Case 2: EATING DISORDERS

- 17 yr old, female
- have an over year diet that didn't seem to stop
- never been overweight and didn't seen any happiness from her diet
- dieting behaviors made her more withdrawn, depressed and anxious
- every time her parents expressed their concerns, she burst into tears or shouted
at them
- stopped eating with the fam and spent most her time in bedroom
- still going to school and doing extremely well at exams but friends are worried
- parents repeatedly suggested to her to see a doctor but she insisted that
nothing's wrong with her, asking to leave her alone
- Lily fainted at school and went to hospital
- discharged a short while but with the recommendation that they saw an eating
disorders specialist
- admitted to health facility as an inpatient due to dangerously low weight
- also has low heart rate (bradycardia) and low temp (hypothermia)
- assessed not only physically but also mentally
- had repeated blood tests and ECG
- was nursed on bed rest with 24 hr care bcos of bradycardia and hypothermia
- was prescribed a gradually increasing diet by dietitian, was supported to
increase dietary intake to improve physical health and weight
- lily and her family received regular family therapy sessions
- lily was able to address a number of life events and issues which had caused her
considerable distress prior to the onset of her eating disorder
- she and her family were also supported to have meals together on the unit and the
dietitian advised her family on how to manage her meal plan at home
- parent's attended parents' support group
- 14 weeks later, on discharge, Lily had gained control over her eating disorder,
dealt with number of significant life issues and was looking forward to relating
more appropriately with friends again

1. Based on the scenario, kindly describe the possible findings of physical

assessment.
- anorexia nervosa
2. Please enumerate some nursing measures that would be applicable to your client
in the scenario, and explain its importance.
- Establish a minimum weight goal and daily nutritional requirements.
: Malnutrition is a mood-altering condition, leading 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 while eating; present and remove
food without persuasion and comment. Promote a pleasant environment and record
intake.
: Patient detects urgency and may react to pressure. Any comment that 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 games.
- Supervise the patient during mealtimes and for a specified period after meals
(usually one hour).
: To ensure compliance with the dietary treatment program. For a hospitalized
patient with anorexia, food is considered a medication.
- Liquids are more acceptable than solid.
: Fluids eliminate the need to choose between foods – something the patient
with anorexia may find difficult.
- Expect weight gain of about 1 lb (0.5 kg) per week.
: To see the effectiveness of the treatment regimen
- If edema or bloating occurs after the patient has returned to normal eating
behavior, reassure her that this phenomenon is temporary.
: She may fear that she’s becoming fat and stop complying with the plan of
treatment.

-Perform complete nursing assessment noting skin, muscle tone and neurological
status; include weight (BMI) and vital sign assessment
: Get a baseline for effectiveness of interventions. Note any deficits or
other issues that may need to be prioritized.
: Determine severity of condition.
- Assess nutritional status and set a weight goal
: Determine if client is under or over weight and nutritional needs
- Assess client for depression and suicide potential
: Clients with eating disorders often have accompanying depression with
suicidal thoughts. Monitor for safety.
- Supervise client during meals and for at least one hour after eating (in inclient
treatment)
: Determine client’s eating habits and prevent purging after meals.
- Encourage liquid intake over solid foods
: Eliminates the need to choose foods, provides hydration and is more easily
digested.
- Provide small meals and snacks appropriately
: Prevents bloating and discomfort in clients following starvation and
encourages eating more appropriate portions.
- Monitor for signs of food hoarding or disposing of food.
: Clients may try to hoard food for secretive eating or dispose of food to
avoid calories.
- Monitor exercise program and set limits and goals accordingly
: Moderate exercise helps maintain muscle strength and tone, but excessive
exercise burns too many calories and contributes to clients’ disorder.
: Alternatively, lack of exercise can lead to depression, muscle wasting and
increased weight and a negative self image.
- Administer TPN supplemental nutrition as appropriate
: In cases of severe malnourishment and life-threatening situations, TPN may
be used to maintain gastric function and provide nourishment.
- Monitor fluid balance and administer oral and IV fluids as appropriate
: Failure to eat or drink and repeated purging through vomiting or excessive
use of laxatives can cause a fluid imbalance and lead to dehydration. Prevent
electrolyte imbalances and cardiac involvement by maintaining adequate hydration.
- Record routine weights per facility protocol
: Monitor progress of interventions and incorporate routine accountability
checks for clients.
- Monitor skin for wounds, dryness, excoriation or deep tissue injuries
: Lack of hydration and proper nutrition lead to decreased perfusion and poor
circulation. Dryness and itching is common. Wounds may develop over bony
prominences.
- Administer medications appropriately
SSRI antidepressants
Anti-anxiety medications
Psychostimulants
: Medications may help relieve the underlying conditions that increase
symptoms by improving mood and thinking.
: Psychostimulants have proven helpful in studies to help treat binge-eating
disorder and maintain weight.
: Some medications may be given to curb appetite so that cognitive behavior
therapy may be more effective.
- Provide education for clients and family members regarding disease, treatment and
support resources
: Help client and family members make informed decisions and reduce stress
and anxiety about treatments. Provide opportunity for continued support and therapy
for optimal recovery.