Data Analysis
Nursing diagnoses for clients with eating disorders
include the following:
- Imbalanced Nutrition: Less Than / More
Than Body Requirements - Ineffective Coping
- Disturbed Body Image
Other nursing diagnoses may be pertinent such as
Deficient Fluid Volume, Constipation, Fatigue, and
Activity Intolerance.
Outcome Identification
For severely malnourished clients, their medical con-
dition must be stabilized before psychiatric treat-
ment can begin. Medical stabilization may include
parenteral fluids, total parenteral nutrition, and
cardiac monitoring.
Examples of expected outcomes for clients with
eating disorders include the following:
- The client will establish adequate nutritional
eating patterns. - The client will eliminate use of compensatory
behaviors such as excessive exercise and use
of laxatives and diuretics. - The client will demonstrate non–food-related
coping mechanisms. - The client will verbalize feelings of guilt,
anger, anxiety, or an excessive need for
control. - The client will verbalize acceptance of body
image with stable body weight.
Interventions
ESTABLISHING NUTRITIONAL
EATING PATTERNS
Typically inpatient treatment is for clients with
anorexia nervosa who are severely malnourished and
clients with bulimia whose binge eating and purging
behaviors are out of control. Primary nursing roles
are to implement and to supervise the regimen for
nutritional rehabilitation. Total parenteral nutrition
or enteral feedings may be prescribed initially when
a client’s health status is severely compromised.
When clients can eat, a diet of 1200 to 1500 calo-
ries per day is ordered, with gradual increases in calo-
ries until clients are ingesting adequate amounts for
height, activity level, and growth needs. Typically, al-
lotted calories are divided into three meals and three
snacks. A liquid protein supplement is given to re-
place any food not eaten to ensure consumption of the
total number of prescribed calories. The nurse is re-
sponsible for monitoring meals and snacks and often
initially will sit with a client during eating at a table
446 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
away from other clients. Depending on the treatment
program, diet beverages and food substitutions may
be prohibited, and a specified time may be set for con-
suming each meal or snack. Clients also may be dis-
couraged from performing food rituals such as cutting
food into tiny pieces or mixing food in unusual combi-
nations. The nurse must be alert for any attempts by
clients to hide or to discard food.
After each meal or snack, clients may be re-
quired to remain in view of staff for 1 to 2 hours to en-
sure that they do not empty the stomach by vomiting.
Some treatment programs limit client access to bath-
rooms without supervision particularly after meals
to discourage vomiting. As clients begin to gain weight
and to become more independent in eating behavior,
these restrictions are lessened gradually.
In most treatment programs, clients are weighed
only once daily usually on awakening and after they
have emptied the bladder. Clients should wear mini-
mal clothing, such as a hospital gown, each time they
are weighed. They may attempt to place objects in
their clothing to give the appearance of weight gain.
Clients with bulimia often are treated on an
outpatient basis. The nurse must work closely with
clients to establish normal eating patterns and to◗ INTERVENTIONS FORCLIENTSWITH
EATINGDISORDERS- Establishing nutritional eating patterns
Sit with the client during meals and snacks.
Offer liquid protein supplement if unable to
complete meal.
Adhere to treatment program guidelines
regarding restrictions.
Observe client following meals and snacks
for 1 to 2 hours.
Weigh client daily in uniform clothing.
Be alert for attempts to hide or discard food
or inflate weight. - Helping the client identify emotions and develop
non–food-related coping strategies
Ask the client to identify feelings.
Self-monitoring using a journal
Relaxation techniques
Distraction
Assist client to change stereotypical beliefs. - Helping the client deal with body image issues
Recognize benefits of a more near-normal
weight.
Assist to view self in ways not related to body
image.
Identify personal strengths, interests, talents. - Providing client and family education(See Client
and Family Teaching)