Zvokudya Zvirongwa zveAnorexia Nervosa Recovery
Kushaya zvokudya zvinovaka muviri zvinosangana neoreorexia nervosa zvinogona kuipa zvinokanganisa masangano ose emuviri. Nokudaro, kudzorerwa kwehutano uye hutano hwehutano ndiko chinhu chinokosha chekurapa anorexia nervosa. Kudzorera muviri kusakondwa ne anorexia nervosa kunogona kutora mwedzi yakawanda kana kunyange makore. Varwere vane anorexia nervosa vanofanira kuve vari pasi pekutarisirwa kwekambani yekurapa, iyo inowanzobatanidza chiremba, chiremba wezvokudya zvinoratidzirwa , chiremba wepfungwa, uye chiremba chepfungwa.
Chero ani anotanga kugadziriswa kwehutano anofanira kunge achiziva nezvekuda kuuraya refeeding syndrome . Ichi chinyorwa chinotanga nezvinodiwa zvingwarira kuti urege kuita izvi zvinogona kumira. Izvo zvino inopa mikana yekugadzirisa kunze kwekudya kwekudya, kuronga zvirongwa zvekudya, humwe hutano hwekuwana uwandu, uye mazano ekukunda kukunda matambudziko anowanikwa pakuwana.
Kudzivisa Kuderedza Simba
Chimwe chinogona kuisa njodzi yekufungidzirwa usati watanga kuyananisira kudya kunoderedza chirwere. Kuderedza chirwere chinokonzerwa nekudzorerwa nokukurumidza kweumwe munhu munharaunda yekushaya nzara, kazhinji kusingaperi, uye kunogona kuuraya. Iyo inoratidzirwa ne electrolyte uye kushanduka kwemvura kunobatanidza kusagadzikana kwemagetsi ekusava nechirwere nevarwere vanotarisana nekugadzirisa kudya kwekudya.
Ko pakupedzisira kudya shure kwenguva yekushaya nzara kungave kwakakuvadza mumuviri here? Biochemistry inotitaurira kuti ketone miviri nemafuta emafuta ehurukuro kubva pakuparara (catabolism) yemisumbu uye adipose tissue inoshandiswa glucose sechinhu chikuru chine simba mune nzara.
Munguva yekudzokorora, kune kuchinja kubva kumafuta kusvika kuma-carbohydrate metabolism. Izvozvo zvinokonzera insulini yakabudiswa kubva pane pancreas inowedzera masero emuviri weglucose, phosphate, potassium, magnesium, sodium, nemvura. Muviri unoshandurawo mune chimwe chivako (anabolic) nzvimbo yeprotein synthesis, iyo inoda kuti kuwedzerwa kunovaka muviri mumasero.
Mumuviri iye zvino ari pangozi yekusava nehuwandu hwezvinhu izvi zvinokosha mumutambo weropa. Zvirwere zvemakiriniki zvinogona kusanganisira kusagadzikana kwepfungwa yemwoyo, congestive moyo kusakundikana, kupera kwekuputika, coma, kugumburwa, skeletal-muscle kushaya simba, kurasikirwa kwekufamba kwemuviri, uye kukanganisa kwehupi.
Kuti udzivise refeeding syndrome, mazinga e phosphorus, magnesium, potasium, calcium, uye thiamin inofanira kuongororwa kwemazuva mashanu okutanga uye rimwe zuva rimwe kwevhiki dzinoverengeka. Electrocardiogram (EKG) inofanirawo kuitwa. Kurongeka kwekurapa kunodiwa.
