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 and bulimia nervosa include establishing adequate nutritional intake, correcting fluid and electrolyte imbalance, assisting the patient to develop realistic body images, 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 the program with order disciplines.
Included in this post are seven (7) nursing care plans and nursing diagnoses for patients with eating disorders: anorexia nervosa and bulimia nervosa:
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Deficient Fluid Volume
- Disturbed Thought Process
- Disturbed Body Image, Chronic Low Self-Esteem
- Impaired Parenting
- Risk for Impaired Skin Integrity
- Deficient Knowledge
- Other Possible Nursing Diagnoses
Imbalanced Nutrition: Less Than Body Requirements
Patients with anorexia and bulimia nervosa may use laxatives to control their weight, leading to inadequate nutrient absorption and less than body requirements. Inadequate food intake in anorexia nervosa can also result in nutrient deficiencies and imbalanced nutrition. Both conditions can have significant physical and emotional consequences that require professional treatment.
- Imbalanced Nutrition: 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 the normal range (bulimia)
- Pale conjunctiva and mucous membranes; poor skin turgor/muscle tone; edema
- Excessive loss of hair; increased growth of hair on the body (lanugo)
- Bradycardia; cardiac irregularities; hypotension
- The client will verbalize understanding of nutritional needs.
- The client will establish a dietary pattern with caloric intake adequate to regain/maintain an appropriate weight.
- The client will demonstrate weight gain toward the individually expected range.
Nursing Assessment/Interventions and Rationales
For Bulimia Nervosa:
1. Identify the patient’s elimination patterns.
To prevent self-induced vomiting.
2. 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.
3. Outline the risks of laxative, emetic, and diuretic abuse for the patient.
Bulimic patients may include abuse laxatives, emetics, and diuretics.
4. Supervise the patient during mealtimes and for a specified period after meals (usually one hour).
Prevents vomiting during or after eating.
For Anorexia Nervosa:
1. Supervise the patient during mealtimes and for a specified period after meals (usually one hour).
To ensure compliance with the dietary treatment program. For a hospitalized patient with anorexia, food is considered a medication.
2. Liquids are more acceptable than solids.
Fluids eliminate the need to choose between foods – something the patient with anorexia may find difficult.
3. Expect weight gain of about 1 lb (0.5 kg) per week.
To see the effectiveness of the treatment regimen.
4. 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:
1. 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.
2. Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake.
The patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides a focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the 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 the patient and avoid manipulative games.
3. Provide smaller meals and supplemental snacks, as appropriate.
Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: The patient may feel bloated for 3–6 weeks while the body adjusts to food intake.
4. Make a selective menu available, and allow patients to control choices as much as possible.
A patient who gains confidence in self and feels in control of the environment is more likely to eat preferred foods.
5. Be alert to choices of low-calorie foods and beverages; hoard food; dispose of food in various places, such as pockets or wastebaskets.
Patients will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.
6. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results.
Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight.
7. Weigh with back-to-scale (depending on program protocols).
Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others.
8. Avoid room checks and other control devices whenever possible.
External control reinforces feelings of powerlessness and therefore is usually not helpful.
9. Provide one-to-one supervision and have a 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. The patient may desire food and use a binge-purge syndrome to maintain weight. Note: The patient may purge for the first time in response to the establishment of a weight gain program.
10. Monitor the 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, and weight and combating depression; however, patients may exercise excessively to burn calories.
11. Maintain a matter-of-fact, nonjudgmental attitude if giving tube feedings, hyperalimentation, and so on.
Perception of punishment is counterproductive to the patient’s self-confidence and faith in their own ability to control destiny.
12. Be alert to the possibility of the patient disconnecting the tube and emptying hyperalimentation if used. Check measurements, and tape tubing snugly.
Sabotage behavior is common in an attempt to prevent weight gain.
13. Provide nutritional therapy within a hospital treatment program as indicated when the 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 the patient from SO (who may be contributing factors) and provides exposure to others with the same problem, creating an atmosphere for sharing.
14. Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss.
Provides structured eating situation while allowing the patient some control over choices. Behavior modification may be effective in mild cases or for short-term weight gain.
15. Provide diet and snacks with substitutions of preferred foods when available.
Having a variety of foods available enables the patient to have a choice of potentially enjoyable foods.
16. Administer liquid diet, tube feedings, and 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.
17. Blenderize and tube-feed anything left on the tray after a given period of time if indicated.
May be used as part of a behavior modification program to provide a total intake of needed calories.
18. 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.
19. Avoid giving laxatives.
Use is counterproductive because it may be used by the patient to rid the body of food and calories.
20. Administer medication as indicated:
- 20.1. Cyproheptadine (Periactin)
A serotonin and histamine antagonist 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.
- 20.2. Tricyclic antidepressants: amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin)
Lifts depression and stimulates the appetite.
- 20.3. selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac)
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.
- 20.4. Antianxiety agents: alprazolam (Xanax)
Reduces tension, anxiety, and nervousness and may help the patient to participate in treatment.
- 20.5. Antipsychotic drugs: chlorpromazine (Thorazine)
Promotes weight gain and cooperation with the psychotherapeutic program; however, used only when absolutely necessary because of the possibility of extrapyramidal side effects.
- 20.6. Monoamine oxidase inhibitors (MAOIs): tranylcypromine sulfate (Parnate)
May be used to treat depression when other drug therapy is ineffective; decreases the urge to binge in bulimia.
21. Assist with electroconvulsive therapy (ECT) if indicated. Discuss reasons for use and help the 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 the patient to begin eating and become accessible to psychotherapy.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to endocrine system and metabolism disorders:
- Acid-Base Balance
- Addison’s Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 17 Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 5 Care Plans
- Thyroidectomy | 5 Care Plans
2 thoughts on “7 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans”
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Question: Does it mean we have just two types of eating disorder?