Anorexia Nervosa

Defined

Anorexia nervosa is a clinical syndrome in which the person has a morbid fear of obesity. It is characterized by the
individual’s gross distortion of body image, preoccupation with food, and refusal to eat. The disorder occurs
predominantly in females 12 to 30 years of age. Without intervention, death from starvation can occur.

Symptomatology (Subjective and Objective Data)

1. Morbid fear of obesity. Preoccupied with body size. Reports “feeling fat” even when in an emaciated condition.

2. Refusal to eat. Reports “not being hungry,” although it is thought that the actual feelings of hunger do not cease
until late in the disorder.

3. Preoccupation with food. Thinks and talks about food at great length. Prepares enormous amounts of food for
friends and family members but refuses to eat any of it.

4. Amenorrhea is common, often appearing even before noticeable weight loss has occurred.

5. Delayed psychosexual development.

6. Compulsive behavior, such as excessive hand washing, may be present

7. Extensive exercising is common.

8. Feelings of depression and anxiety often accompany this disorder.

9. May engage in the binge-and-purge syndrome from time to time (see following section on bulimia nervosa.

Bulimia Nervosa

Defined

Bulimia nervosa is an eating disorder (commonly called “the binge-and-purge syndrome”) characterized by extreme
overeating, followed by self-induced vomiting and abuse of laxatives and diuretics. The disorder occurs
predominantly in females and begins in adolescence or early adult life.

Symptomatology (Subjective and Objective Data)

1. Binges are usually solitary and secret, and the individual may consume thousands of calories in one episode.

2. After the binge has begun, there is often a feeling of loss of control or inability to stop eating.

3. Following the binge, the individual engages in inappropriate compensatory measures to avoid gaining weight
(e.g., self-induced vomiting; excessive use of laxatives, diuretics, or enemas, fasting; and extreme exercising).

4. Eating binges may be viewed as pleasurable but are followed by intense self-criticism and depressed mood.

5. Individuals with bulimia are usually within normal weight range, some a few pounds underweight, and some a
few pounds overweight.

6. Obsession with body image and appearance is a predominant feature of this disorder. Individuals with bulimia
display undue concern with sexual attractiveness and how they will appear to others.

7. Binges usually alternate with periods of normal eating and fasting.

8. Excessive vomiting may lead to problems with dehydration and electrolyte imbalance.

9. Gastric acid in the vomitus may contribute to the erosion of tooth enamel.
S.N ASSESSMENT NURSING NURSING IMPLEMENTATION RATIONAL EVALUATION
DIAGNOSIS GOAL

1. Subjective and Imbalance Short term If client is unable or Without Client has
objective data nutrition less goal: Goal unwilling to maintain adequate achieved and
than body Client will adequate oral intake, nutrition, a maintained at
requirement gain 0.5–1.0 physician may order a life- least 85% of
related to kg per week liquid diet to be threatening expected body
refusal to administered via situation weight. Vital
Long-term nasogastric tube. exists. signs, blood
eat ,self-
Goal By Nursing care of the
induced pressure, and
discharge individual receiving
vomiting, laboratory
from tube feedings should
abuse of treatment, be administered serum studies
laxatives client will according to are within
evidenced by exhibit no established hospital normal limits.
loss of signs or protocol. Client
weight ,poor symptoms of verbalizes
muscle tone malnutrition. For the client who is importance of
Adequate adequate
hypotension, able and willing to
consume an oral diet, calories are nutrition.
pale,
the dietitian will required to
determine number of affect a
calories required to weight gain of
provide adequate 0.5-1 kg per
nutrition and realistic. week.
Without a
Sit with client during time limit,
mealtimes for support meals can
and to observe amount become
ingested. A limit lengthy,
(usually 30 minutes) drawn-out
should be imposed on sessions,
time allotted for providing
meals. client with
attention
based on food
and eating.
Emotional
issues must be
resolved if
 these
Encourage the client maladaptive
to explore and identify responses are
the true feelings and to be
fears that contribute to eliminated
maladaptive eating
behaviors.

The
2. therapeutic
Short-term nurse-client
Establish a trusting Client is able to
Goal The relationship is
Ineffective relationship with assess
client will built on trust.
client by being maladaptive
denial related verbalize
honest, accepting, and coping
to Delayed understandin
available and by behaviors
ego g of the
keeping all promises. accurately.
development correlation
Convey unconditional Client is able to
,Unfulfilled between Anger is a
positive regard. verbalize
tasks of trust emotional normal adaptive coping
issues and human
and strategies that
maladaptive response, and
autonomy ,Fe can be used in
eating Acknowledge client’s
elings of should be the home
behaviors anger at feelings of
helplessness expressed in environment
(within time loss of control
and lack of brought about by the an
deemed
control in life appropriate established eating appropriate
situation for individual regimen associated manner.
evidenced by client). with the program of Feelings that
Preoccupation behavior modification are not
with extreme expressed
fear of remain
Long-term unresolved
obesity, and
Goal By time and add an
distortion of
of discharge
own body additional
from
image. component to
treatment,
an already
the client will
demonstrate serious
the ability to situation
discontinue
use of
maladaptive
eating
behaviors and
to cope with
emotional
issues in a
more
 adaptive When client
manner. feels control
over major
to Explore with client life issues, the
maladaptive ways in which he or need to gain
eating she may feel in control
behaviors. control within the
through
environment without
maladaptive
resorting
eating
behaviors will
diminish

Client’s own
identification
of strengths
and positive Client is able to
Short-term verbalize
attributes can
Goal Client Help client reexamine positive aspects
negative perceptions increase
will verbally about self and
acknowledge of self and recognize sense of self- Client
Disturbed misperception positive attributes. worth. expresses
body of body image interest in
image/low as “fat” within welfare of
self-esteem specifi ed others and less
related to time preoccupation
Positive with own
Lack of
reinforcement appearance.
positive
enhances self-
feedback
Offer positive esteem and
evidenced by reinforcement for may
Distorted independently made encourage
body image, decisions influencing client to
views self as client’s life. continue
fat, even in
functioning
the presence
more
of normal
independently
body weight
or severe As client
emaciation. begins to feel
Help client realize that better about
perfection is self and
unrealistic, and identifies
explore this need with positive self-
him or her. attributes,
and develops
the ability to
accept certain
personal
inadequacies,
the need for
unrealistic
achievements
should
diminish.