Saint Mary’s University
SCHOOL OF HEALTH and NATURAL SCIENCES
Nursing Department
Bayombong, Nueva Vizcaya
Course No. NCM117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Year Level: BSN 3
Contact Hours/Credit Units: 4 hours/week (4units)
CHAPTER 11
EATING DISORDERS
l. Introduction
An eating disorder is more than just about food. It is a type of mental illness that involves unhealthy
thoughts and behavior towards food, weight and body shape.
ll. Learning Objectives
1. Apply the moral and ethical-legal principles in dealing with the care of clients with eating
disorder.
2. Obtain a comprehensive psychiatric history and conduct a thorough assessment of mental
status of clients with eating disorder.
3. Formulate a holistic nursing care plan for clients with eating disorder.
4. Execute a safe, appropriate mental health activity for clients with eating disorder.
4. Utilize effectively the therapeutic use of self in caring for clients with eating disorder.
lll. Core Content of the Chapter
Terminology:
1. Pica – Ingestion of non-nutritive and non-edible substances.
2. Ruminating – Repeated regurgitation and rechewing of food.
3. Feeding disorder – It is the failure to eat adequately.
4. Binge – Eating of unusual large amount of food in a relatively short period of time.
5. Purge – To eliminate food by inducing vomiting, enema, laxative and diuretics.
6. Emaciated – A person made excessively thin by the lack of nutrition.
7. Bulimia – A disorder characterized by binge eating, over concerned with body shape and weight.
8. Anorexia – A disorder characterized by restrictive eating resulting in emaciation, disturbance in
body image and intense fear of becoming obese.
9. Obesity – It is the consumption of more calories than what the body needs.
ETIOLOGY:
1. Biological factor – A person with a mother or sister who has had anorexia nervosa are likely to
develop the disorder.
2. Psychological factor – A person with eating disorder tends to be perfectionist, with unrealistic
expectation of themselves and others.
3. Family factor – Some person with eating disorder belongs to overprotective family
4. Social factor – A person who are into relationship that they need to be thin to be continually
accepted.
5. Cultural pressures – In westernized country where female are pressured to be thin to be
accepted.
6. Media factor – People who are happy and successful are almost always portrayed by actors or
models who are young, thin and toned.
7. Lifestyle – People who are socialites, dancers, models, gymnast, actress, entertainers and male
homosexuals.
8. Physical and sexually abused – Person who usually survived tends to have eating disorders.
NURSING DIAGNOSIS:
Alteration in health maintenance
Altered nutrition: less than body requirement
Altered nutrition: more than body requirement
Anxiety
Body image disturbances
Ineffective family coping: compromised
Ineffective individual coping
Self-esteem disturbances
ANOREXIA NERVOSA: “The relentless pursuit of thinness” or “weight phobia”
Behavior:
Adolescent and youngest female child are often affected.
They use denial, don’t accept that they have problem. They are more difficult to treat.
10-20% die and half of them are suicidal.
They eat in social functioning but purge themselves. But avoids social functions
gradually.
As a child, they are chubby or overweight
A perfect girl, ideal, conscientious, hardworking and people pleasers
A person with low tolerance to changers and cannot adjust to new situation.
Dependent to family.
Focus in losing weight.
Depress, irritable, withdraws and decrease libido,
As disorder progresses they become deceitful, stubborn, hostile and manipulative.
NURSING MANAGEMENT:
1. Use reinforcement to help patient gain weight. 7. Weigh patient not facing the weighing scale.
2. Acceptance and nonjudgmental. 8. Set limits
3. Listen to the patient. 9. Let them participate in the planning process.
4. Be honest. 10. Teach them about their illness.
5. Avoid long silence. 11. Be consistent.
6. Close observation. 12. Involve family in the treatment.
HOW TO ESTABLISH EATING PATTERN:
1. Sit with the patient during meals and snack time.
2. Offer CHON and CHO food patient prefers.
3. Adhere to the treatment program.
4. Observe patient after meals or snacks.
5. Be aware to hide or discard food.
MEDICATION: Antidepressant after electrolyte imbalance is corrected.
THERAPY:
> family therapy
> individual therapy
> group therapy
BULIMIA NERVOSA: “The diet-binge-purge disorder”
Behavior:
Late adolescent and early adulthood
Occurs after a period of dieting.
Belongs to a family that places great value on one’s appearance
They try to be thin to be accepted.
Extrovert, low self-esteem and self-destructive.
Depress, perfectionist, ashamed, feeling of emptiness, highly dependent on the
approval of others to maintain self-esteem.
They feel unworthy, cannot talk about their feelings, with deeply buried anger
Uncontrolled impulses.
Binge can be controlled at times by the patient.
After an episode they become guilty for uncontrolled urge and purges by cleansing.
NURSING MANAGEMENT, MEDICATION, AND THERAPY IS THE SAME WITH ANOREXIA.
Patient with this kind of disorder is willing to be treated so they cooperate.
CHARACTERISTIS OF ANOREXIC FROM THE BOLIMIC CLIENT:
ANOREXIC: BULIMIC:
Appearance: - Decrease normal weight or underweight - Normal weight or overweight
Age: - 14-18 years old, they are younger. - 15-25 years old, they are older
Family: - Rigid/controlled - More conflicts, violent
Character: - Introvert/isolates - Extrovert/sexually active/on drugs/stealing
Awareness: - Denies - Aware of the disorder
SIDE EFFECTS OF STABILIZATION:
abdominal discomfort feels bloated
edema immediate weight gain
constipation craving for particular
food diarrhea
swelling of fingers digestive distress
OBESITY:
ETIOLOGY:
1. Lack of adequate variety of food to eat.
2. Side effects of steroids.
3. Compulsive eating.
TYPES OF OBESITY:
1. Developmental – obese since childhood.
2. Reactive – maladaptive, occur later, used as coping styles when in stress.
NURSING MANAGEMENT:
1. Assess suicidal thoughts
2. Assess depression.
3. Provide one on one session.
4. Provide activity.
5. Provide group activity.
Other Eating disorders and related problems:
PICA= behavior occurs between 2-3 yrs. and at least one month.
Possible cause: MR, neglect, poor family supervision
ANOREXIA ATHLETICA= Obsessed with exercise and engaged in it beyond the requirements for
good health.
MUSCLE DYSMORPHIA (bigorexia)=a disorder opposite anorexia. Client worry excessively that
they are too small, undeveloped and frail muscles.
ORTHOREXIA NERVOSA=a pathological fixation on eating “proper, pure or superior” food.
NIGHT EATING SYNDROME=lack of appetite for breakfast because client is preoccupied eating
late in the day or night.
NOCTURNAL SLEEP-RELATED=a client who eats while asleep.
RUMINATING SYNDROME=a client eats, swallows and regurgitates food back into the mouth,
chewed and swallowed.
GOURMAND SYNDROME=an obsession with fine food including its purchase, preparation,
presentation and consumption.
PRADER-WILLI SYNDROME=a congenital problem usually associated with M.R which includes
incessant eating.
IV. Activity:
Short video clip
Short Quiz
Long Quiz
V. Bibliography:
Videbeck, S. (2020). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.
Prepared by:
Mrs. Rosalie C. Carreon, RN, MSN
Nursing Department
