Nursing Care Plans for Anorexia Nervosa

Anorexia nervosa is an eating disorder of complex and life-threatening proportions. It is an illness of starvation that is brought on by a severe disturbance of body image and a morbid fear of obesity.

Causes for Anorexia Nervosa

Complications for Anorexia Nervosa
Serious medical complications can result from the

• Malnutrition,
• Dehydration,
• Electrolyte imbalances

It’s caused by prolonged starvation, vomiting, or laxative abuse:

• For example, malnutrition may cause hypoalbuminemia and subsequent edema or hypokalemia, leading to ventricular arrhythmias and renal failure.
• Poor nutrition and dehydration, coupled with laxative abuse, produce changes in the bowel similar to those in chronic inflammatory bowel disease.
• Frequent vomiting can cause esophageal erosion, ulcers, tears, and bleeding as well as tooth and gum erosion and dental caries.
• Cardiovascular complications can be life-threatening and include decreased left ventricular muscle mass, chamber size, and myocardial oxygen uptake, reduced cardiac output, hypotension, bradycardia, electrocardiographic changes, heart failure, and sudden death, possibly caused by ventricular arrhythmias.
• Amenorrhea may occur when the patient loses about 25% of her normal body weight. It usually is associated with anemia.
• Possible complications of prolonged amenorrhea include estrogen deficiency and increasing the risk of calcium deficiency and osteoporosis
• Infertility.

Treatment for Anorexia Nervosa

A team approach to care ”combining medical management, nutritional counseling, and individual, group, or family psychotherapy or behavior modification therapy” is the best approach. Treatment is difficult, and results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically for managing eating disorders.

Treatment may include:

• Behavior modification
• All forms of psychotherapy, from psychoanalysis to hypnotherapy
• Vitamin and mineral supplements
• Group, family, or individual psychotherapy

Nursing diagnoses Nursing Care Plans for Anorexia Nervosa

• Activity intolerance
• Anxiety
• Chronic low self-esteem
• Constipation
• Deficient fluid volume
• Delayed growth and development
• Disturbed body image
• Hypothermia
• Imbalanced nutrition: Less than body requirements
• Ineffective coping
• Ineffective denial
• Noncompliance
• Social isolation

Nursing outcomes, interventions, and Patient teaching Nursing Care Plans for Anorexia Nervosa

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Predisposing Factors for Somatoform Disorders

The patient with a somatoform disorder complains of physical signs and symptoms and typically travels from physician to physician in search of treatment. Physical examinations and laboratory tests can’t uncover an organic basis for the patient's signs and symptoms, nor are the somatic symptoms due to the effects of alcohol or recreational or prescription drugs. They're prevalent in 5% of the primary practice and include a variety of conditions that differ in symptoms and whether they're intentionally produced.

Predisposing Factors for Somatoform Disorders

Psychosocial

• Psychodynamic: Some psychodynamicists view hypochondriasis as an ego defense mechanism. They hypothesize that physical complaints are the expression of low self-esteem and feelings of worthlessness, and that the individual believes it is easier to feel something is wrong with the body than to feel something is wrong with the self. The psychodynamic theory of conversion disorder proposes that emotions associated with a traumatic event that the individual cannot express because of moral or ethical unacceptability are “converted” into physical symptoms. The unacceptable emotions are repressed and converted to a somatic hysterical symptom that is symbolic in some way of the original emotional trauma.
• Family Dynamics:  Some families have difficulty expressing emotions openly and resolving conflicts verbally. When this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child’s illness, leaving unresolved the underlying issues that the family cannot confront openly. Thus, somatization by the child brings some stability to the family, as harmony replaces discord and the child’s welfare becomes the common concern. The child in turn receives positive reinforcement for the illness.
• Sociocultural/Familial Factors:  Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it be within society or within the family. When the sick person is allowed to avoid stressful obligations and postpone unwelcome challenges, is excused from troublesome duties, or becomes the prominent focus of attention because of the illness, positive reinforcement virtually guarantees repetition of the response.
• Past Experience with Physical Illness: Personal experience, or the experience of close family members, with serious or lifethreatening illness can predispose an individual to hypochondriasis. Once an individual has experienced a threat to biological integrity, he or she may develop a fear of recurrence. The fear of recurring illness generates an exaggerated response to minor physical changes, leading to hypochondriacal behaviors.
• Cultural and Environmental Factors: Some cultures and religions carry implicit sanctions against verbalizing or directly expressing emotional states, thereby indirectly encouraging “more acceptable” somatic behaviors. Cross-cultural studies have shown that the somatization symptoms associated with depression are relatively similar, but the “cognitive” or emotional symptoms such as guilt are predominantly seen in Western societies.In Middle Eastern and Asian cultures, depression is almost exclusively manifested by somatic or vegetative symptoms. Environmental influences may be significant in the predisposition to somatization disorder. Some studies have suggested that a tendency toward somatization appears to be more common in individuals who have low socioeconomic, occupational, and educational status.

