Eating

Disorder
Group 4
BSN-3-B-2
 Table of Contents

01 02 03
Epidemiology Importance of assessing Psyhopathology
the psychosocial
development of patient
with mental illness.

04 05 06
Drug Study Nursing Care Plan Discharge Plan
 Case
Scenario
 Case Scenario
Name: Maggie

Age: 16 yr old

Sex: Female

Nationality: Filipino

Religion: Roman Catholic

Marital Status: Single

Chief Complaint: “too fat and has no interest in

gaining weight”

Admitting Diagnosis: Anorexia nervosa

 History of Present Illness
Maggie, 16 years old, stands 5’7” tall and weighs 92 pounds. Though it is early
November, she is wearing sweatpants and 3 layers of shirts. Her hair is dry, brittle and
uncombed, and she wears no makeup. Maggie’s family physician referred her to a
specialist because of a noticeable 20-lb-weight loss in 4 months and absence of
menstruation. She also lethargic, weak, and has trouble sleeping. Maggie is an avid
ballet student and believes she still needs to lose more weight to achieve the figure of
a perfect ballerina. Her ballet instructor has expressed concerns to Maggie’s parents
about her appearance and fatigue.
 Medications Prescribed
- Olanzapine (Zyprexa) 2.5 mg p.o. qd at hs

- Cyproheptadine hydrochloride (Periactin) 2 mg p.o. q6 hours initially for 1 week

then increased to 8 mg q6 hours over 3 weeks

Multidisciplinary approach in treatment for Maggie is started. A nutritionist and/or

dietitian to improve her weight and Internal Medicine to improve overall
physiologic condition worked with Maggie’s primary physician. Once health has
improved, Maggie is to participate in the family therapy.
History of Past Illness
Two years ago, Maggie expressed the desire to be a pescatarian and declared a
less-to-no-rice-diet. She said she needed to maintain a certain weight as she dreams of
becoming a successful ballerina. A month after, with the sudden and drastic change in
her diet, but continuous workout routines in ballet classes, Maggie’s parents received a
call from her school informing them that Maggie had fainted and was brought to the
hospital. She was discharged a short while later with a referral to a dietician since
Maggie wanted to continue her pescatarian diet as she believed it could give her a
figure fit for a ballerina.

Family History
Unremarkable
Personal History
Maggie sends most of her time isolated in her room and often exercises for long hours,
even in the middle of the night. She seldom goes out with friends and thus, they had
stopped calling her. But they were worried about her. Every time Maggie’s parents
expressed their concerns about her dieting behaviors, she would burst into tears or
shouted at them. She had stopped eating with the family and spent most of her time in
her bedroom; insisted that there was nothing wrong with her, asking them why
they couldn't just leave her alone. Her parents had started to disagree about how to
handle her behavior and argued frequently. As a result, Maggie's younger brother and
sister were very angry with her and wouldn’t talk to her.

Education History
Maggie’s family reports that she has gone from an “A” student to an
average-to-barely-passing in school type of student.
Mental Status Examination:
Maggie gives little information as she is reluctant to discuss her eating habits.
She says she is “too fat and has no interest in gaining weight.” Patient states she does
not understand why her parents are “forcing” her to come to “this place where they all
want to do is fatten you up and keep you ugly.” Maggie is wearing sweatpants, a tank
top with an oversized t-shirt on top of it and an oversized hoodie. Her
shoulder-length hair is dry, brittle and uncombed, and she wears no makeup making
the dark circles under her eyes show.

Physical Examination
Maggie is observed to be lethargic and with muscle weakness, averaging 3/5 with
muscle strength grading. Maggie is also noted to have bradycardia and hypothermia.
Thin and pale for her age, her skin appears dull and pale, too, allowing for dark
tissues and blood vessels beneath her skin to be observed. Her bony prominences
are very much visible under her skin.
 Psychosocial Development
Stages of Development Patient’s Development

Prenatal & Perinatal (Pregnancy – Birth) Patient was born full-term, delivered via NSD w/out any complications or defect. The pregnancy was planned and wanted. No drugs
were taken by the mother during pregnancy

Early Childhood (0-6 years) Patient had a good relationship with her parents and other siblings. Her primary caregiver was her mother. No delays in development
were noted. No unusual behavior was also noted.

