NUR C306-302N GROUP 4 - CLO 2 Concept Map (PT)

Eating Disorder:
“Anorexia

Nervosa"
PRESENTED BY ARANDIA |CANONIGO
LLAMES|LLORENTE|MARZAN|SELUDO|TAN
 CASE

SCENARIO
D.R., a single 19-year-old female experiencing anorexia nervosa, was admitted to a
mental health center inpatient unit weighing 64 lb, approximately 54 lb
underweight, with liver, kidney, and pancreas damage. D.R. was hospitalized for 59
days. Treatment consisted of utilizing a hierarchy of reinforcements in the form of
privileges mutually agreed upon between patient and therapist, psychodynamic and
supportive psychotherapy, and involvement in the ward milieu therapeutic program.
All privileges had to be earned. Access to food was controlled by the staff. For pounds
gained privileges were granted, for pounds lost privileges were curtailed.
Dynamically, D.R.'s eating behavior was viewed as an unconscious spite and revenge
reaction toward her parents as well as an attempt to elicit attention. At the time of
discharge D.R. weighed 104.5 lb. Prior to discharge D.R. agreed that if her weight
dropped below 100 lb she would return for readmission. Five months later D.R.'s
weight stabilized between 102 and 104 lb. Two years later, D.R. 's weight remains at
that level. The study cautions against using solely a behavior modification approach
in the treatment of anorexia nervosa.

EATING DISORDER:“ANOREXIA NERVOSA"

 RISK FACTORS
Eating Disorder:“Anorexia Nervosa"
Psychological
Personality traits
Body Image Disturbance
Cognitive Rigidity
Decrease Facial Ezpressitivity
Social Ranking and Threat
Rduced theory of mind
EATING DISORDER:“ANOREXIA NERVOSA"
Biological Psychosocial Behavioral
Genetic Predisposition Parental Eating Problems Over control of eating
Gender; mostly female Peer Stress (bullying) Weight Control Behaviors
OCD or Autistic Spectrum Trauma Overconcern with BMI
Appetite Dysregulation Vulture Perfectionism
MEtabolic Vulnerability Thin Idealisation Social Isolation
Environmental Influences Socioeconomic Status Impaired Physical and Mental
Quality of Life
 DIAGNOSTIC PROCEDURES
Eating Disorder:“Anorexia Nervosa"

01 Physical Exam A physical examination helps your PCP determine your health's general status. It gives

you a chance to talk to them about any continuous pain or manifestation that you're

experiencing or any other health problems that you might have.

02 Labaratory Test Laboratory tests are often part of a regular checkup to look for modifications in your

health. They also assist doctors in diagnosing medical conditions, plan or evaluate

treatments, and monitor diseases.

03 Psychological

Evaluation
Psychologists utilize tests and other assessment tools to measure and monitor a

client's behavior to arrive at a diagnosis and compass treatment.

EATING DISORDER:“ANOREXIA NERVOSA"

Medical

Management
Physical treatments:
Weight restoration/nutritional rehabilitation
Eliminating binge eating and/or purging

behaviors and other problematic eating patterns.

Hospitalization

Psychological treatments:
Cognitive-behavioral therapy
Interpersonal psychotherapy
Behavior Therapy
Psychodynamic psychotherapy
Group and/or Family therapy/interventions
Acceptance and commitment therapy
PROGNOSIS
Mortality rates are high, approaching 10% per

decade among affected people who come to

clinical attention; unrecognized mild disease

probably rarely leads to death. With treatment,

prognosis is as follows:

Half of patients regain most or all of lost

weight, and any endocrine and other

complications are reversed.

About one fourth have intermediate

outcomes and may relapse.

The remaining one fourth have a poor

outcome, including relapses and

persistent physical and mental

complications

Children and adolescents treated for anorexia

nervosa have better outcomes than adults.

 5 NURSING DIAGNOSIS
1 Imbalanced Nutrition: Less than Body Requirements related to unwillingness

to eat as evidenced by body weight 55% below expected normal range

Rationale: nutritional imbalance occurs when there is an abnormal level in

certain nutrients caused by a shortage or excess in supply. It is a significant

health concern that can lead to serious diseases and can make underlying

medical conditions worse.

