Weight loss doesnt relieve fear so it continues

Weight loss doesn’t relieve fear, so it continues
 Obsessive-compulsive personality
o Thoughts obsessed surrounding food and weight
o Implements ritualistic weight loss behaviors
 Low self-esteem
o Self-esteem based on size, shape
o Weight loss = achievement
o Weight gain = failure
 Self-criticism / guilt
o Self-imposed guilt
o Weight gain fail = self-criticism
 Anxiety/Depression
o Mood disturbances – Root in emotion and diet effects
 Delayed sexual development
o Decreased pituitary
o Follicle FSH
o Luteinizing LH
o Amenorrhea
o Decreased ovarian/estrogen
o Behind peer group in sexual
development
Physical Assessment
 Profound weight loss
o <85% weight “skin & bones”
 Hypothermia

o Low temp, maybe 35’C
o Little to no body fat to regulate temp
 Muscle wasting
o Increased BUN, decreased protein, nitrogen, albumin
 Decreased bone mass
o Thin brittle bones
o Fracture & osteoporosis later in life
 Dehydration
o Severe, electrolyte imbalance
o Decrease perfusion, decreased urine output > can lead to renal failure.
Need 30ml per hr. filtered
 Bradycardia
o r/t dehydration
o decreased cardiac output, easily fatigued
 Dizziness
o Orthostatic hypotension r/t dehydration
 Dependent edema
o Poor vascular return
o Small legs with large swollen ankles
 Poor skin turgor
o r/t dehydration (deficient hydration and perfusion)
o Tenting, >30 seconds
 Lanugo
o Fine hair to provide warmth
o Normal on newborn child, not normal on child/adult
 Amenorrhea
 Abnormal thyroid
o Decreased metabolic demands
 Constipation
o Decreased diet, H2O, GI shut down, ileus, absence of GI motility
Nursing Diagnosis
 Altered body weight
 Altered nutrition
 Ineffective coping
 Altered self-concept
 Potential for self-harm
Treatment Goals
 Restore nutrition
o Refeeding program (restore back to normal)
o Based on calculated weight
 Normal eating patterns - maintain
 Realistic self-concept and body image
o What she sees is real/true
 Separation without anxiety
o Ability to cope with stress
 Control obsessive compulsive behaviors in adaptive ways
Primary Interventions - Physiological
Dry scaly skin with yellow hue

 Priority ----- SAFETY FIRST!!!!!!
 Structured environment
o Often involuntary hospitalization
 Bed rest - complete
o Decreased metabolic needs
o Use little energy to conserve muscle mass that is left
 Daily weight
o Post morning void “Dry weight”
 Intake and Output
o Strict I&O
o Prevents manipulation of weight
o Skin turgor, monitor hydration
 Monitor vital signs
o HR, BP
 Monitor labs
o CBC, Electrolytes, Liver enzymes, Protein, Creatinine, Nitrogen, Kidney
function, UA
 Administer medication
o Not primary treatment modality
o Anti-anxiety meds
o SSRI – stimulates appetite, helps with digestion
o Antipsychotic – helps with impulsiveness
 Electrolyte balance
o IV potassium replacement
 Control vomiting
o Close observation
o Make bathroom inaccessible 2-3 hrs. during and after meal (will still try to