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3 Glaucoma Nursing Care Plans

Nurseslabs — Mon, 14 May 2012 14:17:04 +0000

Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness.

There are two primary categories of glaucoma: (1) open-angle and (2) closed-angle (or narrow angle). Chronic open-angle glaucoma is the most common type, accounting for 90% of all glaucoma cases. It develops slowly, may be associated with diabetes and myopia, and may develop in both eyes simultaneously. Chronic glaucoma has no early warning signs, and the loss of peripheral vision occurs so gradually that substantial optic nerve damage can occur before glaucoma is detected.

Narrow-angle, or angle-closure, glaucoma is the less common form and may be associated with eye trauma, various inflammatory processes, and pupillary dilation after the instillation of mydriatic drops. Acute angle-closure glaucoma is manifested by sudden excruciating pain in or around the eye, blurred vision, and ocular redness. This condition constitutes a medical emergency because blindness may suddenly ensue.

Below are 3 nursing care plans for Glaucoma

3 Glaucoma Nursing Care Plans

Disturbed Visual Sensory Perception — Glaucoma Nursing Care Plans
Anxiety — Glaucoma Nursing Care Plans
Knowledge Deficit — Glaucoma Nursing Care Plans

Other Nursing Diagnoses:

Trauma, risk for—poor vision.
Social Interaction, impaired—limited physical mobility (poor vision), inadequate support system.
Therapeutic Regimen: ineffective management—complexity of therapeutic regimen, economic difficulties, inadequate number and type of cues to action, perceived seriousness (of condition) or benefit (versus side effects).

Glaucoma Nursing Priorities

Prevent further visual deterioration.
Promote adaptation to changes in/reduced visual acuity.
Prevent complications.
Provide information about disease process/prognosis and treatment needs.

Glaucoma Discharge Goals

Vision maintained at highest possible level.
Patient coping with situation in a positive manner.
Complications prevented/minimized.
Disease process/prognosis and therapeutic regimen understood.
Plan in place to meet needs after discharge.

3 Glaucoma Nursing Care Plans Original source at: Nurseslabs

Knowledge Deficit — Glaucoma Nursing Care Plans

Nurseslabs — Mon, 14 May 2012 14:16:45 +0000

NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs

May be related to

Lack of exposure/unfamiliarity with resources
Lack of recall, information misinterpretation

Possibly evidenced by

Questions; statement of misconception
Inaccurate follow-through of instruction
Development of preventable complications

Desired Outcomes

Verbalize understanding of condition, prognosis, and treatment.
Identify relationship of signs/symptoms to the disease process.
Verbalize understanding of treatment needs.
Correctly perform necessary procedures and explain reasons for the actions.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Review pathology/prognosis of condition and lifelong need for treatment.	Provides opportunity to clarify/dispel misconceptions and present condition and something that is manageable.
Discuss necessity of wearing identification, e.g., MedicAlert bracelet.	Vital to provide information for caregivers in case of emergency to reduce risk of receiving contraindicated drugs (e.g., atropine).
Demonstrate proper technique for administration of eye drops, gels, or discs. Have patient perform return demonstration.	Enhances effectiveness of treatment. Provides opportunity for patient to show competence and ask questions.
Review importance of maintaining drug schedule, e.g., eye drops. Discuss medications that should be avoided, e.g., mydriatric drops (atropine/propantheline bromide), overuse of topical steroids, and additive effects of[beta]-blocking when systemic [beta]-blocking agents are used.	This disease can be controlled, not cured, and maintaining a consistent medication regimen is vital to control. Some drugs cause pupil dilation, increasing IOP and potentiating additional loss of vision. Note: All [beta]-blocking glaucoma medications are contraindicated in patient with greater than first-degree heart block, cardiogenic shock, or overt heart failure.
Identify potential side effects/adverse reactions of treatment, e.g., decreased appetite, nausea/vomiting, diarrhea, fatigue, “drugged” feeling, decreased libido, impotence, cardiac irregularities, syncope, heart failure (HF).	Drug side/adverse effects range from uncomfortable to severe or health-threatening. Approximately 50% of patients develop sensitivity/allergy to parasympathomi-metics (e.g., pilocarpine) or anticholinesterase drugs. These problems require medical evaluation and possible change in therapeutic regimen.
Encourage patient to make necessary changes in lifestyle.	A tranquil lifestyle decreases the emotional response to stress, preventing ocular changes that push the iris forward, which may precipitate an acute attack.
Reinforce avoidance of activities such as heavy lifting/pushing, snow shoveling, wearing tight/constricting clothing.	May increase IOP, precipitating acute attack.Note: If patient is not experiencing pain, cooperation with drug regimen and acceptance of lifestyle changes are often difficult to sustain.
Discuss dietary considerations, e.g., adequate fluid, bulk/fiber intake.	Measures to maintain consistency of stool to avoid constipation/straining during defecation.
Stress importance of routine checkups.	Important to monitor progression/maintenance of disease to allow for early intervention and prevent further loss of vision.
Advise patient to immediately report severe eye pain, inflammation, increased photophobia, increased lacrimation, changes in visual field/veil-like curtain, blurred vision, flashes of light/particles floating in visual field.	Prompt action may be necessary to prevent further vision loss/other complications, e.g., detached retina.
Recommend family members be examined regularly for signs of glaucoma	Hereditary tendency to shallow anterior chambers places family members at increased risk for developing the condition. Note: African-Americans in every age category should have frequent examinations because of increased incidence and more aggressive course of glaucoma in these individuals.
ntify strategies/resources for socialization, e.g., support groups, Visually Impaired Society, local library, and transportation services.	Decreased visual acuity may limit patient’s ability to drive/casue patient to withdraw from usual activities.