Sangano reNational Institute for Health uye Clinical Excellence Zvirwere zvevarwere vanokurudzira kuti kune ngozi yakawanda yekuita kuti refeeding syndrome iite kana kutanga kwako kunosvika 1 000 kana zvishoma pamashizha pazuva. Kuderedza dambudziko rehutano kunowedzera zvikuru nezvinotevera:
- Varwere vane imwe yezvinotevera zviratidzo:
- Mutumbi mashoma index pasi pe16
- Kurasikirwa kwehuwandu hwehuwandu hunopfuura 15 muzana mumwedzi 3-8 yapfuura
- Zvishoma kana kusina zvokudya zvinovaka muviri kwemazuva anopfuura gumi
- Kuderera kwe potassium, phosphate, uye / kana magnesium isati yapera
- Varwere vane zviratidzo zviviri kana kupfuura zvinotevera:
- Mutumbi mashoma index inopfuura 18.5
- Kurasikirwa kwehuwandu hwehuwandu hunopfuura 10 muzana mumwedzi 3-6 yapfuura
- Zvishoma kana kusina zvokudya zvinovaka muviri kwemazuva anopfuura mashanu
- Nhoroondo yekudhakwa zvisina kunaka kana zvinodhaka, kusanganisira insulin, chemotherapy, antacids kana diuretics
Dzimwe nhungamiro pamusoro pekudzivirira refeeding syndrome inowanika kuburikidza neChikemy for Eating Disorders 'Mutungamiri weAradio Management. Pasi pemamiriro ezvinhu aya, kudzorerwa kwezvokudya kunofanira kuenderera zvishoma nezvishoma kuti urege kudzivirirwa kuti uwane refeeding syndrome. Rimwe boka rezvechiremba rinodikanwa kusanganisira chiremba uye Chiremba Dietitian Nutritionist (RDN) kuverenga, kuongorora, uye kuwedzerwa kudya kwezuva nezuva uye kudya kwemvura uyewo kuongorora plasma uye urinary electrolytes, plasma glucose, basa rinokosha, uye rwiyo rwemwoyo pamberi uye panguva refeeding.
Nemhaka yehutano hwekudzorera hutachiona uye zvimwe zvisingaverengeki zvezvehutano zvine chokuita nenzara, varwere vakawanda vane anorexia nervosa vanotanga kugadziriswa kwezvokudya muzvipatara zvezvokurapa kana nzvimbo dzokurapa.
Zvasara zvechikamu ichi zvinotungamirirwa kune avo vasiri pangozi yekudzorera hutachiwana uye vakashandurwa mishonga kuti vatange kana kuti varambe vachigadzirisa chikafu chekugadzirisa kudya kwepanyama.
Outpatient Nutritional Rehabilitation
Kutsvakurudzwa kwemazuva ano kwakaratidza kuti kune varwere vasiri pangozi yekuberekwa kwehutano, hutsinye uye hurumende yekudzorera zvirongwa zvinotungamirira kukurumidza kugadzirisa uye zviri nani zvizere zvikamu. Hazvisi zvisingazivikanwi kuti zuva nezuva zvidikanwi zvevanhu vanorarama kubva kune anorexia kusvika 3 000 kusvika ku5 000 makoriori ezuva rimwe nerimwe kwehafu yehafu pound kusvika pamapiro maviri pavhiki kubudirira kusvika pakuwana chinangwa chiyero. Izvi zvinonyanya kukosha kune vechidiki vanenge vachiri kukura uye vaduku vakuru.
Vachiri kuyaruka vanobatanidzwa mumhuri -Based Treatment nevabereki vari kutarisira rubatsiro rwekugadzirisa zvekudya zvinowanzokwanisa kuchengetedzwa zvakachengetwa pavanodya 2 000 kusvika 2,500 makoriori pazuva. Nevamwe vari kunze kweboka rinotsigira uye kuongorora, vabereki vanowanzosimudzirwa kuwedzera zvirongwa zvekudya kune 3000 kusvika ku5 000 makoriori pazuva rekudzorera kuyerwa.
Vabereki nevarwere vanowanzovhiringidzika pane zvakadai zvakanyanya se caloric sezvinosimudzira kufambira mberi. Sei vachikwirira kudai? Vanhu vane anorexia nervosa vanowanzova hypermetabolic, izvo zvinoreva kuti metabolism yavo yakakwira muzvikwata zvepamusoro sezvo muviri unoyera kuvakazve mhuka dzese dzakarasika munguva yenzara. Vanhu vanowanzova nekushisa kwemuviri kwakakosha sezvo kupiwa simba kunogona kushandurwa kuva kupisa, pane kungoshandiswa chete kugadzira mishonga. Ichi chinokonzera chiratidzo chinogonesa zvakanyanya.
Uyezve, varwere vakawanda vane anorexia nervosa vanoita mune zvekudzidzira zvakanyanya kunyange pasinei nekuoma kwakanyanya. Kurovedza kwakadaro kungave kwakavanzwa uye kunogona kuderedza kuderedza kuedza kuwedzera kuwedzera kuburikidza nekuwedzera makoriro anoshandiswa. Kutevedza muviri kazhinji hakusi mishonga inorayirwa mumatangiro ekutanga ekugadzirisa kudya, asi varwere vangada kuongororwa kuti vadzivirire.
