ANOREXIA NERVOSA

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight thats far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. Anorexia nervosa is a disease that affects all organ systems, principally the cardiovascular and endocrine systems. However, complications can also involve other systems, including the GI, renal, reproductive, neurologic, orofacial, dermatologic, and hematologic symptoms. A typical case of anorexia nervosa involves a young person (teenager or young adult) who is mildly overweight or of normal weight and who begins a diet and exercise plan to lose weight. As she loses weight and receives initial positive reinforcement for this behavior (eg, compliments by peers on her appearance), the reward is high and causes an inability to stop this behavior once an ideal weight is achieved.

Nursing Diagnoses
1. Imbalanced Nutrition: Less Than Body Requirements
Common Related Factors Severe fear of obesity Defining Characteristics Body weight 15% to 29% or more below ideal weight for height

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

Ongoing Assessment
Actions/Interventions Rationale Record the patients weight and height on This ensures accurate record of weight

intake. Weigh regularly, maintaining changes. standard conditions (i.e., same scale, same time of day, patient wearing similar clothes). Weigh the patient in a matter-of-fact manner This reduces risk of 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, including initial Clinical anorexia can follow ordinary weight motivation for weight loss or food loss dieting. restrictions. Conduct a nutritional assessment: It is critical that the 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 patients beliefs and fears Excessive focus on food and weight can be a about food and weight gain maladaptive method of coping with stress.

Knowledge about nutrition sources of information

and This information provides the basis for an individualized teaching plan about maintaining adequate nutritional intake. Behaviors used to reduce calorie This provides data on patient thinking and intake (dieting), to increase energy thought distortions. output (exercising), and generally to lose weight (vomiting, purging, and laxative abuse)

Assess cardiovascular, metabolic, renal, Assessment provides data on the severity of gastric, hematological, and endocrine system malnutrition. functioning. Monitor intake (i.e., daily food plans that These data help determine the patients actual track eating trends along with emotional caloric intake and eating behaviors. states and triggering events). Record intake and output for the hospitalized patient.

Therapeutic Interventions
Actions/Interventions Rationale Prescribe appropriate nutrition and total A gradual refeeding prescription ensures calories per day to relieve acute starvation. steady weight gain and reduces risk of medical complications. Supervise all activities immediately before This decreases opportunity to engage in

and after meals; maintain supervision compensatory activities to reduce calorie consistency. intake. Provide food and meals without comment. This helps separate emotional behaviors from eating behaviors. Set limits on all exercise but allow daily Preventing all forms of exercise may induce activity. severe anxiety. Assure the patient that treatment is not Patients have an overwhelming fear of designed to produce obesity. weight gain and obesity. Acknowledge any anger, sadness, or feeling This helps provide external emotional of loss that the patient may have toward controls that have not yet been internalized treatment. by the patient. Provide supplemental feedings and nutrition Nutritional supplements may be necessary if as indicated. the patient is malnourished. Tube or parenteral feedings may be necessary if the patient is unable to allow herself or himself oral feedings.

2. Disturbed Body Image

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

Ongoing Assessment
Actions/Interventions Rationale Explore the patients understanding of his or Patients with anorexia have a distorted body her physical body, especially as it relates to image. maturation. Assess to what degree the patients negative body image and negative

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

Therapeutic Interventions
Actions/Interventions Encourage reexamination of positive negative self-perceptions. Encourage the patient to identify differences between real people celebrities. Encourage recognition, expression, acceptance of unpleasant feelings. Rationale and The patient needs to develop a realistic understanding of his or her body image. the Patients often use media reports of celebrities and as a guide for their eating behaviors.

and Patients with anorexia have a need for control in multiple areas of their lives. Mastery over food may have become a method for reducing tensions. Help the patient develop a realistic, Patients must understand the complex health acceptable perception of body image and problems associated with anorexia. food. Refer the patient to individual counseling Multiple approaches are needed to achieve and a support group for eating disorders. long-term changes in behavior. Groups that come together for mutual support and guidance can provide long-term assistance.