Knowledge Deficit — Glaucoma Nursing Care Plans Original source at: Nurseslabs

Anxiety — Glaucoma Nursing Care Plans

Nurseslabs — Mon, 14 May 2012 14:16:41 +0000

NURSING DIAGNOSIS: Anxiety [specify level]

May be related to

Physiological factors, change in health status; presence of pain; possibility/reality of loss of vision
Unmet needs
Negative self-talk

Possibly evidence by

Apprehension, uncertainty
Expressed concern regarding changes in life events

Desired Outcomes

Appear relaxed and report anxiety is reduced to a manageable level.
Demonstrate problem-solving skills.
Use resources effectively.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Assess anxiety level, degree of pain experienced/suddenness of onset of symptoms, and current knowledge of condition.	These factors affect patient perception of threat to self, potentiate the cycle of anxiety, and may interfere with medical attempts to control IOP.
Provide accurate, honest information. Discuss probability that careful monitoring and treatment can prevent additional visual loss.	Reduces anxiety related to unknown/future expectations, and provides factual basis for making informed choices about treatment.
Encourage patient to acknowledge concerns and express feelings.	Provides opportunity for patient to deal with reality of situatin, clarify misconceptions, and problem-solve concerns
Identify helpful resources/people.	Provides reassurance that patient is not alone in dealing with problem.