Middle Childhood (6-12 years) Patient has been enrolled in a private school from kindergarten; an “A” student and is sociable. She was enrolled in a ballet summer
class at age 8 as her parents wanted to “enhance her dancing skills” and pushed her to always audition for the main roles in ballet
recitals because they “love watching her perform on stage.” As talented as patient was, most of the time she gets the lead roles.

Late Childhood – Adolescence (13-18 years) Patient became more interested in her ballet classes, most of her friends are ballet dancers. But she was still able to maintain her good
academic standing. She was recommended by her ballet teacher to enroll in Ballet Manila and was accepted. Patient was casted with a
minor role in a Black Swan presentation which led to her believe her body figure was not fit for the lead role’s requirement.
 01
Disease
Process
 Definition

Anorexia nervosa - A disorder that is life threatening and is marked by a person’s restriction of
nutritional intake needed to maintain adequate body weight, severe behavior of fear in gaining
weight and becoming fat, distrubed perception of the shape and proportions of the body, refusal to
acknowledge the severity of the present mental condition.

Patients are categorized into two subgroups; binge eating and purging are characterized as people
who eat and vomit after, while restricting subgroups are those who limit intake.

Contrary to popular belief, patients who suffer from anorexia do not lose their appetites but rather
limit or refuse to consume food. The are selective in their appetites in order to maintain their thin
frame.
 Epidemiology

- An estimate of 5-20% of patients who suffer from anorexia pass as a result of inadequate
nutrition, starvation, and suicide.
- The most common onset of this condition is between the ages 12-25 years old according to
recent findings.
- The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3%
among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males
suffer from this disorder during their lifetime.
- Anorexics who also use laxatives are in greater risk for complications due to an even more
depletion of needed nutrition.
- Low body weights tend often have relapse and the poorest outcome.
- Initial morbidity and relapse from adolescent episodes also occur well into adulthood.
 Signs and Symptoms

- Amenorrhea - Hypothermia
- Constipation - Dental caries
- Weight loss - Pedal edema
- Dehydration - Social withdrawal
- Electrolyte imbalance - Decreased libido
- Hormonal imbalance - Irritability
- Malnutrition - Abandonment behavior
- Hair loss - Depression
- Dry skin - Fear of losing control in food intake
- Hypotension
- Bradycardia
 Treatment and Management

Psychotherapy is a type of individual counseling that focuses on changing the thinking (cognitive
therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes
practical techniques for developing healthy attitudes toward food and weight, as well as approaches
for changing the way the person responds to difficult situations. There are several types of
psychotherapy, including:

Acceptance and commitment therapy: This therapy’s goal is to develop motivation to change actions
rather than your thoughts and feelings.

Cognitive behavioral therapy (CBT): This therapy’s goal is to address distorted views and attitudes
about weight, shape and appearance and to practice behavioral modification (if “X” happens, I can do
“Y” instead of “Z”).

Cognitive remediation therapy: This therapy uses reflection and guided supervision to develop the
capability of focusing on more than one thing at a time.
 Treatment and Management

Family-based therapy (also called the Maudsley Method): This therapy involves family-based
refeeding, which means putting the parents and family in charge of getting the appropriate
nutritional intake consumed by the person with anorexia. It’s the most evidence-based method to
physiologically restore health to an individual with anorexia who is under 18 years of age.

Interpersonal psychotherapy: This therapy is aimed at resolving an interpersonal problem area.

Improving relationships and communications and resolving identified problems may reduce eating
disorder symptoms.

