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HOME  NURSING CARE PLANS  ENDOCRINE AND METABOLIC CARE PLANS

 NURSING CARE PLANS
 ENDOCRINE AND METABOLIC CARE PLANS

7 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care

Plans
By

 Matt Vera, BSN, R.N.

 -

Updated on May 5, 2019

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Anorexia nervosa is an illness of starvation, brought on by severe disturbance

of body image and a morbid fear of obesity.  People with anorexia nervosa
attempt to maintain a weight that’s 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.

Bulimia nervosa is an eating disorder (binge-purge syndrome) characterized

by extreme overeating followed by self-induced vomiting, trying to get rid of the
extra calories in an unhealthy way. It may include abuse of laxatives
and diuretics.

Although these disorders primarily affect women, approximately 5%–10% of

those afflicted are men, and both disorders can be present in the same
individual.
Nursing Care Plans
Nursing care planning for patients with eating disorders: anorexia nervosa,
bulimia nervosa includes establishing adequate nutritional intake, correcting
fluid and electrolyte imbalance, assist patient to develop a realistic body image
and improving self-esteem. Other than the mentioned above, it is also an
important nursing priority to provide support in the treatment program and
coordinate program with order disciplines.

Included in this post are seven (7) nursing care plans and nursing
diagnosis for patients with eating disorders: anorexia nervosa and
bulimia nervosa:

1. Imbalanced Nutrition: Less Than Body Requirements

2. Risk for Deficient Fluid Volume
3. Disturbed Thought Process
4. Disturbed Body Image, Chronic Low Self-Esteem
5. Impaired Parenting
6. Risk for Impaired Skin Integrity
7. Deficient Knowledge
8. Other Possible Nursing Diagnoses
1 - Imbalanced Nutrition: Less Than Body Requirements2 - Risk for Deficient
Fluid Volume3 - Disturbed Thought Process4 - Disturbed Body Image, Chronic
Low Self-Esteem5 - Impaired Parenting6 - Risk for Impaired Skin Integrity7 -
Deficient Knowledge8 - Other Possible Nursing Diagnoses
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Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients
insufficient to meet metabolic needs.

May be related to

 Inadequate food intake; self-induced vomiting

 Chronic/excessive laxative use
Possibly evidenced by
  Body weight 15% (or more) below expected or may be within the
normal range (bulimia)
 Pale conjunctiva and mucous membranes; poor skin
turgor/muscle tone; edema
 Excessive loss of hair; increased growth of hair on the body (lanugo)
 Amenorrhea
 Hypothermia
 Bradycardia; cardiac irregularities; hypotension
Desired Outcomes

 Client will verbalize understanding of nutritional needs.

 Client will establish a dietary pattern with caloric intake adequate to
regain/maintain an appropriate weight.
 Client will demonstrate weight gain toward the individually expected
range.
Nursing Interventions Rationale

For Bulimia Nervosa:

Supervise the patient during mealtimes Prevents vomiting

and for a specified period after meals during or after
(usually one hour). eating.

To prevent self-
Identify the patient’s elimination patterns.
induced vomiting.

Among patients
with bulimia
nervosa, warning
signs include having
Assess her suicide potential. more co-morbid
psychiatric
symptoms and
reporting a history
of sexual abuse.

Outline the risks of laxative, emetic, and Bulimic

diuretic abuse for the patient patients may
 Nursing Interventions Rationale

include abuse of
laxatives, emetics,
and diuretics.

For Anorexia Nervosa:

To ensure
compliance with
the dietary
Supervise the patient during mealtimes treatment program.
and for a specified period after meals For a hospitalized
(usually one hour). patient with
anorexia, food is
considered
a medication.

Fluids eliminate the
need to choose
between foods –
Liquids are more acceptable than solid. something the
patient with
anorexia may find
difficult.

To see the
Expect weight gain of about 1 lb (0.5 kg)
effectiveness of the
per week.
treatment regimen.

She may fear that

If edema or bloating occurs after the
she’s becoming fat
patient has returned to normal eating
and stop complying
behavior, reassure her that
with the plan of
this phenomenon is temporary.
treatment.

For Bulimia and Anorexia:

Establish a minimum weight goal and daily Malnutrition is a

nutritional requirements. mood-altering
condition, leading
 Nursing Interventions Rationale

to depression and
agitation and
affecting cognitive
function and
decision making.
Improved
nutritional status
enhances thinking
ability, allowing
initiation of
psychological work.