Anxiety — Glaucoma Nursing Care Plans Original source at: Nurseslabs

Disturbed Visual Sensory Perception — Glaucoma Nursing Care Plans

Nurseslabs — Mon, 14 May 2012 14:16:40 +0000

NURSING DIAGNOSIS: Sensory Perception, disturbed: visual

May be related to

Altered sensory reception: altered status of sense organ

Possibly evidenced by

Progressive loss of visual field

Desired Outcomes

Participate in therapeutic regimen.
Maintain current visual field/acuity without further loss.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Ascertain type/degree of visual loss.	Affects choice of interventions and patient’s future expectations.
Encourage expression of feelings about loss/possibility of loss of vision.	Although early intervention can prevent blindness, patient faces the possibility or may have already experienced partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), further loss can be prevented.
Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision.	Reduces safety hazards related to changes in visual fields/loss of vision and papillary accommodation to environmental light.
Demonstrate administration of eye drops, e.g., counting drops, adhering to schedule, not missing doses.	Controls IOP, preventing further loss of vision.
Assist with administration of medications as indicated:	These direct-acting topical myotic drugs cause pupillary constriction, facilitating the outflow of aqueous humor and lowering IOP. Note: Ocusert is a disc (similar to a contact) that is placed in the lower eyelid, where it can remain for up to 1 wk before being replaced.
Chronic, open-angle glaucomaPilocarpine hydrochloride (Isopto Carpine, Ocusert [disc], Pilopine HS gel); Timolol maleate (Timoptic), betaxolol (Betoptic), carteolol (Ocupress), metipranolol (OptiPranolol), levobunolol (Betagan); Acetazolamide (Diamox), methazolamide (Neptazane), dorzolamide (Trusopt).	[Beta]-blockers decrease formation of aqueous humor without changing pupil size, vision, or accommodation.Note: These drugs may be contraindicated or require close monitoring for systemic effects in the presence of bradycardia or asthma.Carbonic anhydrase inhibitors decrease the rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, GI upset, and fatigue. Contracts the sphincter muscles of the iris, deepens anterior chamber, and dilates vessels of outflow tract during acute attack or before surgery.
Narrow-angle (angle-closure) typeMyotics (until pupil is constricted); Carbonic anhydrase inhibitors, e.g., acetazolamide (Diamox); dichlorphenamide (Daranide); methazolamide (Neptazane);	Decreases secretion of aqueous humor and lowers IOP.
Sympathomimetids, e.g., dipivefrin (Propine), bromonidine (Alphagan), epinephrine (Epifrin), apraclonidine (Lopidine), latanoprost (Xalatan);	Adrenergic drops also decrease formation of aqueous humor and may be beneficial when patient is unresponsive to other medications. Although free of side effects such as miosis, blurred vision, and night blindness, they have potential for additive adverse cardiovascular effects in combination with other cardiovascular agents. Note: Light-colored eyes are more responsive to these drugs than dark-colored eyes, necessitating added considerations when determining appropriate dosage.
Provide sedation, analgesics as necessary.	Acute glaucoma attack is associated with sudden pain, which can precipitate anxiety/agitation, further elevating IOP. Medical management may require 4–6 hr before IOP decreases and pain subsides.
Prepare for surgical intervention as indicated, e.g.:Laser therapy, e.g., argon laser trabeculoplasty (ALT) or trabeculectomy/trephination; Iridectomy; Malento valve implant; Cyclocryotherapy; Aqueous-venous shunt; Diathermy/cryosurgery.	Filtering operations (laser surgery) are highly successful procedures for reducing IOP by creating an opening between the anterior chamber and the subjunctival spaces so that aqueous humor can bypass the trabecular mesh block. Note: Apraclonidine (Lopidine) eye drops may be used in conjunction with laser therapy to lessen/prevent postprocedure elevations of IOP. Surgical removal of a portion of the iris facilitates drainage of aqueous humor through a newly created opening in the iris connecting to normal outflow channels. Note: Bilateral iridectomy is performed because glaucoma usually develops in the other eye. Experimental ocular implant device corrects or prevents scarring over/closure of drainage sac created by trabeculectomy. Separates ciliary body from the sclera to facilitate outflow of aqueous humor. Used in intractable glaucoma. If other treatments fail, destruction of the ciliary body reduces formation of aqueous humor

Disturbed Visual Sensory Perception — Glaucoma Nursing Care Plans Original source at: Nurseslabs

Imbalanced Nutrition — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:59 +0000

NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements

May be related to

Inadequate food intake; self-induced vomiting
Chronic/excessive laxative use

Possibly evidenced by

Body weight 15% (or more) below expected, or may be within normal range (bulimia)
Pale conjunctiva and mucous membranes; poor skin turgor/muscle tone; edema
Excessive loss of hair; increased growth of hair on body (lanugo)
Amenorrhea
Hypothermia
Bradycardia; cardiac irregularities; hypotension

