Nursing Care for Anorexia?

  1. As you know, I'm a nursing student and I'm doing research on anorexia at the moment. I've know answers to the questions like where it's origins are, symptoms, treatments etc..... Now I need to know about how to manage someone on the ward with anorexia. I'm talking about like general nursing, not psychiatric nursing, because I will be a general nurse, not psychiatric trained. So as a general nurse on the ward, if you have a patient with anorexia, what are some interventions you could do to help with this patient, how could you help manage this patient on the ward. Lets assume they are already under a psychiatrist and/or doctor and are receiving treatment for their anorexia, so as a nurse (general trained), how can you help?

    I also wouldn't mind hearing from those who are psychiatric trained or have personal experience in this area. Any help and suggestions will be great. Thanks so much
  2. 10 Comments

  3. by   pinkiepie_RN
    Umm, not to be smart, but their illness is one of psychiatric origin and you can certainly perform psychiatric interventions on the general floor. That said, I hope this helps or is what you're looking for.

    Even if they're under treatment, I think it would be important to accurately document their I/O, as well as their activity level and weight. It would also depend on what they're on the unit for; if they're there for anorexia related complications such as dehydration, electrolyte imbalance, cardiac problems etc. then some education about how anorexia affects the rest of their body could be a possibility. Also know that anorexia can be a lifelong illness that waxes and wanes. Someone could be experiencing minimal symptoms but then return to disordered eating with a stressful situation, even something like hospitalization.
  4. by   ChristineN
    As a peds nurse that deals with adolescent pts, I frequentally see anorexic pts. I had one a couple weeks ago. There are various interventions and assessments you can try to implement while they are still in the medical setting.

    Assessment wise, they are often bradycardic (try to have them on the heart monitor, if possible). Often their skin is very pale, and their hair is thin and shedding in spots. If you look at their labs, you will see a decreased Albumin, indicative of malnutrition. You will also see their electrolytes will be out of balance, and if they aren't out of balance now, they may be once they pt starts their refeeeding regimin. Some of these pts can also be anemic. If the pt is a female, she may have stopped having menses.

    Interventions that you can incorporate into their daily care include daily weights (make sure the pt is wearing the same thing every time they are weighed, such as a hospital gown). strict I&O's. If the pt is into overexcercising, set limits with pt limiting the amount of time they are allowed to walk/excercise. If pt is into purging, may be beneficial to require pt to have someone present when using the bathroom. Pt's calories will be increased gradually, with input from a dietician.
  5. by   Daytonite
    i have been a medical/surgical rn in the u.s. for over 30 years working medical units and surgical units in acute hospitals. in the u.s. a critical anorexia nervosa patient is going to the psych ward and not the general medical ward unless they require critical care monitoring and then they go to the icu or ccu. there are two types of anorexia:
    1. anorexia nervosa - the eating disorder which is classified as a psychiatric illness. i have never seen or had one of these patients. they go to psychiatric hospitals because they require highly specialized psychiatric care. if they require hospitalization it will be because of starvation, malnutrition and severe electrolyte imbalances.
    2. anorexia - loss of appetite, which is a symptom associated with one of 4 things: (1) a psychiatric disorder (2) an endocrine disorder (3) cancer (4) a chronic disease. it can also be a complication of drug or alcohol addiction and a side effect of many medications.
      • general nursing care: weigh the patient on a regular basis (weekly), monitor electrolyte and blood counts, provide good oral hygiene before and after eating, determine food like and dislikes, have family prepare food that the patient prefers if necessary, serve small frequent meals including snacks, keep area where dining free of bad odors, provide a pleasant atmosphere for dining experience, feed foods with enhanced protein and calories, add powered protein to foods to increase protein and calories content, add extra butter, margarine and milk to soups, add peanut butter or cream cheese to toast and crackers, document food intake, refer to a dietician for nutritional counseling, teach the patient how to increase protein and calorie content of their foods.
    there is a lot of information about the treatment of anorexia nervosa on the internet. you might try asking about this on the psychiatric nursing forum of allnurses:
  6. by   ChristineN
    Quote from Daytonite
    I have been a medical/surgical RN in the U.S. for over 30 years working medical units and surgical units in acute hospitals. In the U.S. a critical anorexia nervosa patient is going to the psych ward and not the general medical ward unless they require critical care monitoring and then they go to the ICU or CCU. There are two types of anorexia:

    While I agree with you that normally an anrorexic pt will be in a psych ward, alot of times what happens on my inpt peds ward is we admit these pts for something else completely, realize something isn't quiet right, and a diagnosis of anorexia nervosa is made. Sometimes these pts need K and/or other electrolyte runs before they can go to a psych facility. One girl needed blood because she was so anemic.
  7. by   Daytonite
    Quote from ChristineN

    While I agree with you that normally an anrorexic pt will be in a psych ward, alot of times what happens on my inpt peds ward is we admit these pts for something else completely, realize something isn't quiet right, and a diagnosis of anorexia nervosa is made. Sometimes these pts need K and/or other electrolyte runs before they can go to a psych facility. One girl needed blood because she was so anemic.
    Sorry, but we never saw them on the general medical unit. This is a special patient that needs very specialized care. Their heart rates are usually so whacked out because their electrolytes are so messed up that they were put on EKG monitoring. As soon as they were better they were moved up to the Psych unit with telemetry attached to them. Where I worked, patients could be on telemetry on any unit and the telemetry monitored from one central location.
  8. by   Bridget41040
    I work on a pediatric med-surg floor and we recently got our first anorexic in about 2 years. We usually don't do a lot of "psych" based patients but after we did "so well" wit the first one we got another.

