anorexia nervosa and its nursing management

Eating disorders are psychological
illnesses defined by abnormal eating
habits that may involve either
insufficient or excessive food intake to
the detriment of an individual's
physical and mental health.

1. Anorexia Nervosa (AN) is a serious mental health condition
characterized by an intense fear of gaining weight, a distorted body
image, and extreme food restriction, often leading to severe weight
loss and malnutrition. It primarily affects adolescents and young
adults, particularly females, but can occur in anyone.
Clinical Features
1.Physical Symptoms:
oSignificant weight loss or failure to gain weight during
growth.
oFatigue, dizziness, or fainting.
oBrittle hair and nails, dry skin.
oAmenorrhea (absence of menstrual periods in females).
oHypotension, bradycardia, and hypothermia.
oGastrointestinal issues (constipation, bloating).
oLanugo (fine body hair growth as a response to cold).
2.Psychological Symptoms:
oDistorted body image.
oIntense fear of gaining weight despite being underweight.
oPreoccupation with food, calories, and dieting.
oSocial withdrawal.
3.Behavioral Symptoms:
oRestrictive eating or avoidance of specific food groups.
oExcessive exercise.
oRitualistic eating patterns (e.g., cutting food into small
pieces).
Management of Anorexia Nervosa
Management is multidisciplinary and tailored to the individual’s
needs, focusing on medical stabilization, nutritional rehabilitation,
psychological therapy, and addressing underlying issues.
1. Medical Management
Stabilization:

2. oAddress life-threatening complications such as severe
malnutrition, electrolyte imbalances, or cardiovascular
issues.
oHospitalization may be required for severely underweight
individuals or those with medical instability.
Monitoring:
oRegular assessment of weight, vital signs, and blood work.
oScreening for refeeding syndrome during nutritional
rehabilitation.
2. Nutritional Rehabilitation
Refeeding:
oGradual reintroduction of calories to prevent refeeding
syndrome.
oA dietitian should create a structured meal plan focusing
on balanced nutrition.
Weight Goals:
oSet realistic and healthy weight targets based on age,
height, and developmental stage.
3. Psychological Therapies
Cognitive Behavioral Therapy (CBT):
oHelps challenge distorted thoughts about body image and
eating habits.
Family-Based Therapy (FBT):
oParticularly effective for adolescents, involving family
members in treatment to support recovery.
Interpersonal Therapy (IPT):
oAddresses interpersonal issues contributing to the eating
disorder.
o4. Pharmacotherapy
There is no primary medication for anorexia nervosa itself, but
pharmacological treatment may address co-existing conditions
such as:
oAnxiety or depression: SSRIs like fluoxetine may be
prescribed once weight is stabilized.

3. oObsessive-compulsive behaviors: SSRIs can also help
here.
5. Support and Education
Support groups and peer networks can be beneficial for
individuals and families.
Psychoeducation about the condition helps individuals and
caregivers understand the disorder and its impacts.
Nursing Management of Anorexia Nervosa
1. Assessment
History Taking: Assess dietary patterns, weight loss methods,
and exercise routines.
Physical Examination: Monitor weight, BMI, vital signs, and
physical signs of malnutrition.
Psychosocial Assessment: Evaluate body image perception,
self-esteem, and presence of comorbid conditions like anxiety or
depression.
2. Establishing Rapport and Trust
Build a therapeutic relationship to promote openness.
Avoid judgment or confrontational approaches, as these may
increase resistance.
3. Nutritional Management
Collaborate with a dietitian to develop a structured refeeding
plan.
Monitor food intake and discourage purging behaviors.
Observe for refeeding syndrome—a potentially fatal condition
caused by rapid nutritional replenishment.
4. Medical Monitoring
Regularly monitor vital signs, electrolyte levels, and ECG for
cardiac arrhythmias.

4. Manage physical complications like hypokalemia or
dehydration.
5. Psychological Support
Encourage expression of feelings and address body image
distortions.
Provide cognitive-behavioral therapy (CBT) or refer to a mental
health professional for psychotherapy.
6. Patient Education
Teach the patient and family about the disorder, its
complications, and the importance of treatment compliance.
Discuss the physiological impacts of starvation and
malnutrition.
7. Preventing Relapse
Develop a relapse prevention plan, including coping strategies
and follow-up care.
Engage the patient in stress management techniques and healthy
lifestyle practices.
8. Family Involvement
Include family in therapy sessions to improve understanding and
support.
Use family-based therapy (FBT), particularly for adolescents, to
strengthen the recovery process.
Nursing Diagnoses for Anorexia Nervosa
1.Imbalanced Nutrition: Less than Body Requirements related to
restricted intake.
2.Disturbed Body Image related to unrealistic perception of body
size.
3.Risk for Electrolyte Imbalance related to purging or starvation.
4.Ineffective Coping related to inability to manage stress or
emotions.