- Disturbed Body Image related to eating disorder as evidenced by negative feelings about their body
- Imbalanced Nutrition less than body Requirements related to limited food intake as evidenced by excessive weight loss
- Risk for Impaired Skin Integrity related to alteration in nutritional state, emaciation as evidenced by signs and symptoms.
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: verbalize feelings about their body image Objective Data: -Seeing themselves as fat even when they are not -Fear of rejection or reaction by others -Negative feelings about their body -Feelings of hopelessness or powerlessness -Frequently looking at self in the mirror -Obsessive weight checking -Not eating in public | Disturbed Body Image Related to eating disorder as evidenced by negative feelings about their body | Patient will verbalize positive feelings about their body. Patient will eat meals in the presence of others. Patient will participate in therapy and psychological counselling. | 1. Encourage cognitive-behavioral therapy. This form of therapy helps improve body image by modifying dysfunctional thoughts, feelings, and behaviors. 2. Establish a therapeutic nurse-patient relationship. Developing an unbiased relationship with the patient will help build trust, which is necessary to treat a chronic eating disorder. 3. Consider underlying mental disorders. Patients with eating disorders often suffer from personality disorders, severe depression, substance abuse, and more. Treatment of these conditions, along with anorexia, is paramount for long-term success. 4. Make distinctions between beauty in the media. Adolescents with anorexia may be influenced by TV, magazines, and social media or even by parents or family members. They may feel pressured to appear a certain way. Patients may need to unlearn what they have been taught about unrealistic beauty standards. 5. Closely monitor for suicidal ideation and behavior. Suicidal thoughts may occur when the patient is experiencing severe anxiety, depression, or hopelessness regarding weight and appearance. Recognition and safety is a priority | Patient verbalized a realistic self-image. Patient demonstrated an acceptance of their self instead of an idealized image. Patient recognized health-destructive behaviors and demonstrate a willingness to follow a treatment plan that will promote overall health. Patient described, touch, and/or observe the affected body part. Patient will be able to demonstrate social involvement. |
| Subjective Data: Verbalize unable to manage nutritional requirements Objective Data: -Excessive weight loss -Fatigue -Hair loss -Brittle nails -Dry skin -Electrolyte imbalances -Anemia -Loss of menses | Imbalanced Nutrition less than body Requirements related to limited food intake as evidenced by excessive weight loss | Patient will verbalize an understanding of their nutritional needs. Patient will display improvement of weight as evidenced by a BMI of at least 19. Patient will demonstrate adherence to dietary interventions and treatment. | 1. Establish a minimum weight goal and daily nutritional requirements. Patients with anorexia are fearful of gaining weight. Instead of providing a weight range that may cause patients to feel their number is “too high,” work towards a minimum weight number. 2. Provide smaller meals or snacks. Re-introduction to food may be tricky as rapid refeeding may cause gastric dilation, especially after a long period of intense dieting. The patient may also fear large meals and need to start with bites or snacks. 3. Allow the patient to choose what they eat from a selective menu. This way, the patient is made to feel like they are in control of the situation while helping them gain some confidence, ultimately leading to healthier choices. 4. Consider other markers of health. Weight isn’t the most important goal. When the patient begins to have better digestion, sex hormones have returned along with menses, energy and sleep are improved, and the patient is mentally stable, they are likely at a stable weight. 5. Administer parenteral nutrition. Nutritional support can be provided if the caloric intake is insufficient to sustain their metabolic needs. TPN may be required to stabilize electrolytes. 6. Consult with a knowledgeable dietician. The dietician should be well-versed in treating patients with eating disorders to provide the most helpful and unbiased nutritional support. | Patient recognized factors that are contributing to being under or overweight. Patient identified appropriate nutritional needs/requirements. Patient consumed adequate nutrition. Patient verbalized appropriate management of nutrition at home |
| Subjective Data: -Pain -Itching -Numbness to affected and surrounding skin Objective Data: -Decreased in body temperature-Cold, clammy skin -Purging -Emaciation -Dehydration | Risk for Impaired Skin Integrity related to alteration in nutritional state, emaciation as evidenced by signs and symptoms. | Patient will verbalize understanding of how poor nutrient intake affects the skin and hair. Patient will demonstrate the prevention of skin breakdown. Patient will demonstrate improved hair growth and skin appearance. | 1. Encourage bathing every other day instead of daily. Frequent baths contribute to further drying of the skin. Do not scrub the skin with abrasive cleansers or cloths. 2. Instruct to use skin cream or lotion frequently, especially after bathing. Lotions and creams will aid in lubricating the skin, which will decrease itching. Maintaining soft and smooth skin may also help in boosting their self-esteem. 3. Encourage vitamins. Biotin is often taken to support hair and nail strength. 4. Educate the patient on the importance of frequent changing of position. Changing positions will help circulation and prevent sores on bony prominences by avoiding prolonged pressure. 5. Emphasize the importance of adequate fluid intake and proper nutrition. Improved nutrition and hydration will enhance skin suppleness and elasticity and prevent dryness and cracking. | Patient verbalized with understanding that poor nutrient intake affects the skin and hair. Patient demonstrated the prevention of skin breakdown. Patient demonstrated improved hair growth and skin appearance. |