Psychodynamic psychotherapy: This therapy involves looking at the root causes of anorexia as the
key to recovery.
 Treatment and Management

Some healthcare providers may prescribe medication to help manage anxiety and depression that
are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be
helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.

Nutrition counseling is a strategy to help treat anorexia that involves the following:

● Teaching a healthy approach to food and weight.

● Helping restore normal eating patterns.
● Teaching the importance of nutrition and a balanced diet.
● Restoring a healthy relationship with food and eating.
 02
Importance of assessing
the psychosocial
development of patient
with mental illness.
 Importance of assessing the psychosocial
development of patient
with mental illness.
“Patient became more interested in her ballet classes, most of her friends are ballet dancers. But she was
still able to maintain her good academic standing. She was recommended by her ballet teacher to enroll in
Ballet Manila and was accepted. Patient was casted with a minor role in a Black Swan presentation which
led to her believe her body figure was not fit for the lead role’s requirement.”

● The Mental Status Examination (MES) is an important standardized tool in psychosocial

assessment. It is believed to be the equivalent of a standard physical examination.
● The patient is in her adolescence stage where body image is the most important to them and is one
of their fear to be damaged. Teenagers often face significant pressure to meet strict, unrealistic and
harmful ideals around beauty and body build, weight, and shape. The patient’s self-esteem was
built on constant praises and always being the center of attention which might have gave her an
unhealthy perception about herself. When she suddenly did not get the lead role, it might have
affected her self-esteem greatly. Assessing her psychosocial development will help in focusing the
treatment to the cause of her diagnosis and give her an appropriate therapy for her age range.
 03
Psychopathology
Non-Modifiable Factors
● Female
● 16 years old ● Absence of menstruation
Brittle hair
Low levels of gonadal hormones ●
● Muscle weakness

● Dry hair
Decreased level of T4 and T3 ● Lethargic
● Hypothermia
● Weakness
● Trouble speaking

Anxiety Increased cortisol level

Skin is dry and pale Dehydration

Metabolic Alkalosis

● Bradycardia
Mitral valve prolapse ● Fatigue

ANOREXIA NERVOSA ●
●
Lose 20 lbs in 4 months
Fainted while in school
 04

Drug
Study
 Olanzapine
Drug Mechanism of Indication & Contraindication Side effects Nursing
Action Drug Rationale Consideration

Generic name Produces Indicated in No contraindication No side effects Before administration

Olanzapine anticholinergic, effective treating indicated in the case indicated in the -Check for allergy of the
histamine and aggressive clients scenario but common case scenario but patient to the drug
Brand name central nervous with personality contraindication is common side -Obtain BP, orthostatic BP
hypersensitivity to the weight and temperature
Zyprexa system depressant disorder. effects are: -Encourage patient to void
drug
effects. Diminishes ● Hypotension before taking the drug to
Classification manifestations of ● Dizziness help ion decrease
anticholinergic effects of
Antipsychotic Therapeutic effect psychotic ● Sedation urinary retention
Diminishes symptoms and ● Constipation
Dosage and psychotic stabilizes moods ● Weight gain During administration
Frequency symptoms through ● Dry mouth -Frequently monitor client
2.5mg qd at hs combined for reduction of symptoms
(daily at bedtime) antagonism of -Routinely assess for
presence of involuntary
dopamine and movement
Route serotonin receptors -Assess client’s
PO orientation,LOC, reflexes,
gait, coordination and
sleep pattern disturbances
-Assess dizziness,
faintness, palpitations and
tachycardia on rising
 Olanzapine
Drug Mechanism of Indication & Contraindication Side effects Nursing
Action Drug Rationale Consideration

Generic name Produces Indicated in No contraindication No side effects After administration