2 Disturbed Body Image related to severe malnutrition as evidenced by patient

weighs 64 lb, approximately 54 lb underweight

Rationale: Body image is simply defined as a perception of oneself, or the

change of his/her view towards self, which may impel a person to retain or alter

his or her body part. Individuals with a risk for disturbed body image affects how

they feel about themselves and similarly, affects external presentation and

expression.
 5 NURSING DIAGNOSIS

3
Chronic Low Self esteem related to dysfunctional family system as evidenced

by patient's eating behavior was viewed as an unconscious spite and revenge

reaction toward her parents

Rationale: Self-esteem is a psychological condition affecting all aspects of our

lives. This condition can have an overall effect on one’s worth and relationships

with other people as well as their mental health.

4 Impaired Parenting related to lack of family cohesiveness as evidenced by

patient attempt to elicit attention to her parents

Rationale: Impaired parenting is a nursing diagnosis accepted by the North

American Nursing Diagnosis Association, defined as inability of the primary

caregiver to create, maintain, or regain an environment that promotes the

optimum growth and development of the child.

5 Disturbed Thought Process related to lack of self worth as evidenced by

perceptual disturbances

Rationale: The diagnosis Disturbed Thought Processes describes an individual

with altered perception and cognition that interferes with daily living. Causes are

biochemical or psychological disturbances like depression and personality

disorders.
 NURSING CARE PLAN
Subjective Cues:

Skipping food
“D.R.'s Stated that her eating behavior was viewed as an unconscious spite and revenge reaction toward her parents

as well as an attempt to elicit attention.”

Objective Cues:
ASSESSMENT Underweight
Dry skin
Weakness and tiredness
Erosion of tooth enamel
Feeling cold
Poor nail quality

DIAGNOSIS
Imbalanced Nutrition: Less than Body Requirements related to unwillingness to eat as evidenced by body weight 55% below

expected normal range

 NURSING CARE PLAN
SHORT TERM
MEDIUM-TERM LONG TERM

After 2 weeks of nursing intervention,

After 2 months of nursing

After 6 months of nursing intervention,

the patient will be able to:

intervention, the patient will be able
the patient will be able to:
PLANNING Verbalize and demonstrate a

to:
Maintain an adequate nutritional

selection of foods or meals that

Have weight within 10% of ideal

status as evidenced by patient will

will achieve a cessation of weight

body weight regain normal body weight

loss

 NURSING CARE PLAN

INDEPENDENT

1. Assess height, weight, meal preparation, serum albumen, usual dietary pattern, weight fluctuation over the last 10

years, psychosocial status, and coping behavior.

Rationale: Assessment of these factors will allow the nurse to choose appropriate interventions.

INTERVENTION 2. Obtain and record a patient's weight every day at the same time.
Rationale: To ensure keeping an accurate record of weight.

3. Monitor fluid intake and output every 8 hr.

Rationale: To provide an adequate fluid replacement.

DEPENDENT

1. Administer antiemetics as ordered before meals.

Rationale: Antiemetics are more effective when given before nausea occurs.

COLLABORATIVE

1. Refer the patient to a dietitian or nutritionist.

Rationale: To recommend options that will supplement the patient's nutritional gaps.
 NURSING CARE PLAN
SHORT TERM LONG TERM
MEDIUM-TERM
After 2 weeks of nursing intervention,
After 6 months of nursing intervention,

the patient: After 2 months of nursing

the patient:
intervention, the patient:

EVALUATION
Verbalized and demonstrated a
Maintained adequate nutritional

selection of foods or meals that

Weighs within 10% of ideal body
status as evidenced by patient

achieved cessation of weight loss\ weight regained normal body weight

GOAL MET GOAL PARTIALLY MET GOAL MET

References
Steele RL. Anorexia nervosa: a case study. Psychother Psychosom. 1976-1977;27(1):47-53.

doi: 10.1159/000286995. PMID: 1052188.

Attia, E., & Walsh, T. (2020). MSD MAnual Professional Version. Anorexia Nervosa.

https://www.msdmanuals.com/professional/psychiatric-disorders/eating-

disorders/anorexia-nervosa