Desired Outcomes

Verbalize understanding of nutritional needs.
Establish a dietary pattern with caloric intake adequate to regain/maintain appropriate weight.
Demonstrate weight gain toward individually expected range.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Establish a minimum weight goal and daily nutritional requirements.	Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function/decision making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work.
Use a consistent approach. Sit with patient while eating; present and remove food without persuasion and/or comment. Promote pleasant environment and record intake.	Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, patient can begin to trust staff responses. The single area in which patient has exercised power and control is food/eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with patient and avoid manipulative games.
Provide smaller meals and supplemental snacks, as appropriate.	Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: Patient may feel bloated for 3–6 wk while body adjusts to food intake.
Make selective menu available, and allow patient to control choices as much as possible.	Patient who gains confidence in self and feels in control of environment is more likely to eat preferred foods.
Be alert to choices of low-calorie foods/beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets.	Patient will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.
Maintain a regular weighing schedule, such as Monday/ Friday before breakfast in same attire, and graph results.	Provides accurate ongoing record of weight loss/gain. Also diminishes obsessing about changes in weight.
Weigh with back to scale (depending on program protocols).	Although some programs prefer patient to see the results of the weighing, this can force the issue of trust in patient who usually does not trust others.
Avoid room checks and other control devices whenever possible.	External control reinforces feelings of powerlessness and therefore is usually not helpful.
Provide one-to-one supervision and have patient with bulimia remain in the day room area with no bathroom privileges for a specified period (e.g., 2 hr) following eating, if contracting is unsuccessful.	Prevents vomiting during/after eating. Patient may desire food and use a binge-purge syndrome to maintain weight. Note: Patient may purge for the first time in response to establishment of a weight gain program.
Monitor exercise program and set limits on physical activities. Chart activity/level of work (pacing and so on).	Moderate exercise helps in maintaining muscle tone/weight and combating depression; however, patient may exercise excessively to burn calories.
Maintain matter-of-fact, nonjudgmental attitude if giving tube feedings, hyperalimentation, and so on.	Perception of punishment is counterproductive to patient’s self-confidence and faith in own ability to control destiny.
Be alert to possibility of patient disconnecting tube and emptying hyperalimentation if used. Check measurements, and tape tubing snugly.	Sabotage behavior is common in attempt to prevent weight gain.
Provide nutritional therapy within a hospital treatment program as indicated when condition is life-threatening.	Cure of the underlying problem cannot happen without improved nutritional status. Hospitalization provides a controlled environment in which food intake, vomiting/elimination, medications, and activities can be monitored. It also separates patient from SO (who may be contributing factor) and provides exposure to others with the same problem, creating an atmosphere for sharing.
Involve patient in setting up/carrying out program of behavior modification. Provide reward for weight gain as individually determined; ignore loss.	Provides structured eating situation while allowing patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.
Provide diet and snacks with substitutions of preferred foods when available.	Having a variety of foods available enables patient to have a choice of potentially enjoyable foods.
Administer liquid diet and/or tube feedings/ hyperalimentation if needed.	When caloric intake is insufficient to sustain metabolic needs, nutritional support can be used to prevent malnutrition/death while therapy is continuing. High-calorie liquid feedings may be given as medication, at preset times separate from meals, as an alternative means of increasing caloric intake.
Blenderize and tube-feed anything left on the tray after a given period of time if indicated.	May be used as part of behavior modification program to provide total intake of needed calories.
Administer supplemental nutrition as appropriate.	Total parenteral nutrition (TPN) may be required for life-threatening situations; however, enteral feedings are preferred because they preserve gastrointestinal (GI) function and reduce atrophy of the gut.
Avoid giving laxatives.	Use is counterproductive because they may be used by patient to rid body of food/calories.
Administer medication as indicated:Cypropheptadine (Periactin); Tricyclic antidepressants, e.g., amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin); selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine (Prozac); Antianxiety agents, e.g., alprazolam (Xanax); Antipsychotic drugs, e.g., chlorpromazine (Thorazine); Monoamine oxidase inhibitors (MAOIs), e.g., tranylcypromine sulfate (Parnate).	A serotonin and histamine antagonist that may be used in high doses to stimulate the appetite, decrease preoccupation with food, and combat depression. Does not appear to have serious side effects, although decreased mental alertness may occur. Lifts depression and stimulates appetite. SSRIs reduce binge-purge cycles and may also be helpful in treating anorexia. Note: Use must be closely monitored because of potential side effects, although side effects from SSRIs are less significant than those associated with tricyclics. Reduces tension, anxiety/nervousness and may help patient to participate in treatment. Promotes weight gain and cooperation with psychotherapeutic program; however, used only when absolutely necessary because of the possibility of extrapyramidal side effects. May be used to treat depression when other drug therapy is ineffective; decreases urge to binge in bulimia.
Prepare for/assist with electroconvulsive therapy (ECT) if indicated. Discuss reasons for use and help patient understand this is not punishment.	In rare and difficult cases in which malnutrition is severe/life-threatening, a short-term ECT series may enable patient to begin eating and become accessible to psychotherapy.