Olanzapine anticholinergic, effective treating indicated in the case indicated in the -Encourage the client to
histamine and aggressive clients scenario but common case scenario but increase fluid intake and
Brand name central nervous with personality contraindication is common side fiber diet to avoid
hypersensitivity to the constipation
Zyprexa system depressant disorder. effects are: -Report and monitor for
drug
effects. Diminishes ● Hypotension orthostatic hypotension
Classification manifestations of ● Dizziness and provide appropriate
safety measures as
Antipsychotic Therapeutic effect psychotic ● Sedation needed
Diminishes symptoms and ● Constipation -Teach client to use good
Dosage and psychotic stabilizes moods ● Weight gain oral hygiene; frequent
rinsing of mouth,taking ice
Frequency symptoms through ● Dry mouth chips and sugarless gum
2.5mg qd at hs combined can prevent dry mouth
(daily at bedtime) antagonism of -Advise client to avoid
hazardous activities or
dopamine and activities that requires
Route serotonin receptors mental alertness and
PO coordination until the drug
response is determined
-Advise patient to avoid
hot tubs , hot showers and
tub baths since
hypotension may occur
 Cyproheptadine hydrochloride
Drug Mechanism of Indication & Drug Contraindication Side effects
Action Rationale

Generic name Antagonizes the effects Cyproheptadine was No contraindication No side effects
Cyproheptadine of histamine at H1 found to be effective in indicated in the case indicated in the case
hydrochloride receptor sites; does not inducing weight gain in scenario but common scenario but common
bind to or inactivate a subgroup of anorexia contraindication is side effects are:
Brand name histamine. Also blocks nervosa patients who hypersensitivity to the ● Dry mouth, nose,
Periactin the effects of serotonin, had lost 41-52 percent drug and throat
which may result in weight from normal. ● Drowsiness
Classification increased appetite ● Dizziness
Antihistamines ● Nausea
● Chest
Dosage and congestion.
Frequency ● Headache
2 mg q6 hours for 1 ● Muscle
week then increased to weakness
8 mg q6 hours over 3
week

Route
PO
 Cyproheptadine hydrochloride
Nursing Consideration

Before:
● Monitor symptoms of seasonal allergies (sneezing, rhinitis, itching eyes, cough) or chronic
urticaria (rash, hives, itching) to help document benefits of this drug in treating these
disorders.
● Ask patient for medical history, especially of: breathing problems, high pressure in the eye,
heart disease, high blood pressure, kidney disease, seizures, stomach/intestine problems,
overactive thyroid, difficulty urinating.
● Assess blood pressure (BP) periodically and compare to normal values. Report low BP
(hypotension), especially if patient experiences dizziness or syncope.
During:
● Monitor signs of increased excitation in children. Severe or problematic excitation may require
a change in dose or drug.
● Periodically assess body weight and other anthropometric measures (body mass index, body
composition). Report a rapid or unexplained weight gain or increased body fat.
● Assess heart rate, ECG, and heart sounds, especially during exercise. Report any rhythm
disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort,
shortness of breath, fainting, and fatigue/weakness.
 Cyproheptadine hydrochloride
Nursing Consideration

After:
● Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-
prevention strategies, especially in older adults or if balance is impaired
● Advise patient about the risk of daytime drowsiness and decreased attention and mental
focus. These problems can be severe in certain people. Use care if driving or in other
activities that require quick reactions and strong concentration.
● Advise patient to avoid alcohol and other CNS depressants because of the increased risk of
sedation and adverse effects.
● Instruct patient to report other troublesome side effects such as severe or prolonged skin rash,
blurred vision, problems with urination, or GI problems (constipation, dry mouth).
 05
Nursing Care Plan
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Imbalanced Short term: Independent Independent Short term:

