Nursing Care Plan for Anorexia Nervosa - Assessment and Diagnosis

Nursing Assessment and Nursing Diagnosis for Anorexia Nervosa

Definition

Anorexia Nervosa is an eating disorder characterized by refusal to maintain weight within the limits of the normal minimum. With characteristic is to lose weight on purpose, or be driven and maintained by the patient.


Etiology

Various psychological factors associated with the development of the typical behavior of Anorexsia Nervosa. Low self-esteem often plays an important role in the emergence of this disease. Weight loss is viewed as an achievement and self-esteem depends on the size and weight. There is also a relationship between eating disorders with mood disorder. Parents may be too in control and protect children too. Other factors that also play a role in the emergence of this disorder is the slimness idealistic society that seeks equaled or even surpassed by the teens. Individuals affected by this disorder have a distorted body image consider themselves obese or obsessed about the size and shape of certain body.


Pathophysiology

The cause of anorexia until now unknown. However, health experts argue that social factors play an important role from anorexia. In some studies there are factors that predispose to an increased risk of anorexsia nervosa include biological factors, sociocultural, and psychological.


Clinical Manifestations

• Sudden weight loss, without any obvious cause.
• Emaciated appearance, loss of subcutaneous fat.
• Changes in eating habits , meal times are not uncommon.
• Exercise and physical activity are excessive.
• Amenorrhoea.
• Dry scaly skin.
• Lanugo on the extremities, back and face.
• The skin turns yellowish.
• Sleep disorders.
• Constipation.
• Erosion esophagus.
• Natural feelings of depression.
• Excessive focus on achieving high results.
• Excessive attention to food and body image.
• Enamel and dentine erosion is high.

Complications

• Heart : bradycardia, tachycardia, arrhythmia, hypotension, heart failure.
• Gastrointestinal : esophagitis , peptic ulcer , hepatomegaly.
• Kidney : serum urea and electrolyte abnormalities.
• Skeletal : osteoporosis, pathologic factors.
• Endokrine ; reduced fertility, increased levels of cortisol and growth hormone, increased gluconeogenesis.
• Metabolic : decreased BMR, body temperature regulation disorders, sleep disorders.

Nursing Care Plan for Anorexia Nervosa

Nursing Assessment for Anorexia Nervosa

1. Identity

• Age : there is no comparison of the age of children to adults, so relatively the same, it's just that many of them suffered by adulthood.
• Gender : Men and women who suffer from anorexia nervosa are relatively the same.

2. Main complaint :

• The most major complaint is perceived by the client when the assessment. Usually the main complaints that clients rarely feel disclosed. Clients usually reveal that it does not suffer anorexsia nervosa with binge and purge.

3. Past medical history :

• It should be examined whether the client had suffered from the same disease or ever in history before, when the time of occurrence, and the handling is done alone before hospitalization. Clients anorexsia nervosa often focuses on how to please others and avoid conflict. Clients often have impulsive behaviors such as substance abuse and theft, anxiety, depression, and personality disorders.

4. History of present illness :

• Is a self-development of the main complaints through PQRST method, palliative or provocative (P) which is the main focus of client complaints, quality (Q), namely how to binge and purge perceived by clients, regional (R) that is spread binge and purge where, Safety (S) the position that how that can reduce binge and purge or clients feel comfortable and Time (T) ie since when clients feel the binge and purge.

5. Family history :

• Assessing whether or not the client's family had suffered from the disease anorexia nervosa.

Physical examination

1. General appearance.
Examines the weight and height. Record the weight loss of 15 % or more below normal. Clients with anorexia nervosa may be overweight or underweight, but usually closer to the expected weight according to age and body size. The general appearance of the client is not unusual, and clients seem open and willing to talk.

2. Awareness.
Awareness about the quality and quantity of the state of the client. Clients are usually embarrassed by the behavior of overeating and draining. Client acknowledges that the behavior is abnormal and tried hard to hide it from others. Clients feel out of control and not able to change the behavior even though the client recognizes the behavior as pathological.

3. Vital Signs.
Assessing the blood pressure, temperature, pulse and respiration.

4. Gastrointestinal system.
Examines the state of the teeth, mouth, and abdomen. Usually the client can be seen from anorexia nervosa ; dental caries, dirty tongue, mucous membranes dry mouth and stomach slightly concave or all of these could not be seen due to the confidential by the client.

5. Nutrition.
Assessed on intake and output of nutrients, eating, appetite, diet and activity after eating. Clients overeat (binge) and perform draining (purge). Client acknowledges that the behavior is abnormal and tried hard to hide it from others.

6. Fluid.
Assess about fluid intake and output reduced excess fluid, fluid and electrolyte balance (sodium, calcium, albumin), inelastic skin turgor and dry mucous membranes.

7. Activity.
Assess about daily activities, difficulty adjusting the diet binge , preventing depletion (purge) and muscle strength. It makes the client can quickly tired due to lack of nutrition and fluid intake is adequate.

8.Psychological.
Assess about emotions, knowledge of the disease and mood. Clients with eating disorders have unstable mood, usually associated with eating or dieting behavior. Avoid foods that are "bad" or fattening foods and gives the client a strong sense of control over her body, while draining overeating or cause anxiety, depression, and feeling out of control. Clients often look sad, anxious, and worried.

Clients anorexia nervosa initially excited and happy, as if nothing is wrong. Pleasant face is usually lost when clients show overeating behavior and draining, and the client may show intense emotions of guilt, shame, and embarrassment. Clients feel out of control and not able to change the behavior even though the client recognizes the behavior as pathological.

This causes the client with anorexia nervosa live a secret, quietly doing excessive eating and draining behind friends and family clients. Total time spent to buy and eat food and then perform dewatering can disrupt the performance of roles both at home and in the environment.


Nursing Diagnosis for Anorexia Nervosa

Nursing diagnoses in patients with anorexia nervosa at the time of clinical nursing care, include the following:
1. Imbalanced Nutrition Less than Body Requirements related to inadequate nutritional intake unwillingness to eat.
2. Risk for Fluid and Electrolyte Imbalance related to an imbalance of oral fluid intake to discharge, use of diuretic drugs.
3. Activity Intolerance related to general physical weakness.
4. Self-concept Disturbance (low self image) related to body shape was not ideal.

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