Zvakakosha kuziva kuti nokuti kuwedzerwa kwema caloric kunokonzera kunyanya kunetseka kune avo vane anorexia nervosa, kuzadzika kwezvinangwa izvi zvinogona kunge zvakaoma kunyange nekuwedzera rubatsiro. Zvisinei, zvakakosha kubvumira kudya kwakakwana kwemuviri kuti muviri uwane zvakare. Zvinorema zvinangwa zvinofanira kugara zvichiverengerwa neboka rako rezvehutano. Kudzoka kwemasimba muvakadzi kunokosha . Zvakare, boka rezvechipatara rinokurudzirwa kuverenga yako chaiyo yekodori zvido zvayo sezvavanoshandiswa panguva yekudzorera.
Zvokupa Zvokudya Zvokurayira
Kana uri kupedza zvinopfuura 1 000 koriori pazuva sekutangira kwako, haisi mungozi yekudzorerazve chirwere sezvakakurukurwa pamusoro apa, uye wakagadziriswa kuti uite kudaro, zvino iwe unogona kufunga nezvekutanga kugadzirisa utano.
Ndokumbira kubvunzurudza chiremba uye chiremba wezvokudya zvakanyoreswa kuti uite zvinorayira zvakanakira muviri wako. Semuenzaniso, kuenzanisira kunyanzvi kwekugadziriswa kwehutano kwemuviri wepaundi-pound kwete pangozi yekuberekwa chirwere chinogona kunge chakaita.
- Zuva 1-4: 1 200-1600 makoriro / zuva
- Zuva 5-7: Kana pasina kuyerwa kwemazivi kunoonekwa, kuwedzera nema 400 makoriori pazuva kuti 1 600-2000 makori / zuva (Kana kuwedzera kuwedzera kuri kuitika iwe ungawedzera zvishoma nezvishoma.)
- Zuva 10-14: Kana uremu hwekupera husati hwasvika 1 kusvika 2 pounds pavhiki, kuwedzerwa kudya zuva nezuva nemazana mazana mana kusvika kuzana mazana mashanu kusvika pazuva kusvika 2,000-2,500
- Zuva 15-21: 2,500-3000 makoriro / zuva
- Zuva 20-28: 3,000-3500 makoriro / zuva
Yeuka caloric inoda kuwedzera kuwedzera sekurema kunowanikwa. Saka varwere vanopora kubva kune anorexia nervosa inowanzodikanwa kuwedzera kuwedzera kwekorori kuitira kuti varambe vachiwedzera kuwedzera. Nokuda kwechikonzero ichi, vhiki rega-weigh-ins iyo rekodhi inobudirira inofadza. Kana uye kana chiyero chekurema chichidzikira kana kuti chimira, kudya kwekorori kunofanira kuwedzerwa.
Chirongwa Chirongwa Recipe yeKubudirira
Sezvo chirongwa chekudya chekoriori-chinokanganisa chinogona kukonzera avo vanorwara kubva kune anorexia, haisi iyo yekutanga chisarudzo chezvokudya zvakanyorwa zvakanyoreswa kurumbidza. Zvisinei, zvingava zvinobatsira kuva nemafungiro emakorire ekuverengwa, kunyanya pakuverenga mavara ekudya uye menus. Chimwe chirevo chekutanga chekuita kwechigunwe chetatu mazana mashanu kusvika ku800-calorie kudya pamwe nematatu matatu-calorie (kana mushure mekutanga kwekorori inofanirwa kuverengwa uye kuongororwa uye kugadzirisa zvirwere zvinenge zvichitorwa kunze). Zvakare, koriori mazinga anogara achifambira mberi, zvichienderana nehuwandu hwehuwandu hunorema.
Chirongwa chekudya chakasarudzwa muenzaniso we anorexia nervosa kupora ndiyo inoshandiswa . Inowanzoshandiswa muchipatara, pokugara uye kunze kwekudya kudya chirwere chekurapa kurapwa. Pakagadzirirwa zvakagadzirirwa varwere vane chirwere cheshuga, urongwa hwacho hune huwandu hwekugadzirisa nokuti hunotora maonero macronutrient zviyero (mapuroteni, makhahydrates, mafuta) pasina kunyatsotarisisa pamakori. Kuverenga kunowanzova nechinangwa chokuwana 50-60% zvikamu zana kubva mumakrohydrates, 15-20% kubva pamapuroteni, uye 30-40% kubva kumafuta ezvokudya zvinokonzerwa nemagetsi. Chimwe nechimwe "kutengesa" (starch, michero, yemiriwo, mukaka, mafuta, mapuroteni / nyama) inofanana nechimwe chikafu uye chikamu chemugove. Izvi zvinobvumira kutsvaga pakusarudzwa kwakakwana kweboka rekudya munguva yekugadzirira kudya kwekudya.
