Nursing Care Plan for Anorexia Nervosa and Bulimia Nervosa

Anorexia Nervosa and Bulimia Nervosa

Anorexia Nervosa

Definition

Anorexia Nervosa is a psychological disease in the form of deliberate starvation due to body image disturbances, excessive fear and irrational about weight gain. (Kimberly, 2011)

Anorexia Nervosa is a food disorder characterized by voluntary hunger and stress from doing exercises that involve psychological, sociological, physiological. (Arif Muttaqin, 2010)

According to the National Eating Disorders Association (NEDA, 2012), anorexia nervosa is a serious and potentially life-threatening disease in which eating disorders are characterized by hunger and excessive weight loss.


Etiology

The exact cause of anorexia nervosa is not known with certainty, but there are several factors as follows;

1. Biological Factors
   
   • Hunger or starvation will cause changes in neuropeptide activity and contribute to neuroendocrine disorders in anorexia nervosa patients.
   • There is a research on the function of the hypothalamic-pituitary-adrenal (HPA) axis in patients with anorexia nervosa in principle found hypercortisolism in which HPA plays a role in releasing the hormone corticotropin which affects patients to anorexia. (Licino, 1996)
   • The central pathway of serotonin eating regulates eating patterns and also participates in regulation of behavior and mood. Disorders of regulatory regulation and mood. Impaired regulation of serotonin regulation has implications for general depressive conditions that clearly will cause eating disorders. In the study of impaired serotonin regulation there is an increased risk of anorexia nervosa. (Jimerson, 1990)
   • Determination of ghrelin, glucose-dependent insulinotropic polypeptide (GIP) provides an increased response to anorexia. A decrease in GIP occurs in objects, although a small intake of calories prevents rapid insulin response in patients with anorexia. (Stock, 2005)
   • In conditions of depressed thyroid function, this abnormality can only be corrected by elimination. Hunger also causes amenorrhea that shows hormone levels (Luitenizing Hormone FSH, Gonadotropin, Realisine Hormone). Even so, some patients with anorexia nervosa suffer from amenorrhea before significant weight loss.
2. Sociocultural factors, anorexia nervosa patients have a family history of depression, alcohol dependence or eating disorders.
   
3. Psychological factors, fear of being fat, pressure to excel, social behavior that equates leanness with beauty.

Pathophysiology

In chronic conditions it provides a decrease in essential fatty acid content (Holman, 1995) which provides manifestations of decreased prostagladin synthesis as a constituent and protective mucous membrane which causes the patient to have a high risk of mucous membrane injury. Lack of fat intake and activities that are always carried out with the aim of losing weight so that patients tend to be weak and provide manifestations of disruption of daily activities, as well as the risk of secondary infection from decreased immunity.

The condition of chronic anorexia nervosa also has an impact on increasing the risk of osteoporosis as a result of shrinkage of bone mass or bone mineral density decreases thus providing a risk of pathological fracture. (Ringgoti, 1995)

Decreased calorie intake reduces fat reserves to be synthesized and protein in the body, endocrine disruption involving the hypothalamic-pituitary-gonadal axis occurs, resulting in estrogen deficiency which causes amenorrea. Whereas in men fluctuating testosterone levels that cause decreased erectile function and sperm count. (Kimberly, 2011)

In addition, a lack of calorie intake will have an impact on decreasing gastrointestinal motility, causing slowing of gastric emptying and constipation. (Wals, 2008)

The most serious risk of anorexia is the deterioration of intolerable physical conditions which increases the risk of death in some anorexia nervosa individuals.


Clinical Manifestations

According to the National Eating Disorders Association (NEDA, 2012), anorexia nervosa has four main symptoms as follows;

1. Resistance maintains weight at or above the minimum body weight that is normal for age and height.
2. Fear of being fat, even though body weight is below normal.
3. Dissatisfaction with certain aspects of physical appearance or serious self-rejection of low body weight.
4. Loss of menstrual periods in girls and post-puberty women.

Anorexia nervosa patients can be treated well on an outpatient basis. However, if the patient shows any of the following signs, the patient must be hospitalized;

1. Rapid weight loss is equivalent to 15% or more of normal body mass.
2. Persistent bradycardia (50 times / minute or less)
3. Systolic hypotension is less than or equal to 90 mmHg
4. Hypothermia (core body temperature less than or equal to 36.1ºC)
5. Medical complications found, suicidal thoughts
6. Persistent sabotage or obstacles to outpatient therapy due to rejection of the condition and the need for therapy

Bulimia Nervosa

Definition

Bulimia nervosa is a behavioral disorder characterized by fond of eating followed by guilt, contempt and self-deprecation where vomiting is induced alone, use of laxatives or diuretics, or restricting diet or fasting to overcome the effects of overeating. (Kimberly, 2011)

Bulimia nervosa is a recurring episode of binge eating and then with compensatory treatment (vomiting, fasting, serving, or a combination thereof). Overeating is accompanied by the subjective feeling of losing control when eating. Vomiting that is intentional or exaggerated, and abuse of laxatives, diuretics, amphetamines and thyroxine can also occur. (Chavez and Insel, 2007)

According to the National Eating Disorders Association (NEDA), bulimia nervosa is an eating disorder characterized by excessive eating cycles and compensatory behaviors such as self-induced (vomiting) are designed to cancel or compensate for the effects of large meals outside normal eating portions.


