Critical Care for Anorexia Nervosa : The MARSIPAN Guidelines in Practice.

Intro -- Contents -- 1: Introduction: Problems Occurring in the Assessment and Treatment of Patients with Severe Anorexia Nervosa -- 1.1 The Problem -- 1.2 The Origins of MARSIPAN -- 1.3 Structure of This Book -- 1.4 Education, Education, Education -- References -- 2: Management of the Really Sick Child or Adolescent with Anorexia Nervosa in Hospital: The Role of Child and Adolescent Menta... -- 2.1 What Are the Tasks? -- 2.2 Working Together -- 2.3 Providing a Safe Nursing Environment and Containing Team Anxiety -- 2.4 Managing on the Ward -- 2.4.1 Feeding the Patient -- Oral Nutrition -- Nasogastric Feeding -- Binge Eating -- 2.4.2 Managing Challenging Behaviours -- Exercise and Activity -- Weight and Height Manipulation -- Vomiting and Purging -- Other -- 2.4.3 Developing Trust and Providing Space -- 2.4.4 Supporting Families -- 2.4.5 Medication -- 2.4.6 Capacity, Consent and the Mental Health Act -- 2.4.7 Parental Responsibility, Parental Consent and the Zone of Parental Control -- 2.5 Patients Under 16 -- 2.6 Patients Aged 16 and 17 -- 2.7 Use of Mental Health Legislation -- 2.8 Emergencies -- 2.9 Court Authorisation and the Children Act -- 2.9.1 Safeguarding -- 2.9.2 Planning Longer-Term Care -- 2.10 Beyond the Ward -- Conclusion -- References -- 3: The Role of the Paediatric Team in the Management of Young People with Severe AN -- 3.1 Introduction -- 3.2 The Importance of Eating Disorders in Children and Adolescents for Paediatric Teams -- 3.3 The Importance of Paediatric Teams to Children and Young People with Eating Disorders -- 3.4 Assessing Medical Risk at Presentation in Children and Young People -- 3.4.1 Risk from Degree of Underweight in Childhood and Adolescence -- 3.4.2 Risk Associated with Cardiovascular Parameters -- Bradycardia -- Hypotension -- Prolonged QT Time (See Also Refeeding Below) -- Other Cardiac Complications.

3.4.3 Dehydration -- 3.4.4 Hypothermia -- 3.4.5 Blood Parameters -- 3.5 Refeeding the Critically Low-Weight Adolescent with AN -- 3.5.1 Potential Risk Factors for Refeeding Hypophosphataemia -- 3.5.2 Considering Resting Energy Expenditure in Designing a Refeeding Plan -- 3.5.3 Recommended Refeeding Guidelines -- 3.5.4 Treatment of Refeeding Syndrome -- 3.6 Where and When to Admit? -- 3.7 Recommendations for Improving Services from Paediatric Teams -- References -- 4: How Can the Adult Psychiatric Team and Adult Medical Team Work Optimally to Help the MARSIPAN Patient? -- 4.1 Introduction -- 4.2 Initial Management in the Primary Care Setting -- 4.2.1 Presentation -- 4.2.2 Diagnosis -- 4.2.3 History -- 4.2.4 Examination -- Physical Health -- Mental Health -- 4.2.5 Community or Hospital Care? -- 4.2.6 Interface Between Primary and Secondary Care -- 4.2.7 Use of Mental Health Legislation -- 4.3 Medical Admission -- 4.3.1 Integration of Medical and Psychiatric Admissions -- 4.3.2 Initial Management in a Medical Assessment Unit -- 4.3.3 Admission to a Medical Ward: How Can the Adult Psychiatric Team Be Helpful to the Medical Staff? -- Getting Skilled Up -- Joint Working with the Medical Team -- The Role of the Senior Psychiatrist on the Medical Ward -- How to Ensure Consistency and Continuity of Care -- Developing a Care Plan -- Compulsory Treatment -- ``Special´´ Nursing -- Refeeding Syndrome and Underfeeding Syndrome -- Resolving the Starting Calorie Issue and Avoiding Underfeeding Syndrome -- Role of Medication in Management of MARSIPAN Patients -- 4.4 Improving Assessment and Treatment of Eating Disorders by Front Line Clinicians -- Conclusion -- References -- 5: How Can the Adult Medical Team Work Optimally with the Adult Psychiatric Team to Help the MARSIPAN Patient? -- 5.1 Introduction and Strategy -- 5.2 Assessment -- 5.3 Biochemical Aspects.

5.4 Electrophysiological Assessment and Cardiac Reserve -- 5.5 The Refeeding Syndrome -- 5.6 Prevention of RFS in Conjunction with Nutrition Planning -- 5.7 Nutritional Support -- 5.8 Energy Needs and Target Prescriptions -- 5.9 Nitrogen/Protein Needs and Prescriptions -- 5.10 Micronutrients -- 5.11 Speed to Targets and Avoiding Refeeding Syndrome -- 5.11.1 Phased Introduction of the Nutritional Plan: Days 1 to 3 -- 5.11.2 Phased Introduction of the Nutritional Plan: Days 4 to 6 -- 5.11.3 Phased Introduction of the Nutritional Plan: Days 7 to 10 -- 5.12 Treatment of Refeeding Syndrome -- 5.13 Tube Feeding -- 5.14 Monitoring -- 5.14.1 Escalating Nutrition -- 5.14.2 Weaning from Artificial Nutrition -- 5.15 Special Nursing and Compulsory Treatment -- 5.16 Safety Assessment for Return to the Psychological Facility -- 5.17 Summary -- References -- 6: Legal and Ethical Issues in the Treatment of Really Sick Patients with Anorexia Nervosa -- 6.1 Introduction -- 6.2 The Ethics of Anorexia Nervosa in Adolescence -- 6.3 The Law and Consent in Adolescent Anorexia Nervosa -- 6.4 The Ethics of Consent and Capacity in Anorexia Nervosa -- 6.5 Ethics of Refusal of Treatment in Anorexia Nervosa -- 6.6 Legal Routes for Compulsion -- 6.7 The Ethics of Compulsion -- 6.8 Leverage and Its Use -- 6.9 Styles of Decision-Making -- 6.10 The Law and Transition to Adulthood -- 6.11 The Ethics of Transition to Adulthood -- 6.12 The Law and Ethics of Healthcare Provision Across Disciplines (and Ages) -- 6.13 Identity and Subculture -- 6.14 The Children of Patients with Severe Eating Disorders -- 6.15 Relationships and Decision-Making -- 6.16 The Question of Futility -- 6.17 Advance Directives -- 6.18 Ulysses Agreements -- 6.19 Giving Up on Treatment -- 6.20 Conclusions -- Appendix -- Summary Sheet 1: Assessing Capacity (Adapted from Tan 2012).

Format for the Assessment of Capacity in Eating Disorders -- Final Decisions Regarding Capacity -- Summary Sheet 2: Key Considerations for Professionals Treating Seriously Ill Patients with AN -- Illness Factors -- Professional Factors -- Treatment Factors -- Tips for Optimising Care -- References -- 7: Putting It All Together. What We Have Learnt, What We Need to Learn -- 7.1 Introduction -- 7.2 Implications for Service Provision -- 7.3 Implications for Training -- 7.3.1 Undergraduate -- 7.3.2 Postgraduate -- 7.3.3 Research -- Conclusion -- References -- Index.

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Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2024. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.