Zvisinei, kuva nekudya kwakakwana kunogona kunge kusina kukosha sekuwedzera kwekudya kwema caloric panguva yekudzorera kuyerwa kwehutano. Munhu Akanyoreswa Dietitian Nutritionist anogona kubatsira kuverenga nekugadzirisa zvirongwa zvekudya zvekudya zvinotora izvi zvose.
Mifananidzo inokwana 3,000-koriori Exchange System Chirongwa chezuva rinogona kunge ine chechi 12, 4 michero, mukaka 4, miriwo 5, 9 nyama, uye 7 mafuta. Dambudziko rezuva rega roga rinogona kugovana kugoverana muzvokudya uye kunopisa sezvinotevera:
Zvokudya zvemanheru: 2 Nhamba, 1 Mafuta, 2 Nyama, 1 Misi, 2 Zvibereko
- 2 zvigunwe zvechigunwe (2 starch exchanges) ne 1 tsp. mafuta (1 kuchinja mafuta)
- 2 yakatsvaira mazai (2 nyama kugoverana) yakaitwa na 2oz mukaka wose pamwe ne 6oz yemukaka wose kune rumwe rutivi kunwa (total-1 mukashandisi wemukaka),
- 4 oz ye juice yearangi uye 1/2 kapu yemichero saladi (chiyero-2 michero yekugoverana)
Mabiko: 2 Starch, 2 Miti, 3 Nyama, 2 Fat, 1 Misi
- Sandwich yakakangwa yakagadzirwa: 2 zvimedu zvechingwa (2 stash exchanges), 2 tsp bata (2 mafuta ekutsinhanisa), 3 zvisikwa zvechizi (3 kugovana nyama)
- Utoro weTumato (1 cup mukate wekutapira-2 mahomwe mashizha) akaitwa ne 1 cup mukaka wose (1 mukaka wokushandura)
Kudya: 4 Kutora, 3 Nyama, 3 Mafuta, 2 Miti, 1 Zvibereko
- 1 mukombe yakabikwa pasta (2 starch exchanges)
- 2 zvidimbu garlic mbiriso (2 stash exchanges) + 2 tsp bata (2 mafuta exchanges)
- 3 oz yepasi nyuchi kana huturuki (3 nhaurirano yemhuka) yakasvibiswa muna 1 tsp mafuta (1 exchange exchange)
- ½ mukate mutsutso mutsva pamwe ne ½ mukombe yakabikwa brocoli (shanduko yemiriwo 2)
- 1 orange (1 michero)
Snack # 1: 2 Kushamba, 1 Misi
- 1 muffin huru (2 starch exchanges)
- 1 mukombe wakakwana mukaka (kushandiswa kwemukaka 1 - hafu nehafu kungawedzerwa mamwe makoriri)
Nyoka # 2: 1 Zvibereko, 1 Misi
- ½ bhanana (1 michero yemichero)
- 1 mukombe wakakwana mukaka wega yogurt (1 mukaka kushandiswa)
Nyoka # 3: 1 Nyama, 2 Kushamba, 1 Miti, 1 Fat
- 1 tsp peanut kana almond butter (1 exchange exchange)
- 2 chingwa chezvingwa (2 starch exchanges)
- 1 kapu karoti (1 shanduko yemafuta), 1 oz hummus (1 mafuta kushandiswa)
Zvimwe Kurema Kuwana Mazano
Kuti uwedzere caloric kudya kuti uwane kuwedzera kuwedzera pfuma, iwe unogona kugara uchiyeuka mamwe mazano ari nyore:
- Wedzera nguva yakawanda yekudya (kubva katatu pazuva pazuva kanomwe pazuva)
- Wedzera chikamu chaicho chemugove
- Wedzera mafuta (kuwedzera mafuta paunenge uchibika zvakadai samafuta, mafuta, cream, cheese zvinogona kuwedzera makorikoni pasina kuwedzera chikamu chikamu)
- Dzorerai pamichero yakaoma nemiriwo zvinogona kuita kuti uwane kuzadza
- Kuwedzera kune zvinovaka muviri (Kuzivazve, Boost Plus) zvichipa 350-360 makorikiti pa8 ounces zvingaratidza zvakanyanya kubatsira pamakorori. Muviri wezvokudya mumufananidzo uyu unokurudzirwa pakarepo sekugadziriswa kwezvokudya zvisina kupera kana kusina kudya kana kudya.
