People with eating disorders may appear healthy even when they are very ill. Add
People with eating disorders may appear healthy even when they are very ill. Additionally, individuals with anorexia nervosa often do not view their behavior as a problem. They are typically only seen in health care settings due to concerned family or friends who encourage them to seek treatment. Conversely, individuals with bulimia nervosa or binge eating disorder may feel shame and sensitivity to the perceptions of others regarding their illness. Therefore, it is vital for the nurse to build a therapeutic nurse-patient relationship with clients with eating disorders and empathize with possible feelings of low self-esteem and lack of control over eating.[1]
This section will apply the nursing process to anorexia and bulimia nervosa.
Assessment
When assessing an individual with a potential or diagnosed eating disorder, it is vital to obtain their perception of the problem while assessing for signs and symptoms. Care planning that does not address their perspective will not be effective. As previously mentioned, clients with anorexia nervosa often do not perceive their behaviors as a problem, so specialized therapeutic techniques may be required. Review signs and symptoms associated with various eating disorders in the “Basic Concepts” section.
Subjective Assessment
A complete nursing assessment includes health history, psychosocial assessment, and screening for risk of suicide or self-harm. Nutritional patterns, fluid intake, and daily exercise should also be assessed. If the client has a binging or purging pattern, the amount of food eaten and/or the frequency of these behaviors should be assessed.
Objective Assessment
Objective assessments include routine weight monitoring and orthostatic vital signs. Common objective assessment findings for individuals with anorexia nervosa and bulimia nervosa are compared in Table 13.4a. Clients with binge eating disorder may have obesity and gastrointestinal symptoms but do not typically have other associated abnormal assessment findings.
Table 13.4a Comparison of Assessment Findings in Anorexia Nervosa and Bulimia Nervosa[2]
| Anorexia Nervosa | Bulimia Nervosa |
|---|---|
| Low weight | Normal to slightly low weight |
| Muscle weakening (from starvation and electrolyte imbalance) | Muscle weakening (from electrolyte imbalance) |
| Peripheral edema (from hypoalbuminemia) | Peripheral edema (from rebound fluids if diuretics are used) |
| Cardiovascular abnormalities (hypotension, bradycardia, heart failure from starvation, and dehydration) | Cardiovascular abnormalities (cardiomyopathy and cardiac dysrhythmias from electrolyte imbalances) |
| Abnormal lab results (hypokalemia and anemia from starvation) | Electrolyte imbalances (hypokalemia and hyponatremia from diuretics, laxatives, or vomiting) |
| Other signs:
Amenorrhea (lack of menstruation) Lanugo (growth of fine hair all over the body) Cold extremities Constipation Impaired renal function Decreased bone density |
Other signs:
Tooth erosion or dental c