Nutrition: Less
The patient stated than body After 3months of Establish a To Improved After 6 months of
that “she still needs requirements nursing intervention minimum weight nutritional status of nursing intervention
to lose more weight related to the patient will be goal and daily the patient. the patient was
to achieve the inadequate food able to establish a nutritional able to establish a
figure of a perfect intake as dietary pattern with requirements. dietary pattern with
ballerina”. evidenced by caloric intake caloric intake
weight loss. adequate to regain Supervise the To ensure adequate to regain
Objective: weight patient during compliance with the weight
mealtimes and for dietary treatment
Weighs 92 pounds. a specified period program.
-20 lb weight loss Long term after meals. Long term
in 4 months.
-Lethargic After 1 year of Provide smaller Gastric dilation may After 1 year of
- Weak nursing intervention meals and snacks, occur if refeeding is nursing intervention
-Thin the patient will be as appropriate. too rapid following a the patient was
- Pale able regain her period of starvation able regain her
- Bony normal weight. dieting normal weight.
prominences are
very much visible Make selective Patient gains
under her skin. menu available, confidence in self
and allow patient to and is more likely to
control choices as eat preferred foods.
much as possible.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Imbalanced Short term: Independent Independent

Nutrition: Less
The patient stated than body After 6 months of Be alert to choices Patient will try to
that “she still needs requirements nursing intervention of low-calorie foods avoid taking in
to lose more weight related to the patient will be and beverage. what is viewed as
to achieve the inadequate food able to establish a excessive calories
figure of a perfect intake as dietary pattern with and may go to
ballerina”. evidenced by caloric intake great lengths to
weight loss. adequate to regain avoid eating.
Objective: weight
Maintain a regular Provides an
Weighs 92 pounds. weighing schedule accurate ongoing
-20 lb weight loss in Long term record of weight
4 months. loss or gain
-Lethargic After 1 year of
- Weak nursing intervention Provide diet and Having a variety of
-Thin the patient will be snacks with foods available
- Pale able regain her substitutions of enables the patient
- Bony normal weight. preferred foods to have a choice of
prominences are when available. potentially
very much visible enjoyable foods.
under her skin.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Imbalanced Short term: Dependent Dependent