Etiology

The cause of bulimia nervosa can not be known with certainty, but there are factors as follows;

1. Biological factors, mental disorders are also caused by chemical processes in the brain, namely the presence of neurotransmitter abnormalities in the brain, primarily the neurotransmitter serotonin is a trigger for bulimia nervosa.
2. Psychological factors, appearance problems, lack of confidence in the weight they have, family conflicts.
3. Cultural factors, excessive emphasis on physical appearance due to cultural influences.

Pathophysiology

Decreasing calorie intake will reduce fat and protein stores in the body. Estrogen deficiency occurs in women due to lack of pleated substrates for synthesis, causing amenorrea. Whereas in men, there is also a decrease in erectile function and sperm count as a result of fluctuating testosterone levels. (Kimberly, 2011)

Caused by repeated vomiting, a person suffering from bulimia nervosa will experience an electrolyte imbalance and nutrients are not fulfilled properly (malnutrition). Vomiting also causes erosion of tooth enamel, especially the surface of the tongue, the back of the tongue (because it is often affected by finger friction to induce vomiting).

Unlike anorexia nervosa, bumilia nervosa does not interfere with bone mineral density, this can occur depending on age, body weight (the thinner the more at risk). Most patients with bulimia nervosa experience depression which results in suicide attempts.


Clinical Manifestations

According to the National Eating Disorders Association (NEDA, 2012) bulimia nervosa has three main symptoms as follows;

1. Regular intake of large amounts of food is accompanied by a sense of loss of control when eating.
2. Usually use inappropriate self-induced compensation behaviors such as vomiting, laxative or diuretic abuse, fasting, or exercise.
3. Extreme attention to body weight and body shape.

Nursing Care Plan

Assessment


The identity examined includes name, age, gender, place of residence as a description of environmental and family conditions, and other information about the patient's identity.

1. Psychological and lifestyle assessments are usually found in adolescents and consider themselves unattractive, unhealthy and undesirable.
2. Psychosocococcal assessment and environmental conditions in the family.

The main complaint, the desire to be thin because they feel overweight.

1. Previous medical history, often obtained by the use of appetite suppressant drugs, diuretics, laxatives (laxatives) or alchohol.
2. Family health history, assesses whether or not a family has experienced bulimia or anorexia nervosa.
3. Physical examination.Physical examination is carried out to assess any changes or disturbances to the vital function of anthropometry: Body weight and anthropometric examination is carried out to assess nutritional status. Widespread endocrine disruption involves the hypotalamus pituytary-gonadal axis, with manifestations in women as amenorrhoea and in men ie loss of interest and seyual potential.
4. Supporting investigation
5. Laboratory

Nursing diagnoses that may appear

1. Imbalanced Nutrition: Less Than Body Requirements
2. Risk for Electrolyte Imbalance
3. Activity Intolerance
4. Disturbed Body Image

Nursing Interventions

1. Imbalanced Nutrition: Less Than Body Requirements

NOC: After nursing actions are fulfilled, the patient's nutritional needs are fulfilled.

Outcomes :

• There is an increase in body weight according to the purpose
• No signs of malnutrition
• No significant weight loss occurred

NIC:

1. Assess for food allergies
2. Monitor for weight loss
3. Give sugar substance
4. Instruct the patient to increase protein and vitamin C
5. Provide information about nutritional needs
6. Collaboration with a nutritionist to determine the number of calories and nutrients a patient needs.

2. Risk for Electrolyte Imbalance

NOC: After nursing, electrolyte balance occurs

Outcomes:

• No signs of dehydration
• Good skin turgor elasticity
• There is no excessive thirst
• Maintain urine output according to age and body weight

NIC:

1. Assess vital signs
2. Monitor hydration status (mucous membrane moisture, adequate pulse, orthostatic blood pressure)
3. Monitor fluid status including fluid intake and output
4. Maintain accurate intake and output records
5. Give IV fluids
6. Push oral input
7. Encourage the family to help patients eat
8. Doctor's collaboration if signs of excess fluid appear to worsen

3. Activity Intolerance

NOC: After nursing actions the client's condition is stable when performing activities

Outcomes :

• Able to do daily activities (ADLs) independently
• Good circulation status
• Vital signs are normal

NIC:

Monitor physical, emotional, social and spiritual responses

1. Monitor adequate nutrition intake as a source of energy
2. Help to choose activities that are consistent with physical, psychological and social abilities
3. Help clients to identify activities that can be done
4. Collaborate with medical rehabilitation personnel in planning appropriate therapeutic programs

4. Disturbed Body Image

NOC: After nursing actions

Outcomes:

• Positive body image
• Being able to identify personal strengths
• Factually describing changes in bodily functions
• Maintaining social interaction

NIC:

1. Assess verbally and non-verbally the client's response to his body
2. Monitor the frequency of self-criticism
3. Explain treatment, treatment of disease
4. Encourage clients to express their feelings
5. Facilitate contact with other individuals in small groups

Bibliography

(Kimberly, 2011) 
(Arif Muttaqin, 2010)
(NEDA, 2012)
(Licino, 1996)
(Jimerson, 1990)
(Stock, 2005)
(Holman, 1995)
(Ringgoti, 1995)
(Kimberly, 2011)
(Wals, 2008)
(Chavez and Insel, 2007)

Tag : Anorexia Nervosa, Bulimia Nervosa, Nursing Care Plan