Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity.
Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating followed by self-induced vomiting. It may include abuse of laxatives and diuretics.
Although these disorders primarily affect women, approximately 5%–10% of those afflicted are men, and both disorders can be present in the same individual.
Below are 7 Nursing Care Plan (NCP) for eating disorders: anorexia nerovsa & bulimia nervosa.
7 Eating Disorders (Anorexia & Bulimia Nervosa) Nursing Care Plan (NCP)
- Imbalanced Nutrition — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Deficient Fluid Volume — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Disturbed Thought Process — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Disturbed Body Image — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Impaired Parenting — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Impaired Skin Integrity — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
- Knowledge Deficit — Anorexia & Bulimia Nervosa Nursing Care Plan (NCP)
Other Possible Nursing Diagnoses
- Nutrition: imbalanced, risk for less than body requirements—inadequate food intake, self-induced vomiting, history of chronic laxative use.
- Therapeutic Regimen: ineffective management—complexity of therapeutic regimen, perceived seriousness/benefits, mistrust of regimen and/or healthcare personnel, excessive demands made on individual, family conflict.
- Reestablish adequate/appropriate nutritional intake.
- Correct fluid and electrolyte imbalance.
- Assist patient to develop realistic body image/improve self-esteem.
- Provide support/involve significant other (SO), if available, in treatment program.
- Coordinate total treatment program with other disciplines.
- Provide information about disease, prognosis, and treatment to patient/SO.
- Adequate nutrition and fluid intake maintained.
- Maladaptive coping behaviors and stressors that precipitate anxiety recognized.
- Adaptive coping strategies and techniques for anxiety reduction and self-control implemented.
- Self-esteem increased.
- Disease process, prognosis, and treatment regimen understood.
- Plan in place to meet needs after discharge.
Patient Assessment Database
- May report: Disturbed sleep patterns, e.g., early morning insomnia; fatigue
- Feeling “hyper” and/or anxious
- Increased activity/avid exerciser, participation in high-energy sports
- Employment in positions/professions that stress/require weight control (e.g., athletics such as gymnasts, swimmers, jockeys; modeling; flight attendants)
- May exhibit: Periods of hyperactivity, constant vigorous exercising
- May report: Feeling cold even when room is warm
- May exhibit: Low blood pressure (BP)
- Tachycardia, bradycardia, dysrhythmias
- May report: Powerlessness/helplessness lack of control over eating (e.g., cannot stop eating/control what or how much is eaten [bulimia]); feeling disgusted with self, depressed or very guilty because of overeating
- Distorted (unrealistic) body image, reports self as fat regardless of weight (denial), and sees thin body as fat; persistent overconcern with body shape and weight (fears gaining weight)
- High self-expectations
- Stress factors, e.g., family move/divorce, onset of puberty
- Suppression of anger
- May exhibit: Emotional states of depression, withdrawal, anger, anxiety, pessimistic outlook
- May report: Diarrhea/constipation
- Vague abdominal pain and distress, bloating
- Laxative/diuretic abuse
- May report: Constant hunger or denial of hunger; normal or exaggerated appetite that rarely vanishes until late in the disorder (anorexia)
- Intense fear of gaining weight (females); may have prior history of being overweight (particularly males)
- Preoccupation with food, e.g., calorie counting, gourmet cooking
- An unrealistic pleasure in weight loss, while denying self pleasure in other areas
- Refusal to maintain body weight over minimal norm for age/height (anorexia)
- Recurrent episodes of binge eating; a feeling of lack of control over behavior during eating binges; a minimum average of two binge-eating episodes a week for at least 3 mo
- Regularly engages in self-induced vomiting (binge-purge syndrome bulimia) either independently or as a complication of anorexia; or strict dieting or fasting
- May exhibit: Weight loss/maintenance of body weight 15% or more below that expected (anorexia), or weight may be normal or slightly above or below normal (bulimia)
- No medical illness evident to account for weight loss