Physiological

• Genetic. Studies have shown an increased incidence of somatization disorder and hypochondriasis in first-degree relatives, implying a possible inheritable predisposition (Sadock & Sadock, 2003). Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and sleepwalking.
• Biochemical. Decreased levels of serotonin and endorphins may play a role in the etiology of pain disorder.
• Medical Conditions. A number of medical conditions, including sleep apnea, endocrine or metabolic disorders, infectious or neoplastic disease, and CNS lesions, have been associated with insomnia and/or hypersomnia. Neurological abnormalities, particularly in the temporal lobe, may be related to precipitation of night terrors.

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Anorexia Nervosa

Anorexia nervosa is an eating disorder of complex and life-threatening proportions. It is an illness of starvation that is brought on by a severe disturbance of body image and a morbid fear of obesity. The key feature of anorexia nervosa is self imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as fat and commonly expresses dissatisfaction with a particular aspect of her physical appearance.

Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics. Anorexia nervosa usually occurs in females. It occurs primarily in adolescents and young adults but may also affect older females and, occasionally, males. The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. The highest mortality is associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide. And only half of people with anorexia nervosa recover completely.

Causes For Anorexia Nervosa

No one knows exactly what causes anorexia nervosa. But are probably combinations of biologic, psychological, and social factors. Abnormalities in central neurotransmitter activity are suggested by an alteration in serotonin metabolism. Psychological factors are the most frequently offered explanations. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder, family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over life or to protect oneself from dealing with issues surrounding sexuality. Anorexia nervosa is generally associated with an enmeshed family system where there are high performance expectations, rigid rules, and disturbed communication patterns. Another theory posits that anorexia nervosa occurs at the time of puberty as a person’s way of avoiding adult responsibility and body image.

Nursing Care Plans for Anorexia Nervosa

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Somatoform Disorders Care Plans

The patient with a somatoform disorder complains of physical signs and symptoms and typically travels from physician to physician in search of treatment. Physical examinations and laboratory tests can’t uncover an organic basis for the patient's signs and symptoms, nor are the somatic symptoms due to the effects of alcohol or recreational or prescription drugs. They're prevalent in 5% of the primary practice and include a variety of conditions that differ in symptoms and whether they're intentionally produced.

Include in Somatoform disorders:

• Body dysmorphic disorder
• Conversion disorder
• Hypochondriasis
• Pain disorder
• Somatization disorder

Body dysmorphic disorder: This disorder, formerly called dysmorphophobia, is characterized by the exaggerated belief that the body is deformed or defective in some specific way. The most common complaints involve imagined or slight flaws of the face or head, such as thinning hair, acne, wrinkles, scars, vascular markings, facial swelling or asymmetry, or excessive facial hair (APA, 2000).

Conversion disorder, Conversion disorder is a loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. The most common conversion symptoms are those that suggest neurological disease such as paralysis, aphonia, seizures, coordination disturbance, akinesia, dyskinesia, blindness, tunnel vision, anosmia, anesthesia, and paresthesia.

Hypochondriasis, Hypochondriasis is an unrealistic preoccupation with the fear of having a serious illness. The DSM-IV-TR suggests that this fear arises out of an unrealistic interpretation of physical signs and symptoms. Occasionally medical disease may be present, but in the hypochondriacal individual, the symptoms are grossly disproportionate to the degree of pathology. Individuals with hypochondriasis often have a long history of doctor shopping and are convinced that they are not receiving the proper care.

Pain disorder, the essential feature of pain disorder is severe and prolonged pain that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (APA, 2000). This diagnosis is made when psychological factors have been judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain, even when the physical examination reveals pathology that is associated with the pain.


Somatization disorder. Somatization disorder is a chronic syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health care professionals. Symptoms can represent virtually any organ system but commonly are expressed as neurological, gastrointestinal, psychosexual, or cardiopulmonary disorders. Onset of the disorder is usually in adolescence or early adulthood and is more common in women than in men. The disorder usually runs a fluctuating course, with periods of remission and exacerbation.

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