Use a consistent approach. Sit with the Patient detects

patient while eating; present and remove urgency and may
food without persuasion and comment. react to pressure.
Promote a pleasant environment and Any comment that
record intake. might be seen as
coercion provides
focus on food.
When staff
responds in a
consistent manner,
the patient can
begin to trust staff
responses. The
single area in which
the patient has
exercised power
and control is food
or eating, and he or
she may experience
guilt or rebellion if
forced to eat.
Structuring meals
and decreasing
discussions about
food will decrease
power struggles
with the patient
and avoid
manipulative
 Nursing Interventions Rationale

games.

Gastric dilation may

occur if refeeding is
too rapid following
a period of
Provide smaller meals and supplemental starvation dieting.
snacks, as appropriate. Note: Patient may
feel bloated for 3–6
weeks while the
body adjusts to
food intake.

Patient who gains

confidence in self
Make selective menu available, and allow
and feels in control
patient to control choices as much as
of the environment
possible.
is more likely to eat
preferred foods.

Patient will try to

avoid taking in
Be alert to choices of low-calorie foods and
what is viewed as
beverages; hoarding food; disposing of
excessive calories
food in various places, such as pockets or
and may go to great
wastebaskets.
lengths to avoid
eating.

Provides an
accurate ongoing
Maintain a regular weighing schedule, such record of weight
as Monday and Friday before breakfast in loss or gain. Also
the same attire, and graph results. diminishes
obsessing about
changes in weight.

Weigh with back to scale (depending on Although some

program protocols). programs prefer
the patient to see
the results of the
 Nursing Interventions Rationale

weighing, this can

force the issue of
trust in the patient
who usually does
not trust others.

External control
reinforces feelings
Avoid room checks and other control
of powerlessness a
devices whenever possible.
nd therefore is
usually not helpful.

Prevents vomiting
during and after
eating. Patient may
desire food and use
Provide one-to-one supervision and have a a binge-purge
patient with bulimia remain in the day syndrome to
room area with no bathroom privileges for maintain weight.
a specified period (2 hr) following eating, if Note: Patient may
contracting is unsuccessful. purge for the first
time in response to
the establishment
of a weight gain
program.

Moderate exercise
helps in
maintaining muscle
tone, weight and
Monitor exercise program and set limits on
combating
physical activities. Chart activity and level
depression;
of work (pacing and so on).
however, patient
may exercise
excessively to burn
calories.

Maintain matter-of-fact, nonjudgmental Perception of

attitude if giving tube feedings, punishment is
hyperalimentation, and so on. counterproductive
 Nursing Interventions Rationale

to patient’s self-
confidence
and faith in own
ability to control
destiny.

Be alert to the possibility of the patient Sabotage behavior

disconnecting tube and emptying is common in an
hyperalimentation if used. Check attempt to prevent
measurements, and tape tubing snugly. weight gain.

Cure of the
underlying problem
cannot happen
without improved
nutritional status.
Hospitalization
provides a
controlled
environment in
which food intake,
vomiting and
Provide nutritional therapy within a elimination,
hospital treatment program as indicated medications, and
when the condition is life-threatening. activities can be
monitored. It also
separates the
patient from SO
(who may be
contributing factor)
and provides
exposure to others
with the same
problem, creating
an atmosphere for
sharing.

Involve patient in setting up or carrying out Provides structured

a program of behavior modification. eating situation
Provide a reward for weight gain as while allowing the
 Nursing Interventions Rationale

patient some
control in choices.
Behavior
individually determined; ignore the loss. modification may
be effective in mild
cases or for short-
term weight gain.

Having a variety of
foods available
Provide diet and snacks with substitutions enables the patient
of preferred foods when available. to have a choice of
potentially
enjoyable foods.

When caloric intake

is insufficient to
sustain metabolic
needs, nutritional
support can be
used to prevent
malnutrition and
death while
therapy is
Administer liquid diet,  tube feedings, continuing. High-
hyperalimentation if needed. calorie liquid
feedings may be
given as
medication, at
preset times
separate from
meals, as an
alternative means
of increasing caloric
intake.

