Eating Disorders (Anorexia & Bulimia) Nursing Care Plan
Restrictive or purging behaviors; refeeding safety, electrolyte monitoring and body-image therapy.
Quick answer
A Eating Disorders nursing care plan centers on stabilize cardiac status, electrolytes and hydration; restore nutrition safely while preventing refeeding syndrome; establish structured, supervised eating with consistent limits. Priority nursing diagnoses are Imbalanced nutrition, Disturbed body image, Ineffective coping, Risk for electrolyte imbalance. The plan below gives assessment cues, measurable goals, 3 intervention sets with rationales, and patient teaching.
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 numbers to know
Refeeding syndrome
Start nutrition low and advance slowly, monitoring phosphate, potassium and magnesium daily in the first week.
Purging clues
Russell's sign (knuckle calluses), dental enamel erosion, parotid swelling and hypokalemia.
Supervision
Observe during meals and for at least one hour afterward to prevent purging or food hiding.
Cardiac risk
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.
Nursing assessment
Subjective data
- 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 data
- 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
Key nursing diagnoses
Goals and expected outcomes
- 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.
Nursing interventions and rationales
Medical stabilization
- 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.
Structured nutrition
- 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.
Therapeutic relationship
- 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 and family 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.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Eating Disorders (Anorexia & Bulimia) questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Endocrine & Metabolic care plans
Plans that share these nursing diagnoses
Care plan writing guides
Common questions
What are the nursing diagnoses for Eating Disorders?
Priority nursing diagnoses for Eating Disorders: Imbalanced nutrition; Disturbed body image; Ineffective coping; Risk for electrolyte imbalance.
What are the nursing interventions for Eating Disorders?
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. Follow the dietitian's calorie prescription and advance gradually. Supervise meals with a set time limit and remain with the patient one hour afterward.
What are the nursing care goals for Eating Disorders?
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.
What should you assess in a patient with Eating Disorders?
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; 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