Jadłowstręt psychiczny
Charakterystyka, pielęgnacja i opieka

Jadłowstręt psychiczny (anorexia nervosa) to zaburzenie odżywiania o wysokim ryzyku śmiertelności, charakteryzujące się masą ciała poniżej 75% idealnej, bradykardią (<50 uderzeń/min), hipotensją (ciśnienie skurczowe <90 mmHg), hipotermią (<35,6°C) oraz poważnymi zaburzeniami elektrolitowymi i arytmiami. Hospitalizacja jest wskazana przy ciężkim niedożywieniu, zaburzeniach elektrolitowych, psychozie, wysokim ryzyku samobójstwa lub braku wsparcia społecznego. Kompleksowa ocena pielęgniarska obejmuje monitorowanie masy ciała, BMI, parametrów życiowych, stanu odżywienia, nawodnienia oraz oceny ryzyka samobójczego. Leczenie wymaga stopniowego ponownego odżywiania, zapobiegania zespołowi ponownego odżywienia, wsparcia psychologicznego oraz interdyscyplinarnego podejścia z udziałem lekarzy, psychoterapeutów i dietetyków. Terapie obejmują m.in. CBT, MANTRA, SSCM, FPT oraz Family-Based Treatment, a farmakoterapia jest stosowana głównie w leczeniu współistniejących zaburzeń psychicznych (np. SSRI, leki przeciwlękowe).

  1. Wprowadzenie do jadłowstrętu psychicznego
  2. Wskazania do hospitalizacji
  3. Ocena pielęgniarska
    1. Fizyczne objawy jadłowstrętu psychicznego
  4. Diagnozy pielęgniarskie
  5. Cele i oczekiwane efekty leczenia
  6. Interwencje pielęgniarskie
    1. Monitorowanie stanu fizycznego
    2. Interwencje związane z odżywianiem
    3. Wsparcie psychologiczne
    4. Edukacja i wsparcie rodziny
  7. Multidyscyplinarne podejście do leczenia
    1. Rodzaje terapii
    2. Farmakoterapia
  8. Środowisko terapeutyczne i relacja terapeutyczna
  9. Modele opieki i programy leczenia
    1. Opieka paliatywna w jadłowstręcie psychicznym
  10. Zapobieganie nawrotom i długoterminowa opieka
  11. Wyzwania i trudności w leczeniu jadłowstrętu psychicznego
  12. Podsumowanie
    1. Kolejne rozdziały

Wprowadzenie do jadłowstrętu psychicznego

Jadłowstręt psychiczny (anorexia nervosa) to poważne zaburzenie odżywiania, które stanowi potencjalne zagrożenie dla życia, jeśli nie zostanie odpowiednio rozpoznane i leczone. Charakteryzuje się bardzo niską masą ciała, intensywnym lękiem przed przybieraniem na wadze oraz skrajnymi zachowaniami mającymi na celu zapobieganie przyrostowi masy ciała. Jadłowstręt psychiczny ma jeden z najwyższych wskaźników śmiertelności spośród wszystkich zaburzeń psychicznych, a powikłania medyczne odpowiadają za około połowę wszystkich zgonów w przebiegu tej choroby.12

Pielęgniarki w placówkach medycznych mogą opiekować się pacjentami z jadłowstrętem psychicznym, gdy są oni przyjmowani z powodu zaburzeń elektrolitowych, arytmii serca i ciężkiego niedożywienia. Pielęgniarki psychiatryczne mogą również opiekować się pacjentami z anoreksją w przypadkach prób samobójczych, depresji i stanów lękowych. Pacjenci ci wymagają monitorowania i leczenia powikłań, ostrożnego ponownego odżywiania oraz intensywnej terapii psychologicznej.1

Jadłowstręt psychiczny jest chorobą zarówno psychiczną, jak i fizyczną. Bez odpowiedniego leczenia może prowadzić do niedożywienia, poważnych problemów zdrowotnych, a nawet śmierci. Rozpoznanie objawów we wczesnym stadium i uzyskanie pomocy może zmniejszyć wpływ jadłowstrętu psychicznego i wspierać szybszy powrót do zdrowia.12