Kukunda Matambudziko Mumugwagwa wekuremerwa Kudzorerwa
Sezvo chiratidzo chepakutanga chechirwere ndechekugadziriswa kwezvokudya, chii chinotsungirira neanorexia chichida kudya zvakawanda? Kurwisana kwakajairika uye kunoda rubatsiro rwakananga kubva kune vadikanwa uye neboka revashandi vanogona kubatsira kubata varwere vanozvidavirira kune zvirongwa zvekudya uye kuwedzera kukura uye pamwe nekupikisa dambudziko rekudya pfungwa uye kukurudzira kushandiswa kwekutya zvokudya zuva nezuva. Vegetarian, fat low, carb down, and non-dairy chikafu chinofanira kuora mwoyo (kunze kwekunge chiongororwa nezvirwere zvose) sezvo ivo kazhinji vari chiratidzo chechirwere uye kwete kubva pamatambudziko ehutano.
Kunonoka gastric kubvisa kana gastroparesis inowanzobatwa ne anorexia nervosa uye inogona kubatsira pakuzadza kwokutanga uye kuputika. Izvi zvinowedzera kukanganisa kushandiswa kwekugadzirisa sekudya kudya kunoda kuwedzerwa kunogona kusagadzikana. Kazhinji chikafu-chikafu chekudya uye chekudya zvinotapira zvinobvumira zvikamu zviduku pasina kupa zvipiriso zvekoriori ndicho chinhu chinokosha kukundwa ichi chinetso. Kudya chirwere chekurapa zvirwere kunogona kubatsira kutsigira kudzoka kwemigumisiro yepanyama pamwe nekupikisa kwepfungwa kune zvimwe zvinhu zvekudzikinura. Mapoka anowanzobatanidza chiremba, anyoresa dietitian nutritionist, chiremba wepfungwa, uye chiremba chepfungwa. Paunenge uchitsvaga uye uchivaka kunze kwemauto, zvinokurudzirwa kuva nechokwadi kuti vashandi vane unyanzvi mukurapwa kwezvinetso zvekudya.
Kubvumira mudikanwa kuti abatsire nekuzvidavirira uye kupa rubatsiro rwekugonesa kunogona kuva nesimba zvakanyanya mukudzoka. Family-Based Treatment (FBT kana Maudsley) ihwohwo hunoratidza hutungamiri hwekufananidzira vabereki sechinhu chikuru chekutsigira vana nevechiri kuyaruka vane anorexia nervosa. Mimwe mienzaniso yekurapa inopa rubatsiro rwemhuri kuvanhu vakuru vane anorexia nervosa yakagadzirwawo zvakare.
Kudzoka haisi nzira yakasununguka uye inogona kukurumidza. Yeuka kuti zvinetso zvehupenyu uye kuchinja kwehupenyu hukuru zvinogona kuita kuti udzoke zvakare . Kutsigirwa nekudzokororazve kufambira mberi uye zvinangwa zvinowanzodiwa. Kuita runyararo nechingwa uye kugadzirisa mupfungwa, mupfungwa, uye mumuviri utano uye hupenyu hunoita zvechokwadi.
> Sources:
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> Garber, AK, Mauldin, K., Michihata, N., Buckelew, SM, Shafer, M.-A., & Moscicki, A.-B. (2013). Zvokudya zvepamusoro zveCalorie Kuwedzerwa Kuwedzera kweUkurehwa uye Kuvhara Chipatara Garai Muzvipatara Zvichiri Kuyaruka NeAnorexia Nervosa. Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine , 53 (5), 579-584.
> Marzola, E., Nasser, JA, Hashim, SA, Shih, PB, & Kaye, WH (2013). Nutritional rehabilitation in anorexia nervosa: kudzokorora mabhuku uye zvinoreva kurapwa. BMC Psychiatry , 13 , 290.
> Mehanna, Hisham M., Jamil Moledina, naJane Travis. "Kudzorera Syndrome: Chii Chaicho, uye Nzira Yokudzivirira Uye Kuchibata." BMJ: British Medical Journal . BMJ Publishing Group Ltd., 2008. Web. 27 Nye. 2016.
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