Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

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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.

Writing a Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

A Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this care plan, we will cover eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. So, in this eating disorders care plan, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationale for each. 

 

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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