Professional Documents
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Bulimia Nervosa
Anorexia Nervosa
Eating Disorders
Significant health problem among children,
adolescents and young WOMEN
1% of young women ages 12 to 25
affected by anorexia nervosa
Eating Disorders: Epidemiology
Affects more women than men
Depression commonly affects the clients
Anorexia= 1%
Bulimia= 3-5%
Eating Disorders: Etiology
Biological factors= postulated changes in
the neurotransmitters
Psychoanalytical= disturbed
relationships, usually between mother
and child, distorted body image with
misperception of internal needs and
anxiety control is by body control.
Eating Disorders: Etiology
3. Socio-cultural= thinness is promoted by
media and culture
4. Cognitive-behavioral= obsessive
compulsive behavior and avoidant
behavior are vulnerable to eating
disorders
5. Physical and sexual abuse
Eating Disorders:
Distortions attributed to eating disorders
Selective abstraction = “I’m still fat”
Superstitious thinking
Eating Disorders:
Anorexia Bulimia
Weight less than ideal Binge eating and
Intense fear of purging
becoming fat Binges commonly lead
Body image to feelings of loss of
disturbance control, guilt,
Engages in exercise humiliation
and peculiar food
habits
Lack of sense of control
Eating Disorders: Personality traits
Anorexia Bulimia
Resistance to Feeling of helplessness
acknowledging they
have a problem Variable moods=
fatigue, agitation
Hyper-rigid behaviors
Difficulty learning from Sense of loss of control
experience Low self-esteem
Inflexible thinking leading to self doubt
Social introversion Self-conscious
Limited social Sensitive to rejection
spontaneity from others
Eating Disorders: Personality traits
Anorexia Bulimia
Younger (18-20) Older (24-30 yo)
Unable to Weight fluctuates
maintain body considerably
weight at 85%
expected
Amenorrhea Amenorrhea
Starvation Binge eating
Intense fear of Fears loss of control
becoming obese
Eating Disorders: Personality traits
Anorexia Bulimia
Prefers HEALTH Prefers HIGH calorie
food foods
Preoccupation with Repeated CRASH
buying and
preparing foods dieting, use of
laxatives and
Rigorous exercise
diuretics
Views self as
OVERWEIGHT Aware that behavior
is ABNORMAL
Anorexia Nervosa
A syndrome manifested by self-induced
starvation resulting from FEAR of fatness
rather than from true loss of appetite.
Onset: adolescent years
Female more than male
Anorexia Nervosa
FEATURES of Anorexia Nervosa
Relentless pursuit of thinness
Amenorrhea
Refusal to maintain ideal weight
Distorted body image
Fear of loss of control
Alexithymia: lack of awareness, mistrust
of others and self, starvation-induced
depression
Anorexia Nervosa
FEATURES of Anorexia Nervosa
The patient is pre-occupied with foods
that prevent weight gain and is fearful of
foods that increase weight
They are usually the achievers and
perfectionist
3. OBESITY
The Nursing Process for Eating
Disorders
ASSESSMENT
Psychosocial assessment begins when
the nurse establishes a trusting
relationship with the client and
families
The nurse must identify the reason for
hospitalization and a complete family
assessment
The Nursing Process for Eating
Disorders
ASSESSMENT
Other parts of assessment include a
biological history and medical history
Nutritional assessment is also very
important
PHYSICAL examination and laboratory
exams should be included
The Nursing Process for Eating
Disorders
ASSESSMENT
Other assessment components:
1. Mental status examination
2. Substance abuse history
3. Family and social history
4. Past and present psychiatric treatment
The Nursing Process for Eating
Disorders
DIAGNOSES
Imbalanced Nutrition: Less than body
requirements related to dysfunctional
eating patterns
Disturbed body image related to fear of
weight gain
Powerlessness related to lack of control
over food avoidance
Anxiety
Constipation/Diarrhea
Decreased cardiac output
Ineffective coping
The Nursing Process for Eating
Disorders
PLANNING
To maintain ideal body weight
To provide insight and teach coping
skills
The Nursing Process for Eating
Disorders
IMPLEMENTATION for Anorexia Nervosa
Weigh the patient at specific and regular
intervals (About 2x-3x a week) with minimal
clothing (hospital gown), patient facing
away from the weighing scale
Provide for safety and physical needs
STAY with the patient and observe her
within 1 to 2 hours AFTER EATING
Encourage the client to share feelings to
staff
The Nursing Process for Eating
Disorders
IMPLEMENTATION for Anorexia Nervosa
Teach relaxation techniques
Discuss factors interfering with client’s
inability to eat
Document intake and output
Educate the client about the negative
effects of dietary restriction and LOW
weight and the rationale for normal weight
Instruct the client on how to increase
caloric intake and developing strategies for
coping with anxiety
The Nursing Process for Eating
Disorders
IMPLEMENTATION for Bulimia
1. Encourage development of behavioral
diary
2. Encourage expression of feelings
3. Educate about the physical
consequences of binging, self-
induced vomiting and use of drugs
4. Limit exercising, frequent weighing
and obsessive caloric counting
The Nursing Process for Eating
Disorders
IMPLEMENTATION for Bulimia
5. Stay with client after eating for 1-2
hours
7. Reinforce healthy coping
8. Monitor F and E status
General Interventions
Assess the client’s nutritional status
Establish a CONTRACT with the client
concerning the diet plan for the day
Assist the client in identifying
precipitators of the eating disorder
Encourage the client to state feelings
about the eating behavior
Encourage behavior modification
General Interventions
Convey an accepting and non-
judgmental attitude
Provide POSITIVE reinforcement for
accomplishments
SUPERVISE client during mealtimes
and few hours after
SET A TIME LIMIT FOR EACH MEAL
Provide a pleasant atmosphere for
eating
General Interventions
Monitor for signs of physical
complications related to the eating
disorder
WEIGH client daily with same scale,
same time, same clothing (hospital
gown) and AFTER VOIDING
Encourage participation in diversional
activities
ASSESS AND MANAGE SUICIDAL
BEHAVIORS
General Interventions
LIMIT SETTING:
Restrict use of bathroom for 2 hours after
eating
Accompany to bathroom to ensure that
they will not self-induce vomiting
Stay with client during meals
DO NOT accept excuses to leaving the
area
Limit Eating to 20 minutes
General Interventions
DIET
HIGH protein
HIGH carbohydrates
Serve foods preferred by patient
Small frequent feedings
NGT if patient refuses to eat
General Interventions
DRUG
Antidepressant drugs may be given after
correcting the electrolyte and nutritional
imbalances
Treatment modalities for Eating
disorders
PSYCHOTHERAPY
Individual psychotherapy= anorexia is
considered food phobia. Goal of therapy is
to remove the phobia, restore weight and
restructure cognitive process
FAMILY therapy
Helping family define the problem in the
context of eating behaviors
Treatment modalities for Eating
disorders
GROUP THERAPY
The group composed of patient and a
nurse talk openly about their concerns
Treatment modalities for Eating
disorders
BEHAVIORAL THERAPY
PHARMACOTHERAPY
Fluoxetine (Prozac)
NUTRITIONAL THERAPY
Dietician should be consulted
The Nursing Process for Eating
Disorders
EVALUATION
Evaluate response to treatment
Bulimia should have abstained from
purging and decrease time to count
the calories of food
Anorexia nervosa should stabilize her
weight without loss and able to ingest
food