7 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans

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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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Impaired Parenting

Impaired Parenting: Inability of the primary caregiver to create, maintain, or regain an environment that promotes the optimum growth and development of the child.

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

  • Client will demonstrate individual involvement in problem-solving process directed at encouraging patient toward independence.
  • Client will express feelings freely and appropriately.
  • Client will demonstrate more autonomous coping behaviors with individual family boundaries more clearly defined.
  • Client will recognize and resolve conflict appropriately with the individuals involved.
Nursing InterventionsRationale
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 the competent actions of the 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 the 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 the 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 the 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 interacts. 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.
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See Also

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