Wskazania do hospitalizacji

Pacjenci z jadłowstrętem psychicznym, którzy są poważnie niedożywieni lub psychologicznie zagrożeni, wymagają leczenia w placówce stacjonarnej. Hospitalizacja jest uzasadniona, gdy występuje znaczna utrata masy ciała, brak przyrostu masy ciała, znaczny obrzęk, zmiany w parametrach życiowych, poważne zaburzenia elektrolitowe, zaburzenia pracy serca, ostre zaburzenia medyczne, zmiany stanu psychicznego, psychoza, wysokie ryzyko samobójstwa, brak systemu wsparcia, ograniczony dostęp do leczenia ambulatoryjnego lub niezgodność z zaleceniami bądź kontynuowanie zachowań oczyszczających.1

Do konkretnych kryteriów hospitalizacji pacjenta z jadłowstrętem psychicznym należą: nieadekwatna odpowiedź na terapię ambulatoryjną, nieprawidłowości elektrolitowe, dzienna częstość akcji serca poniżej 50 uderzeń na minutę, ciśnienie skurczowe krwi poniżej 90 mmHg, arytmie, temperatura ciała poniżej 96°F (35,6°C), masa ciała poniżej 75% idealnej masy ciała, zawartość tkanki tłuszczowej poniżej 10% lub odmowa jedzenia.12

Ocena pielęgniarska

Kompleksowa ocena pielęgniarska pacjenta z jadłowstrętem psychicznym powinna obejmować zarówno aspekty fizyczne, jak i psychologiczne.1 Pielęgniarka powinna uzyskać aktualne pomiary wzrostu i masy ciała w celu oceny skuteczności leczenia. Pacjenci z jadłowstrętem psychicznym często wykazują bardzo niski wskaźnik BMI.1

Pielęgniarka powinna również ocenić myśli samobójcze, ponieważ jest to druga najczęstsza przyczyna śmierci u pacjentów z jadłowstrętem psychicznym. Pacjenci mogą zgłaszać objawy bólu głowy, zawrotów głowy, zmęczenia i trudności z koncentracją, które mogą wskazywać na hipowolemię.1

Należy przeprowadzić dokładną ocenę stanu odżywienia, w tym nawyków żywieniowych, preferencji żywieniowych i wszelkich zachowań restrykcyjnych. Ważne jest również monitorowanie parametrów życiowych, stanu nawodnienia i oznak niedożywienia.1

U pacjentów z jadłowstrętem psychicznym mogą występować niedociśnienie ortostatyczne, bradykardia i hipotermia z powodu nieadekwatnego spożycia kalorii. Pielęgniarka powinna być świadoma, że pacjenci z jadłowstrętem psychicznym często są bardzo samokrytyczni i potrzebują poczucia kontroli. Mogą oni wycofywać się z kontaktów z przyjaciółmi i rodziną.12

Fizyczne objawy jadłowstrętu psychicznego

Jadłowstręt psychiczny może powodować powikłania, które mogą wpływać na każdy układ organizmu. Niektóre fizyczne objawy jadłowstrętu psychicznego obejmują:1

  • Przerzedzanie się włosów, łamliwość włosów i paznokci
  • Lanugo (meszek na ciele)
  • Obrzęk
  • Ból lub wzdęcie brzucha
  • Zimne dłonie i stopy
  • Zanik gruczołów piersiowych
  • Utrata masy mięśniowej
  • Arytmie
  • Niedociśnienie ortostatyczne
  • Bradykardia
  • Hipotermia

Pacjentki z jadłowstrętem psychicznym mogą również doświadczać amenorrhea (braku miesiączki) z powodu niedoboru kalorii i zaburzeń hormonalnych.1

Diagnozy pielęgniarskie

Najczęstsze diagnozy pielęgniarskie dla pacjentów z jadłowstrętem psychicznym obejmują:123