    They come in for electrolyte imbalances or severe malnutrition and have to be refeed usually with a NG tube. I don't know if other hospitals would place them in ICU but we just have them on tele. They get so bradycardic it's scary. I've seen a 16 year old's heart-rate consistently run in the 30's while she slept. Scary!

    Our psych doctors usually write scrict monitoring orders... bathroom locked, watched when they go, door always open, no exercising, sit with them for meals... if they don't eat. NG tube, daily labs, etc.
  9. by   jess'
    Hey sorry im not a nurse (thinking bout getting into the area) but randomly saw this post. I have been in and out of inpatient care and hospitals with anorexia. I agree with what the person above wrote. People with eating disorders will be sneaky (its not their personality but the disorder) they will hide food, replace ng tubes with water or half fill them with water as to not look suspicious. nurses used to use tape between the connection to the bottle in a particular order so if it was rewrapped by the patient in the wrong order when they took it off they could tell . They will exercise if left alone and purge if left straight after meals (not always but often), diet pills and laxatives are another problem as is "tanking" before weigh-ins to hide weightloss. I dont know about the medical side obviously but new "unstable" medically patients used to have ecgs done morning and night, or just in the morning, tapering it down to once every few days when they became more stable. At my worst ided have bloods and ecgs at least a few times each day when my heart kept failing along with my liver and kidneys. I read somewhere above that its hard to seperate psyc stuff from medical, i would agree there even if the nursing period is brief, it really was horrible when some nurses in the general hospital treated me like crap, i think they thought i was a waste of time cuse i had done it to myself. It really helped to have kind supportive nurses who cared and talked to me. Control is such a massive part of anorexia, it is terrifying to be in hospital to gain weight and lose the only thing that anorexics have left, i tried to run away once before i was sectioned because i was so afraid of what they were going to do to me. Caring and being supportive i believe was so important
  10. by   tex42cares
    As a mother of a anorexic Jess is right !! Ask Any question about the disorder..I ll let you know what my experience was and continues to be with my 18yr old. The first time she collapsed at school, I took her to the Peds Hospital..she deteriorated rapidly I almost lost her the 4th day.she then spent 9 days in PICU from there another 20 days in tele unit, air ambulance in the middle of a night to a 5 month inpatient program.Oh yes and they act out there too.. she started cutting too. Came home did good for about a month... got into group with older anorexics and she learned some great new tricks With in 4 mos she was back to inpatient for another 5months

    To the original poster.. once you get the anorexic on your unit..truth is there is no "intervention plan to make it stop and have the patient do what you tell them too". by the time you get them their logical reasoning skills are oxygen deprived and dehydrated.

    Oh did I mention I am just starting my journey back to college.. I am called to the profession by personal life experiences(hollywood can not even write my life script)redbeathe
  11. by   jess'
    Im really sorry you are having to go through this with your daughter, i really hope she gets better and that your suffering having to watch this and probably feeling helpless can end, if its any hope i have seen many young girls recover who have been very very seriously ill and have held the illness for years. It will take a very long time but a lot of people i know realized after a time that they really didnt want this anymore and put in years of work to gain back life and things other then the illness. I think the key is the sufferer really has to want to get better and that can take a long time to realize. I know what you mean about bad influences, the first time i was in the ED unit i knew very little tricks but it didnt take long to pick them up, things like pacing the room and refusing to sit down, and to this day i struggle with obsessive walking, something i never had an issue with until entering the ward. Im not sure where you are located but from what i have heard the American ED units are pretty hopeless because people dont have the money to afford the length of treatment needed to get someone mentally as well as physically well. Here in New Zealand there is only 2 Inpatient units, the one in Christchurch ive been in has patients up to 1 year on the ward if they are on the "program" not a "medical stay" and the treatment is completely free. I think we are really lucky over here with medical treatment.
    I really do hope things improve for you and your daughter, im no longer anorexic but suffer from distorted eating habits and restricting, however it doesnt hold me back like it used to and i have managed to go to university and have friends once again, i miss anorexia but i also know that i have alot more now because i have left a lot of the debilitating illness behind
  12. by   tex42cares
    Hi Jess ... Yes it is a tough road.

    There is very little exposure to the disease/disorder in my opinion. It is only those that have been the actual sufferer or 2nd hand sufferer that can speak to it and about it. We are in Texas Jess ..yes it is very expensive and there is no guarantee that any and all treatments work. :heartbeat

    Thanks for the well wishes for my daughter, she has graduated High School and has moved out of the house. "She is in control". The impact is no greater heartbreak than my own. I have spent the past year and half re running thru my memories to triple check what I did wrong,or why did I not see this sooner...Conclusion - The Secret and Hidden ..You can not stop what you can not see..Only The ED Controller must want to stop the suffering. But as a parent I can not allow the destructive behavior to continue in my home. I have a younger daughter too.

    For All Nurses that read this... Medically your anorexia patients can go from ER to CICU in a matter of minutes. I know .. I have walked in those mothers shoes. I have had to give those bedside hair-washes with a straight faced smile ..and the whole time my baby's hair is coming out by the brush loads. I write this not for pity or drama .but as a reminder that this is something that no pills or IV solutions can even put into remission. You can not have surgery for it... you must go thru the fire.