- Cachectic appearance; skin may be dry, yellowish/pale, with poor tugor (anorexia)
- Preoccupation with food (e.g., calorie counting, hiding food, cutting food into small pieces, rearranging food on plate)
- Irrational thinking about eating, food, and weight
- Peripheral edema
- Swollen salivary glands; sore, inflamed buccal cavity; continuous sore throat (bulimia)
- Vomiting, bloody vomitus (may indicate esophageal tearing [Mallory-Weiss syndrome])
- Excessive gum chewing
- May exhibit: Increased hair growth on body (lanugo), hair loss (axillary/pubic), hair is dull/not shiny
- Brittle nails
- Signs of erosion of tooth enamel, gums in poor condition, ulcerations of mucosa
- May exhibit: Appropriate affect (except in regard to body and eating), or depressive affect
- Mental changes: Apathy, confusion, memory impairment (brought on by malnutrition/
- Hysterical or obsessive personality style; no other psychiatric illness or evidence of a psychiatric thought disorder present (although a significant number may show evidence of an affective disorder)
- May report: Headaches, sore throat/mouth, generalized vague complaints
- May exhibit: Body temperature below normal
- Recurrent infectious processes (indicative of depressed immune system)
- Eczema/other skin problems, abrasions/calluses may be noted on back of hands from sticking finger down throat to induce vomiting
- May report: Absence of at least three consecutive menstrual cycles (decreased levels of estrogen in response to malnutrition)
- Promiscuity or denial/loss of sexual interest
- History of sexual abuse
- Homosexual/bisexual orientation (higher percentage in male patients than in general population)
- May exhibit: Breast atrophy, amenorrhea
- May report: Middle-class or upper-class family background
- History of being a quiet, cooperative child
- Problems of control issues in relationships, difficult communications with others/authority figures, poor communication within family of origin
- Engagement in power struggles
- An emotional crisis of some sort, such as the onset of puberty or a family move
- Altered relationships or problems with relationships (not married/divorced), withdrawal from friends/social contacts
- Abusive family relationships
- Sense of helplessness
- History of legal difficulties (e.g., shoplifting)
- May exhibit: Passive father/dominant mother, family members closely fused, togetherness prized, personal boundaries not respected
- May report: Family history of higher than normal incidence of depression, other family members with eating disorders (genetic predisposition)
- Onset of the illness usually between the ages of 10 and 22
- Health beliefs/practice (e.g., certain foods have “too many” calories, use of “health” foods)
- High academic achievement
- Substance abuse
- Discharge plan DRG projected mean length of inpatient stay: 6.4 days
- considerations: Assistance with maintenance of treatment plan
- Complete blood count (CBC) with differential: Determines presence of anemia, leukopenia, lymphocytosis. Platelets show significantly less than normal activity by the enzyme monoamine oxidase (thought to be a marker for depression).
- Electrolytes: Imbalances may include decreased potassium, sodium, chloride, and magnesium.
- Endocrine studies:
- Thyroid function: Thyroxine (T4) levels usually normal; however, circulating triiodothyronine (T3) levels may be low.
- Pituitary function: Thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) is abnormal in anorexia nervosa. Propranolol-glucagon stimulation test studies the response of human growth hormone (GH), which is depressed in anorexia. Gonadotropic hypofunction is noted.
- Cortisol metabolism: May be elevated.
- Dexamethasone suppression test (DST): Evaluates hypothalamic-pituitary function. Dexamethasone resistance indicates cortisol suppression, suggesting malnutrition and/or depression.
- Luteinizing hormone (LH) secretions test: Pattern often resembles those of prepubertal girls.
- Estrogen: Decreased.
- MHP 6 levels: Decreased, suggestive of malnutrition/depression.
- Serum glucose and basal metabolic rate (BMR): May be low.
- Other chemistries: AST elevated. Hypercarotenemia, hypoproteinemia, hypocholesterolemia.
- Urinalysis and renal function: Blood urea nitrogen (BUN) may be elevated; ketones present reflecting starvation; decreased urinary 17-ketosteroids; increased specific gravity/dehydration.
- Electrocardiogram (ECG): Abnormal tracing with low voltage, T-wave inversion, dysrhythmias.
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