  • Zaburzenia odżywiania: mniejsze niż zapotrzebowanie organizmu – pacjenci z jadłowstrętem psychicznym mogą stosować środki przeczyszczające w celu kontrolowania masy ciała, co prowadzi do nieodpowiedniego wchłaniania składników odżywczych i niewystarczającego zaspokojenia potrzeb organizmu. Nieadekwatne spożycie żywności może również skutkować niedoborami składników odżywczych i zaburzeniami odżywiania.1
  • Ryzyko zaburzeń elektrolitowych – pacjenci z jadłowstrętem psychicznym są narażeni na zaburzenia elektrolitowe spowodowane zachowaniami takimi jak nadmierne ograniczanie płynów lub stosowanie środków moczopędnych i przeczyszczających.1
  • Ryzyko zaburzeń gospodarki płynowej – zachowania związane z ograniczaniem płynów mogą prowadzić do odwodnienia i zaburzeń elektrolitowych, które mogą mieć poważne konsekwencje zdrowotne.1
  • Zaburzony obraz ciała – pacjenci z zaburzeniami odżywiania często doświadczają zniekształconego obrazu ciała, postrzegając siebie jako osoby z nadwagą lub nieatrakcyjne, nawet gdy ich masa ciała jest niebezpiecznie niska.1
  • Nieskuteczne radzenie sobie – pacjenci mogą mieć trudności z rozwijaniem zdrowych mechanizmów radzenia sobie z emocjami i stresem.1
  • Zakłócenie procesów rodzinnych – jadłowstręt psychiczny wpływa nie tylko na pacjenta, ale także na funkcjonowanie całej rodziny.1
  • Przewlekła niska samoocena – zniekształcone postrzeganie może znacząco wpłynąć na samoocenę pacjenta, prowadząc do uczucia wstydu, bezwartościowości i negatywnej samooceny.1
  • Poczucie bezsilności – pacjenci mogą czuć się bezsilni wobec swojej choroby i związanych z nią objawów.1
  • Ryzyko cierpienia duchowego – pacjenci mogą doświadczać cierpienia duchowego związanego z ich chorobą.1

Cele i oczekiwane efekty leczenia

Ogólne cele leczenia osób z jadłowstrętem psychicznym to:122

  • Przywrócenie odpowiedniego odżywiania
  • Doprowadzenie masy ciała do zdrowego poziomu
  • Zmniejszenie nadmiernego wysiłku fizycznego
  • Zatrzymanie zachowań związanych z objadaniem się i przeczyszczaniem

Szczegółowe cele i oczekiwane efekty leczenia mogą obejmować:12

  • Pacjent wyrazi zrozumienie potrzeb żywieniowych
  • Pacjent ustali wzorzec żywieniowy z odpowiednią podażą kalorii, aby odzyskać/utrzymać odpowiednią masę ciała
  • Pacjent wykaże przyrost masy ciała w kierunku indywidualnie oczekiwanego zakresu
  • Pacjent utrzyma/wykaże poprawę równowagi płynów, o czym świadczy odpowiednia diureza, stabilne parametry życiowe, wilgotne błony śluzowe i dobry turgor skóry
  • Pacjent wyrazi zrozumienie czynników przyczynowych i zachowań niezbędnych do skorygowania niedoboru płynów
  • Pacjent wykaże poprawioną zdolność podejmowania decyzji i rozwiązywania problemów
  • Pacjent ustali bardziej realistyczny obraz ciała
  • Pacjent wykaże zgodność z terapią i leczeniem

Interwencje pielęgniarskie

Interwencje pielęgniarskie dla pacjentów z jadłowstrętem psychicznym są niezbędne dla powrotu do zdrowia pacjenta i powinny obejmować szerokie spektrum działań.12

Monitorowanie stanu fizycznego

Pielęgniarka powinna regularnie monitorować:123

  • Stan odżywienia i masę ciała – rutynowe ważenie pacjenta zgodnie z protokołem placówki, najlepiej każdego ranka, używając tej samej wagi. Pomaga to monitorować postępy interwencji i wprowadza rutynowe kontrole odpowiedzialności dla pacjentów.
  • Równowagę elektrolitową – pacjenci z jadłowstrętem psychicznym są narażeni na zaburzenia elektrolitowe z powodu niedożywienia i praktyk oczyszczających.
  • Parametry życiowe – monitorowanie ciśnienia krwi, tętna i temperatury ciała, gdyż pacjenci z jadłowstrętem psychicznym mogą wykazywać niedociśnienie ortostatyczne, bradykardię i hipotermię.
  • Stan skóry – monitorowanie skóry pod kątem ran, suchości, otarć lub głębokich uszkodzeń tkanek. Brak nawodnienia i odpowiedniego odżywiania prowadzi do zmniejszonej perfuzji i pogorszonego krążenia.
  • Aktywność – ograniczanie intensywnego wysiłku fizycznego, ponieważ pacjenci z jadłowstrętem psychicznym mogą podejmować nadmierny wysiłek fizyczny, który może być szkodliwy dla ich stanu fizjologicznego.