Imbalanced Nutrition — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs

Disturbed Thought Process — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:57 +0000

NURSING DIAGNOSIS: Thought Processes, disturbed

May be related to

Severe malnutrition/electrolyte imbalance
Psychological conflicts, e.g., sense of low self-worth, perceived lack of control

Possibly evidenced by

Impaired ability to make decisions, problem-solve
Non–reality-based verbalizations
Ideas of reference
Altered sleep patterns, e.g., may go to bed late (stay up to binge/purge) and get up early
Altered attention span/distractibility
Perceptual disturbances with failure to recognize hunger; fatigue, anxiety, and depression

Desired Outcomes

Verbalize understanding of causative factors and awareness of impairment.
Demonstrate behaviors to change/prevent malnutrition.
Display improved ability to make decisions, problem-solve.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Be aware of patient’s distorted thinking ability.	Allows caregiver to have more realistic expectations of patient and provide appropriate information and support.
Listen to/avoid challenging irrational, illogical thinking. Present reality concisely and briefly.	It is difficult to responds logically when thinking ability is physiologically impaired. Patient needs to hear reality, but challenging patient leads to distrust and frustration. Note:Even though patient may gain weight, she or he may continue to struggle with attitudes/behaviors typical of eating disorders, major depression, and/or alcohol dependence for a number of years.
Adhere strictly to nutritional regimen.	Improved nutrition is essential to improved brain functioning.
Review electrolyte/renal function tests.	Imbalances negatively affect cerebral functioning and may require correction before therapeutic interventions can begin.

Disturbed Thought Process — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs

Disturbed Body Image — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:55 +0000

NURSING DIAGNOSIS: Body image, disturbed/Self-Esteem, chronic low

May be related to

Morbid fear of obesity; perceived loss of control in some aspect of life
Personal vulnerability; unmet dependency needs
Dysfunctional family system
Continual negative evaluation of self

Possibly evidenced by

Distorted body image (views self as fat even in the presence of normal body weight or severe emaciation)
Expresses little concern, uses denial as a defense mechanism, and feels powerless to prevent/make changes
Expressions of shame/guilt
Overly conforming, dependent on others’ opinions

Desired Outcomes

Establish a more realistic body image.
Acknowledge self as an individual.
Accept responsibility for own actions.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Have patient draw picture of self.	Provides opportunity to discuss patient’s perception of self/body image and realities of individual situation.
Involve in personal development program, preferably in a group setting. Provide information about proper application of makeup and grooming.	Learning about methods to enhance personal appearance may be helpful to long-range sense of self-esteem/image. Feedback from others can promote feelings of self-worth.
Suggest disposing of “thin” clothes as weight gain occurs. Recommend consultation with an image consultant.	Provides incentive to at least maintain and not lose weight. Removes visual reminder of thinner self. Positive image enhances sense of self-esteem.
Assist patient to confront changes associated with puberty/sexual fears. Provide sex education as necessary.	Major physical/psychological changes in adolescence can contribute to development of eating disorders. Feelings of powerlessness and loss of control of feelings (in particular sexual sensations) lead to an unconscious desire to desexualize self. Patient often believes that these fears can be overcome by taking control of bodily appearance/development/function.
Establish a therapeutic nurse/patient relationship.	Within a helping relationship, patient can begin to trust and try out new thinking and behaviors.
Promote self-concept without moral judgment	Patient sees self as weak-willed, even though part of person may feel sense of power and control (e.g., dieting/weight loss).
States rules clearly regarding weighing schedule, remaining in sight during medication and eating times, and consequences of not following the rules. Without undue comment, be consistent in carrying out rules.	Consistency is important in establishing trust. As part of the behavior modification program, patient knows risks involved in not following established rules (e.g., decrease in privileges). Failure to follow rules is viewed as patient’s choice and accepted by staff in matter-of-fact manner so as not to provide reinforcement for the undesirable behavior.
Respond (confront) with reality when patient makes unrealistic statements such as “I’m gaining weight, so there’s nothing really wrong with me.”	Patient may be denying the psychological aspects of own situation and is often expressing a sense of inadequacy and depression.
Be aware of own reaction to patient’s behavior. Avoid arguing.	Feelings of disgust, hostility, and infuriation are not uncommon when caring for these patients. Prognosis often remains poor even with a gain in weight because other problems may remain. Many patients continue to see themselves as fat, and there is also a high incidence of affective disorders, social phobias, obsessive-compulsive symptoms, drug abuse, and psychosexual dysfunction. Nurse needs to deal with own response/feeling so they do not interfere with care of patient.
Assist patient to assume control in areas other than dieting/weight loss, e.g., management of own daily activities, work/leisure choices.	Feelings of personal ineffectiveness, low self-esteem, and perfectionism are often part of the problem. Patient feels helpless to change and requires assistance to problem-solve methods of control in life situations.
Help patient formulate goals for self (not related to eating) and create a manageable plan to reach those goals, one at a time, progressing from simple to more complex.	Patient needs to recognize ability to control other areas in life and may need to learn problem-solving skills to achieve this control. Setting realistic goals fosters success.
Note patient’s withdrawal from and/or discomfort in social settings.	May indicate feelings of isolation and fear of rejection/judgment by others. Avoidance of social situations and contact with others can compound feelings of worthlessness.
Encourage patient to take charge of own life in a more healthful way by making own decisions and accepting self as she or he is at this moment (including inadequacies and strengths).	Patient often does not know what she or he may want for self. Parents (mother) often make decisions for patient. Patient may also believe she or he has to be the best in everything and holds self responsible for being perfect.
Let patient know that is acceptable to be different from family, particularly mother.	Developing a sense of identity separate from family and maintaining sense of control in other ways besides dieting and weight loss is a desirable goal of therapy/program.
Use cognitive-behavioral or interpersonal psychotherapy approach, rather than interpretive therapy.	Although both therapies have similar results, cognitive-behavioral seems to work more quickly. Interaction between persons is more helpful for patient to discover feelings/impulses/needs from within own self. Patient has not learned this internal control as a child and may not be able to interpret or attach meaning to behavior.
Encourage patient to express anger and acknowledge when it is verbalized.	Important to know that anger is part of self and as such is acceptable. Expressing anger may need to be taught to patient because anger is generally considered unacceptable in the family, and therefore patient does not express it.
Assist patient to learn strategies other than eating for dealing with feelings. Have patient keep a diary of feelings, particularly when thinking about food.	Feelings are the underlying issue, and patient often uses food instead of dealing with feelings appropriately. Patient needs to learn to recognize feelings and how to express them clearly.
Assess feelings of helplessness/hopelessness.	Lack of control is a common/underlying problem for this patient and may be accompanied by more serious emotional disorders. Note: Fifty-four percent of patients with anorexia have a history of major affective disorder, and 33% have a history of minor affective disorder.
Be alert to suicidal ideation/behavior.	Intense anxiety/panic about weight gain, depression, hopeless feelings may lead to suicidal attempts, particularly if patient is impulsive.
Involve in group therapy.	Provides an opportunity to talk about feelings and try out new behaviors.
Refer to occupational/recreational therapy.	Can develop interest and skills to fill time that has been occupied by obsession with eating. Involvement in recreational activities encourages social interactions with others and promotes fun and relaxation.