Blenderize and tube-feed anything left on May be used as

the tray after a given period of time if part of a behavior
indicated. modification
program to provide
 Nursing Interventions Rationale

a total intake of
needed calories.

Total parenteral
nutrition (TPN) may
be required for life-
threatening
situations;
however, enteral
Administer supplemental nutrition as
feedings are
appropriate.
preferred because
they preserve
gastrointestinal (GI)
function and
reduce atrophy of
the gut.

Use is
counterproductive
because they may
Avoid giving laxatives. be used by the
patient to rid the
body of food and
calories.

Administer medication as indicated:

 Cyproheptadine (Periactin) A serotonin and

histamine
antagonist that may
be used in high
doses to stimulate
the appetite,
decrease
preoccupation with
food, and combat
depression. Does
not appear to have
serious side effects,
although decreased
 Nursing Interventions Rationale

mental alertness
may occur.

 Tricyclic Lifts depression and

antidepressants: amitriptyline stimulates the
(Elavil), imipramine (Tofranil), appetite.
desipramine (Norpramin)
SSRIs reduce binge-
purge cycles and
may also be helpful
in treating
anorexia. Note: Use
must be closely
 selective serotonin reuptake monitored because
inhibitors (SSRIs): fluoxetine of potential side
(Prozac) effects, although
side effects from
SSRIs are less
significant than
those associated
with tricyclics.

Reduces
tension, anxiety,
nervousness and
 Antianxiety agents: alprazolam may help the
(Xanax) patient to
participate in
treatment.

 Antipsychotic Promotes weight

drugs: chlorpromazine (Thorazi gain and
ne) cooperation with
the
psychotherapeutic
program; however,
used only when
absolutely
necessary because
of the possibility of
extrapyramidal side
 Nursing Interventions Rationale

effects.

May be used to
treat depression
 Monoamine oxidase inhibitors when other drug
(MAOIs): tranylcypromine therapy is
sulfate (Parnate) ineffective;
decreases urge to
binge in bulimia.

In rare and difficult

cases in which
malnutrition is
severe and life-
Assist with electroconvulsive therapy (ECT)
threatening, a
if indicated. Discuss reasons for use and
short-term ECT
help the patient understand this is not
series may enable
punishment.
patient to begin
eating and become
accessible to
psychotherapy.

1 - Imbalanced Nutrition: Less Than Body Requirements2 - Risk for Deficient

Fluid Volume3 - Disturbed Thought Process4 - Disturbed Body Image, Chronic
Low Self-Esteem5 - Impaired Parenting6 - Risk for Impaired Skin Integrity7 -
Deficient Knowledge8 - Other Possible Nursing Diagnoses

See Also
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 Nursing Care Plan: The Ultimate Guide and Database  – the

ultimate database of nursing care plans for different diseases and
conditions! Get the complete list!

Nursing Diagnosis: The Complete Guide and List – archive of
different nursing diagnoses with their definition, related factors, goals
and nursing interventions with rationale.
Endocrine and Metabolic Care Plans
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 - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
 - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
 - Magnesium (Mg) Imbalances: Hypermagnesemia and
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 Gestational Diabetes Mellitus | 4 Care Plans
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 TAGS

 ANOREXIA NERVOSA

 BULIMIA NERVOSA

 DEFICIENT FLUID VOLUME

 DISTURBED BODY IMAGE

 DISTURBED THOUGHT PROCESS

 EATING DISORDERS

 IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS

 IMBALANCED NUTRITION: MORE THAN BODY REQUIREMENTS

 IMPAIRED PARENTING

 IMPAIRED SKIN INTEGRITY

 KNOWLEDGE DEFICIT

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Matt Vera, BSN, R.N.

https://nurseslabs.com

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently
working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how
frustrating it is to cram on difficult nursing topics and finding help online is near to impossible. His
situation drove his passion for helping student nurses through the creation of content and lectures
that is easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in
number, he wants to educate and inspire students in nursing. As a nurse educator since 2010, his goal
in Nurseslabs is to simplify the learning process, breakdown complicated topics, help motivate
learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

1 COMMENT

1. Ollie PersichettiSeptember 3, 2019 At 10:37 AM

I would like to thank you for the efforts you’ve put in writing this website.
I am hoping to view the same high-grade blog posts by you in the future
as well. In fact, your creative writing abilities has motivated me to get my
very own blog now ;)
Reply
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