7 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans

By
Matt Vera, BSN, R.N.
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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

Nursing care planning for patients with eating disorders: anorexia nervosa, bulimia nervosa includes establishing adequate nutritional intake, correcting fluid and electrolyte imbalance, assist patient to develop a realistic body image and improving self-esteem. Other than the mentioned above, it is also an important nursing priority to provide support in the treatment program and coordinate program with order disciplines.

Included in this post are seven (7) nursing care plans and nursing diagnosis for patients with eating disorders: anorexia nervosa and bulimia nervosa:

  1. Imbalanced Nutrition: Less Than Body Requirements
  2. Risk for Deficient Fluid Volume
  3. Disturbed Thought Process
  4. Disturbed Body Image, Chronic Low Self-Esteem
  5. Impaired Parenting
  6. Risk for Impaired Skin Integrity
  7. Deficient Knowledge
  8. Other Possible Nursing Diagnoses
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Disturbed Body Image, Chronic Low Self-Esteem

Nursing Diagnosis

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

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  • 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

  • Client will establish a more realistic body image.
  • Client will acknowledge self as an individual.
  • Client will accept responsibility for own actions.
Nursing Interventions Rationale
Allow the patient to draw a picture of self. Provides an opportunity to discuss the patient’s perception of self and body image and realities of an individual situation.
Encourage personal development program, preferably in a group setting. Provide information about the proper application of makeup and grooming. Learning about methods to enhance personal appearance may be helpful to a 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 an incentive to at least maintain and not lose weight. Removes visual reminder of thinner self. Positive image enhances sense of self-esteem.
Assist the 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 the 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. The 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, the 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 a person may feel a 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, the patient knows risks involved in not following established rules (decrease in privileges). Failure to follow rules is viewed as a patient’s choice and accepted by staff in a matter-of-fact manner so as not to provide reinforcement for undesirable behavior.
Respond (confront) with reality when a patient makes unrealistic statements. 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 a 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. The nurse needs to deal with own response and feeling so they do not interfere with the care of the 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 the 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 the patient. Patient may also believe she or he has to be the best in everything and holds self-responsible for being perfect.
Let the patient know that is acceptable to be different from family, particularly mother. Developing a sense of identity separate from family and maintaining a sense of control in other ways besides dieting and weight loss is a desirable goal of therapy and program.
Use the 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 the 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 the patient because anger is generally considered unacceptable in the family, and therefore the patient does not express it.
Assist patient to learn strategies other than eating for dealing with feelings. Have the patient keep a diary of feelings, particularly when thinking about food. Feelings are the underlying issue, and the 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 the 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 the time that has been occupied by the obsession with eating. Involvement in recreational activities encourages social interactions with others and promotes fun and relaxation.
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