Disturbed Body Image — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs

Impaired Parenting — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:53 +0000

NURSING DIAGNOSIS: Parenting, impaired

May be related to

Issues of control in family
Situational/maturational crises
History of inadequate coping methods

Possibly evidenced by

Dissonance among family members
Family developmental tasks not being met
Focus on “Identified Patient” (IP)
Family needs not being met
Family member(s) acting as enablers for IP
Ill-defined family rules, function, and roles

Desired Outcomes

Demonstrate individual involvement in problem-solving process directed at encouraging patient toward independence.
Express feelings freely and appropriately.
Demonstrate more autonomous coping behaviors with individual family boundaries more clearly defined.
Recognize and resolve conflict appropriately with the individuals involved.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Identify patterns of interaction. Encourage each family member to speak for self. Do not allow two members to discuss a third without that member’s participation.	Helpful information for planning interventions. The enmeshed, overinvolved family members often speak for each other and need to learn to be responsible for their own words and actions.
Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge competent actions of patient.	Each individual needs to develop own internal sense of self-esteem. Individual often is living up to others’ (family’s) expectations rather than making own choices. Acknowledgment provides recognition of self in positive ways.
Listen with regard when patient speaks.	Sets an example and provides a sense of competence and self-worth, in that patient has been heard and attended to.
Encourage individuals not to answer to everything.	Reinforces individualization and return to privacy.
Communicate message of separation, that it is acceptable for family members to be different from each other.	Individuation needs reinforcement. Such a message confronts rigidity and opens options for different behaviors.
Encourage and allow expression of feelings (e.g., crying, anger) by individuals.	Often these families have not allowed free expression of feelings and need help and permission to learn and accept this.
Prevent intrusion in dyads by other members of the family.	Inappropriate interventions in family subsystems prevent individuals from working out problems successfully.
Reinforce importance of parents as a couple who have rights of their own.	The focus on the child with anorexia is very intense and often is the only area around which the couple interact. The couple needs to explore their own relationship and restore the balance within it to prevent its disintegration.
Prevent patient from intervening in conflicts between parents. Assist parents in identifying and solving their marital differences.	Triangulation occurs in which a parent-child coalition exists. Sometimes the child is openly pressed to ally self with one parent against the other. The symptom (anorexia) is the regulator in the family system, and the parents deny their own conflicts.
Be aware and confront sabotage behavior on the part of family members.	Feelings of blame, shame, and helplessness may lead to unconscious behavior designed to maintain the status quo.
Refer to community resources such as family therapy groups, parents’ groups as indicated, and parent effectiveness classes.	May help reduce overprotectiveness, support/facilitate the process of dealing with unresolved conflicts and change.

