Nursing care plan anorexia nervosa bulimia nervosa

I. Pathophysiology: Eating disorders encompass a spectrum of
psychological problems that involve insufficient or excessive
food intake, resulting in significant health problems across the
life span.
a. Anorexia nervosa (AN)
i. Serious, chronic illness of starvation associated with a
severe disturbance of body image and a morbid fear of
obesity
ii. Constellation of factors involved include an individual’s
genetic makeup, personality, and psychological and
emotional challenges
iii. Divided into early, mild, or established stages
b. Bulimia nervosa (BN)
i. Chronic cycle involving binge eating and purging
ii. Characterized by binges of overeating, which may be
extreme, followed by self-induced vomiting, purging,
and misuse of laxatives, diuretics, or enemas; may also
involve nonpurging behaviors such as excessive exercise
and fasting
iii. Fear of gaining weight motivates purging or compensatory
behaviors
iv. Often seen in persons of normal weight, but may be seen
in overweight clients
c. Binge eating disorder (BED)
i. Characterized by binge eating without inappropriate
compensatory behaviors such as purging or fasting
ii. Ingestion of large amounts of food with a sense of loss
of control; frequent dieting without weight loss

II. Etiology (Murphy, 2007)
a. The hypothalamus, which regulates appetite by signaling
hunger and satiety, may not release balanced amounts of neurotransmitters,
such as serotonin or pancreatic polypeptides.
b. Occurs in either sex and in people of any race, age, or social
stratum
c. Both AN and BN can be present in the same individual.
d. Risk factors
i. Personal characteristics: low self-esteem and feelings of
helplessness
ii. Social factors: popular cultural preferences, media
images, peer pressure, occupational expectations, for
example, model, dancer, athlete
iii. Family structure: theory suggests that girls who live in
families that highly value perfection are at a greater risk
for developing an eating disorder.
iv. Presence of psychiatric comorbidities: anxiety, depression,
addictive behavior, or impulse control disorders
v. Genetics

III. Statistics
a. AN, BN, BED
i. Morbidity: Estimated to affect 8 million Americans
(7 million females, 1 million males); only 1 in
10 individuals with an eating disorder receive treatment
(South Carolina Department of Mental Health
[SCDMH], 2006); incidence increasing in middle-aged
women (Pryor, 2007).
ii. Mortality: Eating disorders have the highest mortality
rate of any mental illness; without treatment, up to 20%
of people with serious eating disorders die, the highest
mortality rate for any mental illness (Murphy, 2007).
iii. Cost: More than $3.8 billion was spent annually in the
United States in 2001 (PsychCentral, 2004).
b. AN
i. Morbidity: More common in girls and women, although
approximately 10% to 15% of cases occur in males
(Bernstein, 2008); only about 50% of those affected will
recover, with best results occurring if treatment is begun
within the first 6 months of onset and supportive parents
and family are present (Speranza, 2007).
ii. Mortality: Ranges from 10% to 20% and often related
to length of illness (Speranza, 2007).
c. BN
i. Morbidity: Most common in white (more than 95%)
adolescents (more than 75%) and young adults, affecting
primarily adolescent girls (6%) and college-aged
women (5%); lifetime prevalence about 3% (National
Institute of Mental Health, 2007).
ii. Mortality: Up to 3% eventually die of complications
from the disease; leading cause of death is suicide,
which is more common in persons with BN than those
with AN (Moreno & Judd, 2008).

Care Setting
Acute care is provided through inpatient stay on a medical
or behavioral unit and for correction of severe nutritional
deficits and electrolyte imbalances or initial psychiatric stabilization.
Long-term care is provided in an outpatient or
day treatment program (partial hospitalization) or in the
community.

Related Concerns
Dysrhythmias,
Fluid and electrolyte imbalances,
Metabolic alkalosis—primary base bicarbonate excess,
Total nutritional support: parenteral/enteral feeding,
Psychosocial aspects of care,

Nursing Priorities
1. Obtain client’s cooperation in treatment.
2. Reestablish adequate, appropriate nutritional intake.
3. Correct fluid and electrolyte imbalance.
4. Assist client to develop realistic body image and improve
self-esteem.
5. Provide support and involve significant other (SO), if
available, in treatment program.
6. Coordinate total treatment program with other disciplines.
7. Provide information about disease, prognosis, and treatment
to client and SO.

Discharge Goals
1. Adequate nutrition and fluid intake maintained.
2. Maladaptive coping behaviors and stressors that precipitate
anxiety recognized.
3. Adaptive coping strategies and techniques for anxiety
reduction and self-control implemented.
4. Self-esteem increased.
5. Disease process, prognosis, and treatment regimen
understood.
6. Plan in place to meet needs after discharge.

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