Interwencje związane z odżywianiem

Kluczową częścią leczenia jadłowstrętu psychicznego jest odżywianie. Ponowne odżywianie polega na zapewnieniu określonej liczby kalorii dziennie, aby osiągnąć docelową masę ciała. Ponowne odżywianie musi być prowadzone stopniowo i ostrożnie, aby zapobiec zespołowi ponownego odżywienia.1

Interwencje związane z odżywianiem mogą obejmować:23456

  • Ocenę stanu odżywienia i ustalenie docelowej masy ciała
  • Pozostawanie z pacjentem podczas posiłków i przez co najmniej godzinę po posiłkach, aby zapobiec wymiotowaniu
  • Monitorowanie pod kątem oznak gromadzenia żywności lub pozbywania się jej
  • Zapewnianie małych posiłków i przekąsek odpowiednio do potrzeb – zapobiega to wzdęciom i dyskomfortowi u pacjentów po okresie głodzenia się i zachęca do spożywania bardziej odpowiednich porcji
  • Zachęcanie do przyjmowania płynów zamiast stałych pokarmów – eliminuje to konieczność wyboru żywności, zapewnia nawodnienie i jest łatwiej trawione
  • Tworzenie menu odpowiadającego gustom i wyborom pacjenta, aby pacjent zachował kontrolę
  • Ustalenie rutyny, na przykład ważenie przed śniadaniem w poniedziałki i piątki oraz zapisywanie wyników
  • W przypadku ciężkiego niedożywienia i sytuacji zagrażających życiu, może być stosowane żywienie parenteralne (TPN) w celu utrzymania funkcji żołądka i zapewnienia pożywienia

Pielęgniarka powinna również monitorować pacjenta pod kątem zespołu ponownego odżywienia, który może wystąpić, jeśli odżywianie zostanie wprowadzone zbyt szybko po długotrwałym głodzeniu. Objawy tego zespołu obejmują poważne zaburzenia elektrolitowe, arytmie i drgawki.1

Wsparcie psychologiczne

Pacjenci z jadłowstrętem psychicznym potrzebują również wsparcia emocjonalnego, ponieważ mierzą się z głębokim bólem i traumatycznymi myślami.1 Pielęgniarka powinna:123

  • Stosować aktywne słuchanie i empatię podczas komunikacji z pacjentem i rodziną
  • Nie komentować, dobrze ani źle, masy ciała lub wyglądu pacjenta, a zamiast tego skupić się na innych cechach
  • Być otwartym i uczciwym w komunikacji
  • Zapewnić czas na refleksję pacjenta nad najlepszym podejściem do powrotu do zdrowia
  • Pozostać nieosądzającym
  • Zapewnić bezpieczne środowisko z aktywnym słuchaniem, otwartą komunikacją i empatią
  • Wspierać autonomię i odpowiedzialność poprzez oferowanie wskazówek, które pozwolą pacjentowi odgrywać aktywną rolę w zarządzaniu swoim zaburzeniem odżywiania

Ważne jest też, aby cele leczenia dla pacjenta z zaburzeniami odżywiania były skoncentrowane na pacjencie lub kierowane przez pacjenta, co oznacza, że pacjent i pielęgniarka współpracują przy formułowaniu wspólnych celów powrotu do zdrowia.1

Edukacja i wsparcie rodziny

Wsparcie rodziny jest bardzo ważne dla powodzenia leczenia jadłowstrętu psychicznego. Członkowie rodziny muszą rozumieć zaburzenie odżywiania i rozpoznawać jego oznaki i objawy.1

Istotną częścią procesu powrotu do zdrowia jest odbudowanie relacji z rodziną. Pielęgniarka pomaga w tym procesie poprzez:12