Nutrition: Less
The patient stated than body After 6 months of Administer To stimulate the
that “she still needs requirements nursing intervention medication as patient’s appetite.
to lose more weight related to the patient will be prescribed
to achieve the inadequate food able to establish a (Cyproheptadine
figure of a perfect intake as dietary pattern with hydrochloride).
ballerina”. evidenced by caloric intake
weight loss. adequate to regain Collaborative
Objective: weight
Refer to Nutritionist To provide
Weighs 92 pounds. and Dietician. adequate
-20 lb weight loss in Long term nutritional plan.
4 months.
-Lethargic After 1 year of Refer to For further
- Weak nursing intervention psychologist. development of
-Thin the patient will be treatment plan.
- Pale able regain her
- Bony normal weight.
prominences are
very much visible
under her skin.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective coping Short Term Goal: Independent: Independent: Proceed to next
She says she is related to eating slide for the
“too fat and has no disorder as Within 7 days, - Establish a trusting - The therapeutic evaluation….
interest in gaining evidenced by fear client will eat relationship with client nurse-client relationship
weight.” of weight gain or regular meals with by being honest, is built on trust.
Every time Maggie’s obesity and family and attend accepting, and available
parents expressed verbalization of activities without and by keeping all
their concerns about “too fat”. discussing food or promises.
her dieting physical
behaviors, she appearance. - Acknowledge client’s - Discussing food with
would burst into anger at feelings of loss client provides positive
tears or shouted at of control brought about feedback for her eating
them. She had Long Term Goal: by established eating behaviors.
stopped eating with After 1 year of regimen.
the family and spent nursing
most of her time in intervention, the - When nutritional status - Emotional issues must
her bedroom; client will be able to has improved, begin to be resolved if
insisted that there verbalize adaptive explore with client the maladaptive behaviors
was nothing wrong coping feelings associated with are to be eliminated.
with her, asking mechanisms that his or her extreme fear
them why they can be realistically of gaining weight.
couldn't just leave incorporated into
her alone. his or her lifestyle, - Assess and document
thereby eliminating condition of skin turgor - Condition of skin
the need for and any changes in skin provides valuable data.
maladaptive eating integrity
behaviors.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective coping Short Term Goal: - Explore family - Client must recognize Proceed to next
She says she is related to eating dynamics. Help client to how maladaptive eating slide for the
“too fat and has no disorder as Within 7 days, client identify his or her role behaviors are related to evaluation….
interest in gaining evidenced by fear will eat regular contributions and their emotional
weight.” of weight gain or meals with family appropriateness within problems—often issues
Every time obesity and and attend activities the family system. Assist of control within the
Maggie’s parents verbalization of without discussing client to identify specific family structure.
expressed their “too fat”. food or physical concerns within the family
concerns about appearance. structure and ways to
her dieting help relieve those
behaviors, she Long Term Goal: concerns. Also, discuss
would burst into After 1 year of importance of client’s
tears or shouted at nursing intervention, separation of self as
them. She had the client will be able individual within the family
stopped eating to verbalize adaptive system, and of identifying
with the family and coping mechanisms independent emotions
spent most of her that can be and accepting them as
time in realistically his or her own.
her bedroom; incorporated into his
insisted that or her lifestyle, Dependent: Dependent:
there was thereby eliminating
nothing wrong the need for - Cyproheptadine - It is used to stimulate
with her, asking maladaptive eating hydrochloride the appetite and
them why they behaviors. (Periactin) 2 mg every 6 promote weight gain.
couldn't just leave hours for 1 week
her alone. increased to 8 mg every
6 hours over 3 weeks.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective coping Short Term Goal: - Administer Olanzapine - Used to treat disturbed Short Term Goal:
She says she is related to eating (Zyprexa) 2.5 mg once or unusual thinking, loss
“too fat and has no disorder as Within 7 days, daily. of interest in life, and Within 7 days, client
interest in gaining evidenced by fear client will eat strong or inappropriate was able to eat
weight.” of weight gain or regular meals with emotions. regular meals with
Every time obesity and family and attend family and attend
Maggie’s parents verbalization of activities without activities without
expressed their “too fat”. discussing food or Collaborative: Collaborative: discussing food or
concerns about physical physical
her dieting appearance. - Encourage patient to - To help client identify appearance.
behaviors, she engage with friends and supportive resources in
would burst into Long Term Goal: family. the community.
tears or shouted at After 1 year of Long Term Goal:
them. She had nursing After 1 year of
stopped eating intervention, the nursing intervention,
with the family and client will be able to the client was able
spent most of her verbalize adaptive to verbalize adaptive
time in coping mechanisms coping mechanisms
her bedroom; that can be that can be
insisted that realistically realistically
there was incorporated into incorporated into his
nothing wrong his or her lifestyle, or her lifestyle,
with her, asking thereby eliminating thereby eliminating
them why they the need for the need for
couldn't just leave maladaptive eating maladaptive eating
her alone. behaviors. behaviors.
 04