Impaired Parenting — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs

Impaired Skin Integrity — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:44 +0000

NURSING DIAGNOSIS: Skin Integrity, risk for impaired

Risk factors may include

Altered nutritional/metabolic state; edema
Dehydration/cachectic changes (skeletal prominence)

Possibly evidenced by

[Not applicable; presence of signs and symptoms establishes and actual diagnosis.]

Desired Outcomes

Verbalize understanding of causative factors and absence of itching.
Identify and demonstrate behaviors to maintain soft, supple, intact skin.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Observe for reddened, blanched, excoriated areas.	Indicators of increased risk of breakdown, requiring more intensive treatment.
Encourage bathing every other day instead of daily.	Frequent baths contribute to dryness of the skin.
Use skin cream twice a day and after bathing.	Lubricates skin and decreases itching.
Massage skin gently, especially over bony prominences.	Improves circulation to the skin, enhances skin tone.
Discuss importance of frequent position changes, need for remaining active.	Enhances circulation and perfusion to skin by preventing prolonged pressure on tissues.
Emphasize importance of adequate nutrition/fluid intake.	Improved nutrition and hydration will improve skin condition.

Impaired Skin Integrity — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs

Knowledge Deficit — Anorexia & Bulimia Nervosa Nursing Care Plans

Nurseslabs — Sat, 05 May 2012 10:25:39 +0000

NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care and discharge needs

May be related to

Lack of exposure to/unfamiliarity with information about condition
Learned maladaptive coping skills

Possibly evidenced by

Verbalization of misconception of relationship of current situation and behaviors
Preoccupation with extreme fear of obesity and distortion of own body image
Refusal to eat; binging and purging; abuse of laxatives and diuretics; excessive exercising
Verbalization of need for new information
Expressions of desire to learn more adaptive ways of coping with stressors

Desired Outcomes

Verbalize awareness of and plan for lifestyle changes to maintain normal weight.
Identify relationship of signs/symptoms (weight loss, tooth decay) to behaviors of not eating/binging-purging.
Assume responsibility for own learning.
Seek out sources/resources to assist with making identified changes.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Determine level of knowledge and readiness to learn.	Learning is easier when it begins where the learner is.
Note blocks to learning, e.g., physical/intellectual/emotional.	Malnutrition, family problems, drug abuse, affective disorders, and obsessive-compulsive symptoms can be blocks to learning requiring resolution before effective learning can occur.
Provide written information for patient/SO(s).	Helpful as reminder of and reinforcement for learning.
Discuss consequences of behavior.	Sudden death can occur because of electrolyte imbalances; suppression of the immune system and liver damage may result from protein deficiency; or gastric rupture may follow binge-eating/vomiting.
Review dietary needs, answering questions as indicated. Encourage inclusion of high-fiber foods and adequate fluid intake.	Patient/family may need assistance with planning for new way of eating. Constipation may occur when laxative use is curtailed.
Encourage the use of relaxation and other stress-management techniques, e.g., visualization, guided imagery, biofeedback.	New ways of coping with feelings of anxiety and fear help patient manage these feelings in more effective ways, assisting in giving up maladaptive behaviors of not eating/binging-purging.
Assist with establishing a sensible exercise program. Caution regarding overexercise.	Exercise can assist with developing a positive body image and combats depression (release of endorphins in the brain enhances sense of well-being). However, patient may use excessive exercise as a way to control weight.
Discuss need for information about sex and sexuality.	Because avoidance of own sexuality is an issue for this patient, realistic information can be helpful in beginning to deal with self as a sexual being.

Knowledge Deficit — Anorexia & Bulimia Nervosa Nursing Care Plans Original source at: Nurseslabs