Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.
Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized by extreme overeating followed by self-induced vomiting, trying to get rid of the extra calories in an unhealthy way. 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.
Nursing Care Plans
- Establish 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.
- 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, hypercholesterolemia.
- 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.
Below are 7 Nursing Care Plans (NCP) for eating disorders anorexia nervosa & bulimia nervosa.
- 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)
- Bradycardia; cardiac irregularities; hypotension
- 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.
|For Bulimia Nervosa:|
|Supervise the patient during mealtimes and for a specified period after meals (usually one hour).||Prevents vomiting during or after eating.|
|Identify the patient’s elimination patterns.||To prevent self-induces vomiting.|
|Assess her suicide potential.||Among patients with bulimia nervosa, warning signs include having more co-morbid psychiatric symptoms and reporting a history of sexual abuse.|
|Outline the risks of laxative, emetic, and diuretic abuse for the patient||Bulimic patients may include abuse of laxatives, emetics, and diuretics.|
|For Anorexia Nervosa:|
|Supervise the patient during mealtimes and for a specified period after meals (usually one hour).||To ensure compliance with the dietary treatment program. For hospitalized patient with anorexia, food is considered a medication.|
|Liquids are more acceptable than solid.||Fluids eliminate the need to choose between foods – something the patient with anorexia may find difficult.|
|Expect weight gain of about 1 lb (0.5 kg) per week.||To see the effectiveness of treatment regimen.|
|If edema or bloating occurs after the patient has returned to normal eating behavior, reassure her that this phenomenon is temporary.||She may fear that she’s becoming fat and stop complying with the plan of treatment.|
|For Bulimia and Anorexia:|
|Establish a minimum weight goal and daily nutritional requirements.||Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and 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 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 or 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 and 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 and Friday before breakfast in same attire, and graph results.||Provides accurate ongoing record of weight loss or 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 (2 hr) following eating, if contracting is unsuccessful.||Prevents vomiting during and 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 and 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 and 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 or 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, tube feedings,
hyperalimentation if needed.
|When caloric intake is insufficient to sustain metabolic needs, nutritional support can be used to prevent malnutrition and 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 and calories.|
|Administer medication as indicated: Cyproheptadine (Periactin);Tricyclic antidepressants: amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin); selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac);
Antianxiety agents: alprazolam (Xanax);
|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.
|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 and life-threatening, a short-term ECT series may enable patient to begin eating and become accessible to psychotherapy.|
- Fluid Volume actual or risk for deficient
May be related to
- Inadequate intake of food and liquids
- Consistent self-induced vomiting
- Chronic/excessive laxative/diuretic use
Possibly evidenced by (actual)
- Dry skin and mucous membranes, decreased skin turgor
- Increased pulse rate, body temperature, decreased BP
- Output greater than input (diuretic use); concentrated urine/decreased urine output (dehydration)
- Change in mental state
- Hemoconcentration, altered electrolyte balance
- Maintain/demonstrate improved fluid balance, as evidenced by adequate urine output, stable vital signs, moist mucous membranes, good skin turgor.
- Verbalize understanding of causative factors and behaviors necessary to correct fluid deficit.
|Monitor and record vital signs, capillary refill, status of mucous membranes, skin turgor.||Indicators of adequacy of circulating volume. Orthostatic hypotension may occur with risk of falls and injury following sudden changes in position.|
|Note amount and types of fluid intake. Measure urine output accurately.||Patient may abstain from all intake, with resulting dehydration; or substitute fluids for caloric intake, disturbing electrolyte balance.|
|Discuss strategies to stop vomiting and laxative and diuretic use.||Helping patient deal with the feelings that lead to vomiting and laxative or diuretic use will prevent continued fluid loss. Note: Patient with bulimia has learned that vomiting provides a release of anxiety.|
|Identify actions necessary to regain or maintain optimal fluid balance (specific fluid intake schedule).||Involving patient in plan to correct fluid imbalances improves chances for success.|
|Review electrolyte and renal function test results.||Fluid, electrolyte shifts, decreased renal function can adversely affect patient’s recovery or prognosis and may require additional intervention.|
|Administer and monitor IV, TPN; electrolyte supplements, as indicated.||Used as an emergency measure to correct fluid and electrolyte imbalance and prevent cardiac dysrhythmias.|
- 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
- Verbalize understanding of causative factors and awareness of impairment.
- Demonstrate behaviors to change/prevent malnutrition.
- Display improved ability to make decisions, problem-solve.
|Be mindful of patient’s distorted thinking ability.||Allows caregiver to have more realistic expectations of patient and provide appropriate information and support.|
|Listen to or 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 or behaviors typical of eating disorders, major depression, or alcohol dependence for a number of years.|
|Adhere strictly to nutritional regimen.||Improved nutrition is essential to improved brain functioning.|
|Review electrolyte and renal function tests.||Imbalances negatively affect cerebral functioning and may require correction before therapeutic interventions can begin.|
- 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
- Establish a more realistic body image.
- Acknowledge self as an individual.
- Accept responsibility for own actions.
|Allow the patient to draw picture of self.||Provides opportunity to discuss patient’s perception of self and body image and realities of individual situation.|
|Encourage 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 and 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 and sexual fears. Provide sex education as necessary.||Major physical and 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, and 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 (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 (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 and feeling so they do not interfere with care of patient.|
|Assist patient to assume control in areas other than dieting and weight loss such as management of own daily activities, work, and 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 and discomfort in social settings.||May indicate feelings of isolation and fear of rejection and 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 and 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, and 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 and hopelessness.||Lack of control is a common and 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 and behavior.||Intense anxiety and 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 or 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.|
5. Impaired Parenting
- 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
- 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.
|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, over involved 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 (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 or facilitate the process of dealing with unresolved conflicts and change.|
- 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.]
- Verbalize understanding of causative factors and absence of itching.
- Identify and demonstrate behaviors to maintain soft, supple, intact skin.
|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 and fluid intake.||Improved nutrition and hydration will improve skin condition.|
- 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
- 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.
|Determine level of knowledge and readiness to learn.||Learning is easier when it begins where the learner is.|
|Note blocks to learning (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 and 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 and vomiting.|
|Review dietary needs, answering questions as indicated. Encourage inclusion of high-fiber foods and adequate fluid intake.||Patient and 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 (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 and 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.|
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.