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NCP Anorexia Nervosa

Eating Disorder

Anorexia nervosa is a disorder characterized by an intense fear of obesity or weight gain


and the inability or refusal to maintain body weight at 85% minimum expected for height. It is
generally considered to be a disorder of young women that begins in adolescence or young
adulthood. It is becoming more common in males. Anorexia nervosa is marked by severely
restricted calorie intake, despite hunger, which leads to malnourishment and serious weight loss.
The patient with anorexia nervosa achieves and maintains massive weight loss by calorie
restriction; self-induced vomiting; abuse of cathartics, laxatives, or enemas; and/or excessive
exercising. Many patients have severe disturbances in self-concept, self-esteem, and body image
and may benefit from a therapeutic approach that involves nutritional consults, individual and family
therapy, and medical management of the complicated organ system imbalances that this order
brings about. Patients may be hospitalized briefly during the initial acute phase of treatment, when
medical problems require intensive monitoring and complicated therapies. The initial aim of
treatment is to stabilize the patient medically and stop weight loss. When medically stable, the
patient can be managed in outpatient day treatment or partial hospitalization programs.

Nursing Diagnosis

Imbalanced Nutrition: Less Than Body Requirements

Common Related Factors Defining Characteristics


Severe fear of obesity Body weight 15% to 29% or
Severely distorted self-concept, more below ideal weight for
self-esteem, and/or body height
image Self-restricted calorie intake
Absence of physical conditions despite hunger
that would explain weight loss Obsession with food, calories,
or prevent weight gain weight, and control issues

Common Expected NOC Outcomes


Outcomes Nutritional Status: Food and
Patient stops losing weight. Fluid Intake; Weight Control
Patient begins to gain weight. NIC Interventions
Patient recognizes eating Eating Disorders Management;
disorder. Weight Gain Assistance;
Nutritional Therapy
Ongoing Assessment

Actions/Interventions Rationale
Record the patients weight and
height on intake. Weigh regularly,
maintaining standard conditions This ensures accurate record
(i.e., same scale, same time of of weight changes.
day, patient wearing similar
clothes).
Weigh the patient in a matter-of- This reduces risk of acting-out
fact manner without discussion. behaviors. Weight gain is only
one aspect of the total
therapeutic program; other
critical factors include
nutritional adequacy, behaviors
related to eating, appropriate
use of exercise, and
development of a healthy body
image.
Obtain weight history, including Clinical anorexia can follow
initial motivation for weight loss ordinary weight loss dieting.
or food restrictions.
Conduct a nutritional It is critical that the health care
assessment: provider openly discuss and
have an understanding of the
complex food and weight-
related behaviors of the patient
so that appropriate supports
can be integrated into the
treatment plan.
Assess the patients beliefs and Excessive focus on food and
fears about food and weight weight can be a maladaptive
gain method of coping with stress.
Knowledge about nutrition and This information provides the
sources of information basis for an individualized
teaching plan about
maintaining adequate
nutritional intake.
Behaviors used to reduce This provides data on patient
calorie intake (dieting), to thinking and thought
increase energy output distortions.
(exercising), and generally to
lose weight (vomiting, purging,
and laxative abuse)
Assess cardiovascular, Assessment provides data on
metabolic, renal, gastric, the severity of malnutrition.
hematological, and endocrine
system functioning.
Monitor intake (i.e., daily food These data help determine the
plans that track eating trends patients actual caloric intake
along with emotional states and and eating behaviors.
triggering events). Record intake
and output for the hospitalized
patient.

Therapeutic Interventions

Actions/Interventions Rationale
A gradual refeeding prescription
Prescribe appropriate nutrition
ensures steady weight gain and
and total calories per day to
reduces risk of medical
relieve acute starvation.
complications.
Supervise all activities This decreases opportunity to
immediately before and after engage in compensatory
meals; maintain supervision activities to reduce calorie
consistency. intake.
Provide food and meals without This helps separate emotional
comment. behaviors from eating behaviors.
Set limits on all exercise but Preventing all forms of exercise
allow daily activity. may induce severe anxiety.
Assure the patient that Patients have an overwhelming
treatment is not designed to fear of weight gain and obesity.
produce obesity.
Acknowledge any anger, This helps provide external
sadness, or feeling of loss that emotional controls that have not
the patient may have toward yet been internalized by the
treatment. patient.
Provide supplemental feedings Nutritional supplements may be
and nutrition as indicated. necessary if the patient is
malnourished. Tube or
parenteral feedings may be
necessary if the patient is
unable to allow herself or
himself oral feedings.

Nursing Diagnosis
Disturbed Body Image

Common Related Factors Defining Characteristics


Distorted views of ones
Difficulty coping with development body weight and shape for
and maturation age
Inability to achieve unreasonable Negative feelings about self
personal goals and body
Alexithymia (channeling Self-loathing (impulsive or
uncomfortable feelings into obsessive)
behaviors such as self-starvation) Intense fear of gaining or not
being able to lose weight
Common Expected Outcomes NOC Outcome
Patient identifies positive thoughts Body Image
and feelings regarding body and NIC Interventions
self. Self-Awareness
Patient identifies a direct means of Enhancement; Body Image
coping with problems. Enhancement

Ongoing Assessment

Actions/Interventions Rationale
Explore the patients understanding of his
or her physical body, especially as it
Patients with anorexia
relates to maturation. Assess to what
have a distorted body
degree the patients negative body image
image.
and negative self-concept are related to
overwhelming anxiety.
Assess to what degree culture, religion, Cultural and social
race, and gender influence the patients norms about body
negative views of self. size and shape may
influence the patients
thinking and feelings
about his or her body
image.
Determine the family or patients These data need to
perceptions regarding psychological and be compared to the
physical changes brought about by patients thinking prior
anorexia. to the onset of
anorexia.
Obtain the patients assessment of Patients learn they
personal strengths and weaknesses. have the ability to
handle day-to-day
stress.
Assess the patients ability to identify The patient may not
here and now emotional states and be aware of the
precipitating events that trigger negative relationship between
behaviors. feelings and eating
behaviors.
Therapeutic Interventions

Actions/Interventions Rationale
Encourage reexamination of The patient needs to develop a
positive and negative self- realistic understanding of his or
perceptions. her body image.
Encourage the patient to Patients often use media
identify the differences reports of celebrities as a guide
between real people and for their eating behaviors.
celebrities.
Encourage recognition, Patients with anorexia have a
expression, and acceptance of need for control in multiple
unpleasant feelings. areas of their lives. Mastery
over food may have become a
method for reducing tensions.
Help the patient develop a Patients must understand the
realistic, acceptable perception complex health problems
of body image and food. associated with anorexia.
Refer the patient to individual Multiple approaches are
counseling and a support needed to achieve long-term
group for eating disorders. changes in behavior. Groups
that come together for mutual
support and guidance can
provide long-term assistance.