  • Zapewnienie edukacji pacjentowi i jego bliskim na temat choroby, leczenia i planowania posiłków
  • Włączanie członków rodziny lub opiekunów (w stosownych przypadkach) w edukację żywieniową lub planowanie posiłków dla dzieci i młodzieży z jadłowstrętem psychicznym, którzy odbywają terapię samodzielnie
  • Kierowanie pacjentów i ich bliskich do odpowiednich zasobów w ramach planowania wypisu

Leczenie może angażować członków rodziny lub przyjaciół pacjenta, aby wspierać pacjenta. Jest to wysiłek zespołowy.1

Multidyscyplinarne podejście do leczenia

Najlepiej jest leczyć jadłowstręt psychiczny, stosując podejście zespołowe. Zespół składa się z lekarzy, specjalistów w dziedzinie zdrowia psychicznego i innych pracowników służby zdrowia, wszystkich z doświadczeniem w leczeniu zaburzeń odżywiania.1

Kompleksowe leczenie jadłowstrętu psychicznego zazwyczaj obejmuje:12

  • Indywidualną i grupową psychoterapię
  • Leki (zarządzanie i edukacja)
  • Poradnictwo żywieniowe i edukację
  • Grupy samopomocowe
  • Terapię zajęciową
  • Terapię rekreacyjną
  • Specjalistyczne sesje na tematy takie jak obraz ciała, duchowość i problemy kobiet

Multidyscyplinarny zespół obejmuje, jako minimum, lekarza (lekarza, zaawansowanego praktyka, psychiatrę itp.), specjalistę w dziedzinie zdrowia psychicznego (psychologa, licencjonowanego pracownika socjalnego) i zarejestrowanego dietetyka.1

W skoordynowanym kontekście opieki, świadczeniodawcy omawiają szczegóły planu leczenia dla wspólnych pacjentów, współpracują w dostarczaniu spójnych komunikatów pacjentom i informują pozostałych świadczeniodawców o fizycznym, emocjonalnym i psychologicznym stanie zdrowia pacjenta.1

Rodzaje terapii

Jednym z najczęściej stosowanych podejść do leczenia jadłowstrętu psychicznego jest terapia poznawczo-behawioralna (CBT). Może ona pomóc pacjentom rozwinąć zdrowsze myśli i zachowania związane z jedzeniem i obrazem ciała.12

Inne skuteczne terapie obejmują:123456

  • Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) – zazwyczaj składa się z 20 sesji, z tygodniowymi sesjami przez pierwsze 10 tygodni i elastycznym harmonogramem po tym okresie. Do 10 dodatkowych sesji dla osób z złożonymi problemami.
  • Specialist Supportive Clinical Management (SSCM) – zazwyczaj składa się z 20 lub więcej cotygodniowych sesji (w zależności od nasilenia). Ma na celu pomóc ludziom w rozpoznaniu związku między ich objawami a nieprawidłowym zachowaniem związanym z jedzeniem.
  • Eating-disorder-focused focal psychodynamic therapy (FPT) – zazwyczaj składa się z do 40 sesji w ciągu 40 tygodni. Skupia się na tworzeniu hipotezy specyficznej dla danej osoby i dotyczącej znaczenia objawów dla osoby, jak objawy wpływają na osobę i jak objawy wpływają na relacje osoby z innymi i z terapeutą.
  • Family-Based Treatment (FBT) – jest najbardziej skuteczną metodą leczenia dzieci i młodzieży. Podkreśla rolę rodziny w pomaganiu osobie w powrocie do zdrowia.