Discharge
Plan
(METHOD)
 M-Medication
● Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day)
can promote weight gain in inpatients with anorexia nervosa. Olanzapine (Zyprexa) has been used with
success because of its antipsychotic effect (on bizarre body image distortions) and associated weight
gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has
been partially or completely restored (Davis & Attia, 2017); however, close monitoring is needed
because weight loss can be a side effect.
● Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and
correction of electrolyte imbalances.
 E-Exercise
● Low intensity exercise
○ Group Walking
○ Individual walk at a casual pace.
○ Stretching
 T-Treatment
● Hospital admission is indicated only for medical necessity, such as for clients with
dangerously low weight, electrolyte imbalances, or renal, cardiac, or hepatic
complications.
● Treatment settings include inpatient specialty eating disorder units, partial
hospitalization or day treatment programs, and outpatient therapy. The choice of setting
depends on the severity of the illness, such as weight loss, physical symptoms, duration
of binging and purging, drive for thinness, body dissatisfaction, and comorbid psychiatric
conditions
● Longer inpatient stays are required for those who gain weight more slowly and are more
resistant to gaining additional weight.
● Outpatient therapy has the best success with clients who have been ill for fewer than 6
months, are not binging and purging, and have parents likely to participate effectively in
family therapy. Cognitive–behavioral therapy (CBT) can also be effective in preventing
relapse and improving overall outcomes
● Psychotherapy
● Nutrition counseling
● Family/Group therapy
 H-Health Teaching
● Discourage patient from performing food rituals such as cutting food into tiny
pieces or mixing food in unusual combinations.
● Help the patient in taking control of their nutritional requirements
independently.
● Provide extensive teaching about basic nutritional needs and the effects of
restrictive eating, dieting, and the binge-and-purge cycle.
● Help the client to set realistic goals for eating throughout the day.
● Help the client in accepting a healthy body image.
● The nurse explains to family and friends that they can be most helpful by
providing emotional support, love, and attention. They can express concern
about the client’s health, but it is rarely helpful to focus on food intake,
calories, and weight
● It is not possible for family and friends to force the client to eat. The client
needs professional help from a therapist or psychiatrist.
● Tell the patient that the recovery is not fast, it will take months therefore
treatment compliance is a must.
 O-Outpatient
● Nutrition counseling or consultation with a dietitian is typically recommended as part of
outpatient treatment as well. These appointments typically last thirty minutes to an hour
and may occur every week or less frequently. They encompass nutrition education, meal
planning, and accountability for your meals.
● Regular physician visits are also extremely important for anyone suffering from an eating
disorder. Your physician will be able to assess if you are experiencing any medical
complications from your disorder and can determine if you need a higher level of care with
additional medical monitoring. Many sufferers also see a physician who specializes in
mental illnesses, a psychiatrist. This is the person who will prescribe and monitor any
medications to help with the symptoms you are experiencing.
● Tell the patient to continue and follow the meal plan/treatment since recovery is not
immediate, it will take months (3 meals and 3 snacks).
 D-Diet
● Clients receive nutritionally balanced meals and snacks that gradually increase caloric
intake to a normal level for size, age, and activity. Severely malnourished clients may
require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate
nutritional intake. Generally, access to a bathroom is supervised to prevent purging as
clients begin to eat more food. Weight gain and adequate food intake are most often the
criteria for determining the effectiveness of treatment
● When clients can eat, a diet of 1,200 to 1,500 calories/day is ordered, with gradual increases in
calories until clients are ingesting adequate amounts for height, activity level, and growth
needs. Typically, allotted calories are divided into three meals and three snacks. A liquid protein
supplement is given to replace any food not eaten to ensure consumption of the total number of
prescribed calories. The nurse is responsible for monitoring meals and snacks and often initially
will sit with a client during eating at a table away from other clients. Depending on the treatment
program, diet beverages and food substitutions may be prohibited, and a specified time may be
set for consuming each meal or snack.
 References

Books
● Psychiatric-Mental Health Nursing of Shiela Videbeck (8th Edition)
● Nursing Diagnosis in Psychiatric Nursing Care Plans and Psychotropic Medications - Mary C.
Townsend (8th Edition)
● Mosbys Drug guide for Nursing students (11th edition)

Webs
● https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139006849#:~:text=
Advise%20patient%20to%20avoid%20alcohol,(constipation%2C%20dry%20mouth).
● http://robholland.com/Nursing/Drug_Guide/data/monographframes/C125.html
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409365/
● https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa
● https://www.youtube.com/watch?v=fCmmmtB5seY
●
 Members
MARBIDA, DIANNE NICOLE
MARCELO, JANIEL CYNTH
MARQUEZ, TRISHA MAE
NUNEZ, NEIL
OLIVA, MICHAEL
ORIAS, ALYSSA MORIELLE
PELIGRINO, RAIN CHLOE
Eating
Disorder
Group 4
BSN-3-B-2