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Let's explore the different eating disorders. Anorexia nervosa consists of restricting the food that they're eating, so they're not going to be eating very much at all. This is going to lead to significantly low body weight. Bulimia nervosa will also lead to low body weight, but the difference is they're going to eat, but then they're going to purge. They're going to vomit it all out afterwards. Eating disorders such as binge eating are a little bit different. So, this is where the patient is just going to eat a lot and they're not purging afterwards. They're eating a lot. They might be a little larger in size, right? They're going to gain weight and then they're going to feel really guilty afterwards. So, eating disorders often coexist with other mood disorders or personality disorders, such as substance abuse, and they involve an altered perception of their weight or uncontrolled eating. The patient's going to verbalize an understanding of their nutritional needs after we're done with them. That's our “what” that we're hoping for right? We want them to improve their weight toward the normal range, whether it's larger or smaller, and they need to establish a realistic body image. We need them to realize that they're not fat. If they're super skinny (skin and bone), we need them to understand that this is not realistic at all. Your expectations are not realistic.
Now, let's take a look at the care plan for eating disorders, starting with the subjective data.
So, the patient with anorexia nervosa may have an obsession with calories or fat content on foods. They might look at that calorie content on the back of the box and just obsess over it like, oh, this is too many calories. This is because of their disturbed body image and their fear of gaining weight. So, those with bulimia nervosa might not be as obsessed with those calories, but instead they might disappear after they've eaten. This is because they're going to vomit, right? So, This will prevent their body from absorbing the calories which they need, so the patient may also have a chronically sore throat. This is because of the repeated vomiting, so it might really be sore all the time. They might even have a scratchy voice. Patients with eating disorders, they are probably gonna show denial. They're not gonna accept that they have a low body weight and they might be really fatigued and weak because they are not getting those nutrients that they need and they also might have a lack of muscle mass.
Now let's talk about the objective data. The patient might notice that they're restricting their eating. They're just not eating very much at a time and they might not like to eat around people either. So, the patient may appear really emaciated, you know, really, really skinny, and they might have really brittle hair that breaks super easily, really thin and brittle. Their nails might break really easily. They might even have hair covering their body, which is called lanugo, which is so unusual, right? You think of that in babies, but this is because the body is attempting to protect itself. They're so thin that they're freezing, so they're going to start getting hair to keep them warm. Then the patient might look really lethargic because remember, they're not getting that nutrition that they really need for their body to function properly. The patient with binge eating disorder might eat really abnormally fast sometimes around you, but sometimes in secret, you might not even see it going on. Those with bulimia nervosa might eat normally fast as well, but then they disappear into another room so that they can purge.
Now, let's talk about the nursing interventions for the patient with an eating disorder. You should assess the patient, taking notes on their skin, their muscle tone, neuro status and mental health. Obtain a baseline, know any deficits or issues that require prioritization,such as nutrition. That's probably going to be your first priority. So you'll want to get nutrition in them one way or another. You will assess the patient's nutritional status and set a weight goal. This is so that you can determine if the patient is underweight or overweight and this is our little scale here, and remember to watch for food hoarding because sometimes they will, and also watch for disposal of food. These people can be really strategic in the ways that they handle their food. Make sure you supervise them during their meals and for one hour after in case they're going to go purge. So, this is so that you can try to determine what their eating habits are and so you can prevent that purging, right? Provide small meals. Snacks are awesome because you know, throughout the day just do small meals, small snacks and even liquids because it's a lot easier to digest and it's easier for them to choose a simple liquid than try to figure out what they are going to eat? It's going to make digestion easier. It'll help to minimize the bloating.
You want to record weights and monitor their exercise program. This is so that you can monitor their progress and improve muscle strength and tone as they increase their caloric intake. You're going to provide medication and TPN as appropriate. So TPN would be for really severe malnourishment. Other medications might need to be given for mental disorders that they have along with therapy. Provide education for the patient and the family. This is important because the family might be very involved in this patient's life, so give them information about the disease, about treatment and resources. This is to help reduce stress and help them make decisions because this can be a really scary time for them.
We love you guys. Now go out and be your best self today and as always, happy nursing!
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