CARE PLAN

You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the
psychiatric unit last night after assessment and treatment at a local hospital emergency
department for "blacking out at school." She has been given a preliminary diagnosis of anorexia
nervosa. As you begin to assess her, you notice that she has very loose clothing, she is wrapped
in a blanket, and her extremities are very thin. She tells you, "I don't know why I'm here. They're
making a big deal about nothing:' She appears to be extremely thin and pale, with dry and brittle
hair, which is very thin and patchy, and she constantly com-
plains about being cold. As you ask questions pertaining to weight and nutrition, she becomes
defensive and vague, but she does admit to losing "some" weight after an appendectomy 2 years
ago. She tells you that she used to be fat, but after her surgery she didn't feel like eating and
everybody started commenting on how good she was beginning to look, so she just quit eating
for a while. She informs you that she is eating lots now, even though everyone keeps "bugging
me about my weight and how much I eat." She eventually admits to a weight loss of "about 40
pounds and I'm still fat."

Provide two nursing dx and interventions along with objective data and short term and long term
goals.

(1)Nursing diagnosis

• To observe patients’ nutritional status as eating disorders can be life-threatening. It is also

important to ensure they maintain adequate nutrition and electrolyte balance. If an eating
disorder has been identified, the nurse must monitor weight on a regular basis.
• To monitor patients’ elimination pattern as excessive use of diuretics and laxatives is
common among patients with eating disorders. As a consequence, patients may require
intervention to treat constipation.
• Monitoring skin condition for breakdown and poor healing is an important part of the
nurse’s role. A lack of protein, needed to aid tissue repair, makes the skin more likely to
break down. In addition, it is vital that good oral hygiene is achieved as recurrent
vomiting may cause dental problems.
• Imbalanced nutrition
Short term Goals:

• To be non-judgemental and accepting of patients with eating disorders. This can be

achieved by building a trusting relationship and by encouraging patients to talk about
their concerns.
• To be non-judgemental and accepting of patients with eating disorders. This can be
achieved by building a trusting relationship and by encouraging patients to talk about
their concerns.
Long term Goals:

• To ensure that patients take some responsibility for treatment of their condition. This can
be achieved by establishing a contract with them over the amount and type of food to be
eaten at each meal. By ensuring that positive feedback is given, compliance with the
eating regimen can be maintained and patients’ self-esteem promoted.
• To educate family and carers about a patient’s eating disorder. The family can then be
encouraged to participate in the patient’s care and provide support. Observing for
potential suicide risk must also be considered.

Situation - J.M.is already diagnosis with anorexia nervosa . Physical alterations -many occur and
can include decreased temperature, pulse , GI disturbances, electrolyte imbalances, dry scaly skin
, presence of lanugo on extremities, sleep disturbances ,deficiency cyanosis and numbness of
extremities and bone degeneration.

Background-Onset often with the stressful life event )(appendectomy) . Intensely fears obesity.

Assessment- Body image is distorted and a disturbed self concept .preoccupied with foods that
prevent weight gain and has a phobia against food that reduce weight gain .

Recommendations-assess nutritional status and severity of any medical problems. Establish a

plan concerning the nutritional plan for the day.encourage the client to express feelings about the
eating behaviour and how the client feels about her health. Encourage psychotherapy. Administer
antidepressant medication. Encourage the client to participate in diversional activities. Monitor
and elimination patterns.