{
  "name": "Eating Disorders (Anorexia & Bulimia)",
  "slug": "eating-disorders",
  "url": "https://nursingplex.com/care-plans/eating-disorders",
  "category": "Endocrine & Metabolic",
  "summary": "Restrictive or purging behaviors; refeeding safety, electrolyte monitoring and body-image therapy.",
  "nursing_diagnoses": [
    "Imbalanced nutrition",
    "Disturbed body image",
    "Ineffective coping",
    "Risk for electrolyte imbalance"
  ],
  "overview": [
    "Anorexia nervosa is characterized by restriction of intake leading to significantly low body weight, intense fear of weight gain and distorted body image. Bulimia nervosa involves recurrent binge eating followed by compensatory purging, laxative use, fasting or excessive exercise, usually at a normal or near-normal weight.",
    "Both are psychiatric illnesses with severe medical consequences. Starvation causes bradycardia, hypotension, hypothermia, amenorrhea, osteoporosis and lanugo; purging causes hypokalemia, metabolic alkalosis, dental erosion, esophageal tears and cardiac arrhythmias. Refeeding syndrome is a real danger when nutrition is restored too quickly.",
    "Nursing care combines medical stabilization and structured meal supervision with a non-punitive therapeutic relationship, because control and shame are central to the illness."
  ],
  "key_facts": [
    {
      "label": "Refeeding syndrome",
      "text": "Start nutrition low and advance slowly, monitoring phosphate, potassium and magnesium daily in the first week."
    },
    {
      "label": "Purging clues",
      "text": "Russell's sign (knuckle calluses), dental enamel erosion, parotid swelling and hypokalemia."
    },
    {
      "label": "Supervision",
      "text": "Observe during meals and for at least one hour afterward to prevent purging or food hiding."
    },
    {
      "label": "Cardiac risk",
      "text": "Bradycardia below 40, QT prolongation and hypokalemia are common indications for hospitalization."
    }
  ],
  "nursing_priorities": [
    "Stabilize cardiac status, electrolytes and hydration.",
    "Restore nutrition safely while preventing refeeding syndrome.",
    "Establish structured, supervised eating with consistent limits.",
    "Address distorted body image and underlying anxiety or control issues.",
    "Involve family and arrange long-term multidisciplinary follow-up."
  ],
  "assessment": {
    "subjective": [
      "Statements of feeling fat despite low weight",
      "Reports of guilt after eating, food rituals or calorie counting",
      "Admission of binge episodes, vomiting, laxative or diuretic use",
      "Reports of amenorrhea, cold intolerance, fatigue or dizziness",
      "Expressions of perfectionism, low self-worth or need for control"
    ],
    "objective": [
      "Low BMI or rapid weight loss; weight discrepancies suggesting water loading",
      "Bradycardia, hypotension, orthostasis, hypothermia",
      "Lanugo, dry skin, hair loss, edema; dental erosion and parotid enlargement",
      "Hypokalemia, hypophosphatemia, metabolic alkalosis, prolonged QT on ECG",
      "Amenorrhea and low bone density"
    ],
    "related_factors": [
      "Distorted body image and fear of weight gain",
      "Anxiety, depression, obsessive traits or trauma history",
      "Family dynamics and sociocultural thinness pressure",
      "Use of restriction or purging as a coping and control mechanism"
    ]
  },
  "goals": [
    "The client will achieve the prescribed weekly weight-restoration target without refeeding complications.",
    "The client will maintain electrolytes within normal limits.",
    "The client will complete supervised meals without compensatory behavior.",
    "The client will verbalize more realistic perceptions of body size and worth."
  ],
  "interventions": [
    {
      "title": "Medical stabilization",
      "points": [
        "Weigh daily in a gown after voiding, back to the scale, at the same time.",
        "Monitor orthostatic vitals, cardiac rhythm and QT interval.",
        "Check phosphate, potassium and magnesium daily during early refeeding and replace as ordered.",
        "Track strict intake and output and watch for edema during refeeding."
      ]
    },
    {
      "title": "Structured nutrition",
      "points": [
        "Follow the dietitian's calorie prescription and advance gradually.",
        "Supervise meals with a set time limit and remain with the patient one hour afterward.",
        "Restrict bathroom access after meals and monitor for hidden or discarded food.",
        "Avoid arguing about food; state expectations calmly and consistently."
      ]
    },
    {
      "title": "Therapeutic relationship",
      "points": [
        "Focus conversation on feelings and function rather than weight and appearance.",
        "Set clear, consistent limits negotiated by the whole team.",
        "Support participation in cognitive behavioral therapy and family-based treatment.",
        "Give positive feedback for non-weight achievements and coping efforts."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the medical consequences of starvation and purging in factual, non-shaming terms.",
    "Teach families how to support meals without policing or criticism.",
    "Review warning signs of relapse and how to access help quickly.",
    "Encourage continued therapy, nutrition follow-up and bone density monitoring."
  ]
}