

The causes of eating disorders

 Eating disorders are caused by a number of factors they include:                                        Psychological and Emotional Health: People with eating disorders normally have psychological and emotional complications. This interferes with their daily activities making them have low self-esteem, perfectionism and troubled relationships.  The relationships among the family members may cause stress among the family members. This stress may lead to eating disorders. The stress from the families may be controlled through offering counselling to the members (Celio et al 2000). Society: The modern society usually cultivates the atmosphere of thinness. This is as a result of peer influence and what the people sees in the media that make them have the desire to be thin (Zabinski et al 2001).                                         Biology: The genetic composition of an individual vulnerable to eating disorders is not stable. Individuals with first degree relatives with eating disorders are likely to develop eating disorders through genetic inheritance. Serotonin which is a chemical occurring in the brain is said to cause this problem (Celio et al 2000). Mental health disorders: People who have eating disorders develop mental health complications like depression and anxiety. Obsessive compulsive disorder is an anxiety disorder which can occur up to two thirds of the victims of anorexia and one third of the people with bulimia. Other disorders which are associated with anxiety are; phobia, an anxiety disorder which makes the victims fear been humiliated in public. Panic disorder is the periodic attacks of terror affecting the patients with eating disorders. Post-traumatic stress disorders may also negatively affect these patients.             Overweight:  More teenagers especially the girls are reported to be overweight .This is as a result of poor feeding behaviours. They are reported to use pills, vomit and laxatives to help reduce weight. Body disorders: There are various body disorders which results to musculature or mass muscles. This mostly affects the men who consider themselves as been underdeveloped. Such individuals are characterised by eating disorders and the use of steroids in order to become muscular. Body dysymophic disorder is another type of disorder which causes eating disorder. People with this disorder suffer from excessive emotional problems. Patients with this disorder are prone to suicidal thoughts and habits. Early puberty: This disorder mainly arises to teenage girls. It occurs as a result of emotional variance among the girls. Excessive Physical activities: Most athletes are perfectionists which is a characteristic of eating disorder .Anorexia is caused by excessive physical  activities .In female athletes, a lot  of exercise and low body weight normally postpone puberty, making them have boyish shape.

The consequences of eating disorders

 The medical problems which are associated with eating disorders include: Tooth erosion, cavities, and gum problems, Water retention, swelling, and abdominal bloating, low potassium levels, irregular menstrual periods, swallowing problems and esophagus damage and Drug and alcohol abuse. Conditions like Hormonal changes including reproductive problems, thyroid, stress, and growth hormones, Heart problems such as abnormal heart rhythm, Electrolyte imbalance, Fertility problems, Bone density loss, Anemia and neurological problems are also associated with the eating disorders (Celio et al 2000).                   The health consequence of anorexia includes the results associated with starvation because the body is denied the essential nutrients and therefore cannot function as required. The body slows down all its processes in order to conserve energy which leads to slow heart rate and low blood pressure leading to the changing of the heart muscle (Sundgot-Borgen, & Torstveit, 2004). Therefore the risk of heart failure increases since the heart rate and the blood pressure becomes lower and lower. The density of the bones is reduced. That results to dry brittle bones. The disorder also causes muscle loss and weakness. It can also lead to dehydration which may result to kidney failure, fainting, fatigue, and general body weakness. There may also be downy layer of hair in the whole body including the face which is normally aimed at keeping the body warm since the body lacks the nutrients to keep it warm. Hair loss, dry hair and dry skin are also common (Sundgot-Borgen, & Torstveit, 2004).              The health consequences of bulimia nervosa include, effects on the digestive system and it can also lead to electrolyte and chemicals imbalances in the body where the chemical imbalances can lead to effects in the heart and other major organs of the body. Bulimia nervosa can lead to irregular heartbeats and heart failure or even worse, death due to the electrolyte imbalances. This electrolyte imbalance is caused by dehydration and loss of potassium in the body, lack of sodium and chloride which leads to serious consequences in the body such as purging behaviors. This problem can also lead to: potential for gastric rupture during periods of bingeing, Inflammation and possible rupture of the esophagus from frequent vomiting, tooth decay and staining from stomach acids released during frequent vomiting. Problems such as chronic irregular bowel movements and constipation as a result of laxative abuse, Peptic ulcers and pancreatitis can also be experienced as a result of bulimia nervosa. The binge eating disorder leads to the same results as a person who is suffering from clinical obesity.  The consequences include: High blood pressure, high cholesterol levels, and heart disease as a result of elevated triglyceride levels, type II diabetes mellitus and gallbladder disease may result (Winzelberg et al, 2000).                                                                      The nurses have a role in eliminating these problems. They can do so by taking caution of advising the people who have got such complications. It is difficult to identify the people suffering from these disorders since there are no many outward signs of the eating disorders. It is however easy to identify those who have increased body size and change in body shape and those who change in expressions of emotions including those who develop anxiety.  An early and adequate intervention leads to the best clinical results (Winzelberg et al, 2000). The nurses should do the counseling to the victims and advise them on the diet which is suitable for them. The diet may involve the trial to restore the normal weight for the victims and stopping of the binge eating. It is also important for the nurses to treat the physical complications especially those which are associated with the psychiatric disorders.  They should provide counseling to the families and look for means to prevent relapse. They should try to prevent or control depression among the individuals since this depression can cause the eating disorders.  They should advocate for the antiepileptic drug topiramate, which helps in reducing bingeing and purging episodes on the victims of bulimia. For the individuals who are overweight, the nurses to  restore the normal weight and   a through nutritional intervention.                                                                                                         Advanced nursing practices have really improved the services which are offered to the patients. With the improved skills, experience and knowledge, the patients receive the expected services and there has been noted improvement in the nursing sector. The nurses can now understand  each and every patient’s needs. They can therefore satisfy the needs of the patients.  Nurses who lack the art of critical thinking are not in a position to handle the patients fully as required and satisfy all the basic needs of the patients. Through the nursing advancement most of them have acquired the art of critical thinking and are more effective in their work.


Wade, T. D., Davidson, S., & O’Dea, J. A. (2003). A preliminary controlled evaluation of a school‐based media literacy program and self‐esteem program for reducing eating disorder risk factors. International Journal of Eating Disorders, 33(4), 371-383.

Becker, C. B., Smith, L. M., & Ciao, A. C. (2005). Reducing eating disorder risk factors in sorority members: A randomized trial. Behavior Therapy, 36(3), 245-253.

Winzelberg, A. J., Eppstein, D., Eldredge, K. L., Wilfley, D., Dasmahapatra, R., Dev, P., & Taylor, C. B. (2000). Effectiveness of an Internet-based program for reducing risk factors for eating disorders. Journal of consulting and clinical psychology, 68(2), 346.

Celio, A. A., Winzelberg, A. J., Wilfley, D. E., Eppstein-Herald, D., Springer, E. A., Dev, P., & Taylor, C. B. (2000). Reducing risk factors for eating disorders: comparison of an Internet-and a classroom-delivered psychoeducational program. Journal of consulting and clinical psychology, 68(4), 650.

Zabinski, M. F., Pung, M. A., Wilfley, D. E., Eppstein, D. L., Winzelberg, A. J., Celio, A., & Taylor, C. B. (2001). Reducing risk factors for eating disorders: Targeting at‐risk women with a computerized psychoeducational program. International Journal of Eating Disorders, 29(4), 401-408.

Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25-32.