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 Defining

Factors Characteristics
Severe fear of obesity
Body weight 15% to
Severely distorted
29% or more below
self-concept, self-
ideal weight for height
esteem, and/or body
Self-restricted calorie
image
intake despite hunger
Absence of physical
Obsession with food,
conditions that would
calories, weight, and
explain weight loss or
control issues
prevent weight gain
Common Expected NOC Outcomes
Outcomes Nutritional Status: Food
Patient stops losing and Fluid Intake;
weight. Weight Control
Patient begins to gain NIC Interventions
weight. Eating Disorders
Patient recognizes Management; Weight
eating disorder. Gain Assistance;
Nutritional Therapy

Ongoing Assessment

Actions/Interventions Rationale
Record the patient’s
weight and height on
intake. Weigh regularly,
This ensures accurate
maintaining standard
record of weight
conditions (i.e., same
changes.
scale, same time of
day, patient wearing
similar clothes).
Weigh the patient in a This reduces risk of
matter-of-fact manner acting-out behaviors.
without discussion. 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, Clinical anorexia can
including initial follow ordinary weight
motivation for weight loss dieting.
loss or food restrictions.
Conduct a nutritional It is critical that the
assessment: health care 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 patient’s Excessive focus on
beliefs and fears about food and weight can
food and weight gain• be a maladaptive
method of coping with
stress.
Knowledge about This information
nutrition and sources of provides the basis for
information• an individualized
teaching plan about
maintaining adequate
nutritional intake.
• Behaviors used to This provides data on
reduce calorie intake patient thinking and
(dieting), to increase thought distortions.
energy output
(exercising), and
generally to lose weight
(vomiting, purging, and
laxative abuse)
Assess cardiovascular, Assessment provides
metabolic, renal, data on the severity
gastric, hematological, of malnutrition.
and endocrine system
functioning.
Monitor intake (i.e., These data help
daily food plans that determine the
track eating trends patient’s actual
along with emotional caloric intake and
states and triggering eating behaviors.
events). Record intake
and output for the
hospitalized patient.

Therapeutic Interventions

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

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

Ongoing Assessment

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

Therapeutic Interventions

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