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Outline
Pathophysiology
Eating disorders are a serious, sometimes fatal illness that cause a significant change in a client’s eating behaviors that most commonly occurs in young women (teens – 20s), but can occur in clients of any gender or age. Early detection and treatment improves the likelihood of recovery. Types of eating disorders include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging) and binge-eating disorder (binge-eating without purging). Inadequate nutrition can lead to serious medical complications and even death. These conditions frequently coexist with other mood or personality disorders and substance abuse.
Etiology
Diagnostic Criteria:
Anorexia Nervosa
- Restriction of nutritional intake that leads to significant low body weight
- Intense fear of gaining weight or becoming fat
- Altered perception of body weight or shape
Bulimia Nervosa
- Recurrent episodes of binge-eating and BOTH:
- Eating a larger amount of food in a short period of time than normal
- Lack of control over eating
- Recurrent purging: self-induced vomiting, misuse of laxatives, diuretics, fasting or excessive exercise
- Binge-eating and purging both occur at least once a week for 3 months
- Self perception is unreasonably influenced by body shape and weight
Binge-Eating Disorder
- Recurrent episodes of binge-eating and BOTH:
- Eating a larger amount of food in a short period of time than normal
- Lack of control over eating
- Binge-eating episodes are associated with 3 or more of the following:
- Eating quickly, until uncomfortably full, or alone due to embarassment
- Eating large amounts of food when not physically hungry
- Feeling disgusted with oneself or guilty afterward
- Marked distress regarding binge-eating
- Binge-eating occurs at least once/wk for 3 months
- Binge-eating is not associated with purging
Desired Outcome
Client will verbalize understanding of nutritional needs. Client will improve weight toward normal range. Client will establish more realistic body image. Client will demonstrate compliance with therapy and treatment.
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) Nursing Care Plan
Subjective Data:
- Obsession with calories or fat content of foods
- Depression
- Fear of gaining weight
- Denial of low body weight
- Constipation
- Feeling cold most of the time
- Feeling tired
- Muscle weakness
- Chronic sore throat
- Abdominal pain
- Eating alone or in secret
- Frequent dieting
*Note – the presence of these symptoms individually do not indicate an eating disorder, assess the full clinical picture.
Objective Data:
- Restricted eating
- Emaciation
- Low blood pressure
- Infertility
- Lethargy
- Brittle hair and nails
- Dry, yellowing skin
- Muscle wasting
- Thinning bones
- Eating very fast
- Growth of hair all over the body (lanugo)
Nursing Interventions and Rationales
- Perform complete nursing assessment noting skin, muscle tone and neurological status; include weight (BMI) and vital sign assessment
Get a baseline for effectiveness of interventions. Note any deficits or other issues that may need to be prioritized.
Determine severity of condition.
- Assess nutritional status and set a weight goal
Determine if client is under or over weight and nutritional needs
- Assess client for depression and suicide potential
Clients with eating disorders often have accompanying depression with suicidal thoughts. Monitor for safety.
- Supervise client during meals and for at least one hour after eating (in inclient treatment)
Determine client’s eating habits and prevent purging after meals.
- Encourage liquid intake over solid foods
Eliminates the need to choose foods, provides hydration and is more easily digested.
- Provide small meals and snacks appropriately
Prevents bloating and discomfort in clients following starvation and encourages eating more appropriate portions.
- Monitor for signs of food hoarding or disposing of food.
Clients may try to hoard food for secretive eating or dispose of food to avoid calories.
- Monitor exercise program and set limits and goals accordingly
Moderate exercise helps maintain muscle strength and tone, but excessive exercise burns too many calories and contributes to clients’ disorder.
Alternatively, lack of exercise can lead to depression, muscle wasting and increased weight and a negative self image.
- Administer TPN supplemental nutrition as appropriate
In cases of severe malnourishment and life-threatening situations, TPN may be used to maintain gastric function and provide nourishment.
- Monitor fluid balance and administer oral and IV fluids as appropriate
Failure to eat or drink and repeated purging through vomiting or excessive use of laxatives can cause a fluid imbalance and lead to dehydration. Prevent electrolyte imbalances and cardiac involvement by maintaining adequate hydration.
- Record routine weights per facility protocol
Monitor progress of interventions and incorporate routine accountability checks for clients.
- Monitor skin for wounds, dryness, excoriation or deep tissue injuries
Lack of hydration and proper nutrition lead to decreased perfusion and poor circulation. Dryness and itching is common. Wounds may develop over bony prominences.
- Administer medications appropriately
- SSRI antidepressants
- Anti-anxiety medications
- Psychostimulants
Medications may help relieve the underlying conditions that increase symptoms by improving mood and thinking.
Psychostimulants have proven helpful in studies to help treat binge-eating disorder and maintain weight.
Some medications may be given to curb appetite so that cognitive behavior therapy may be more effective.
- Provide education for clients and family members regarding disease, treatment and support resources
Help client and family members make informed decisions and reduce stress and anxiety about treatments. Provide opportunity for continued support and therapy for optimal recovery.
References
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