Indywidualne programy CBT dla dorosłych z jadłowstrętem psychicznym powinny:12

  • Zazwyczaj składać się z do 40 sesji w ciągu 40 tygodni, z dwiema sesjami tygodniowo w pierwszych 2 lub 3 tygodniach
  • Mieć na celu zmniejszenie ryzyka dla zdrowia fizycznego i wszelkich innych objawów zaburzeń odżywiania
  • Zachęcać do zdrowego odżywiania i osiągnięcia zdrowej masy ciała
  • Obejmować odżywianie, restrukturyzację poznawczą, regulację nastroju, umiejętności społeczne, problemy z obrazem ciała, poczucie własnej wartości i zapobieganie nawrotom

Farmakoterapia

Niestety, nie znaleziono leków, które pomogłyby w leczeniu jadłowstrętu psychicznego.1 Jednak leki mogą być stosowane jako część kompleksowego planu leczenia, szczególnie w leczeniu współistniejących zaburzeń psychicznych.123

Niektóre leki stosowane w leczeniu jadłowstrętu psychicznego to:123

  • Selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI), takie jak fluoksetyna (Prozac) – mogą być przepisywane w celu zarządzania współistniejącymi zaburzeniami lękowymi lub depresją
  • Leki przeciwlękowe
  • Psychostymulanty
  • Cyproheptadyna (Periactin) – może być stosowana w niektórych przypadkach w celu złagodzenia utraty masy ciała lub tłumienia apetytu
  • Klomipramina (Anafranil)
  • Chlorpromazyna (Thorazine)
  • Olanzapina (Zyprexa)

Nie należy oferować leków jako jedynego leczenia jadłowstrętu psychicznego.1

Środowisko terapeutyczne i relacja terapeutyczna

Ustanowienie terapeutycznej relacji z pacjentami z jadłowstrętem psychicznym jest niezbędne, aby pomóc ułatwić ich powrót do zdrowia i zapewnić wsparcie.1 Pielęgniarki powinny być świadome, że reakcje mogą wpływać na terapeutyczne relacje z pacjentami cierpiącymi na zaburzenia odżywiania, takie jak jadłowstręt psychiczny.1

Amerykańskie Stowarzyszenie Pielęgniarek (ANA) ustanowiło podstawowe standardy dla pielęgniarstwa psychiatrycznego, w tym odpowiedzialność pielęgniarek za utrzymanie terapeutycznego środowiska dla pacjentów, aby pomóc w ich powrocie do zdrowia.1

Środowisko oddziału specjalistycznego dla zaburzeń odżywiania jest celowo zorganizowane, aby pomóc pacjentowi w ustanowieniu zdrowych wzorców żywieniowych i normalizacji jedzenia.1 Pielęgniarki powinny zdawać sobie sprawę, że pacjenci z bulimią nervosa zwykle szybciej nawiązują terapeutyczną relację pielęgniarka-pacjent niż pacjenci z jadłowstrętem psychicznym.1

Badania wskazują na związek między jakością relacji między pacjentami a pielęgniarkami a przyrostem masy ciała i postrzeganą jakością doświadczenia szpitalnego. Polegając na sile pozytywnych, przemyślanych i dobrze zaplanowanych interakcji, pielęgniarki mogą przyczynić się do korzystnych efektów fizycznych i pozytywnego doświadczenia szpitalnego. Pacjenci wskazywali, że motywacja do przestrzegania opieki wynika z silnych relacji z pielęgniarkami.1

Badania wskazują, że proces przyrostu masy ciała może być wzmocniony, gdy towarzyszy mu proces zaangażowania terapeutycznego. Sojusz terapeutyczny może być skutecznym sposobem dla pielęgniarek, aby zapewnić przyrost masy ciała i poprawić doświadczenie szpitalne.1

Modele opieki i programy leczenia

Leczenie zaburzeń odżywiania może wymagać różnych poziomów opieki, od leczenia ambulatoryjnego, przez programy dzienne, placówki stacjonarne, aż po hospitalizację.1 Pacjenci z ciężkimi powikłaniami jadłowstrętu psychicznego mogą wymagać opieki szpitalnej.1

W modelu współpracy opieki (CCM), pielęgniarki pełnią rolę menedżerów współpracy opieki, zapewniając optymalną ciągłość i koordynację opieki.1 Model ten wzmacnia samozarządzanie i współpracę z dostawcami opieki zdrowotnej, oferuje przyjazne dla użytkownika i praktyczne wskazówki oraz ma na celu stabilizację, zmniejszenie nawrotów, pogorszenia i ponownych przyjęć do szpitala, będąc tym samym opłacalnym.1

W przypadku jadłowstrętu psychicznego o ciężkim i długotrwałym przebiegu (SE-AN), pacjenci prezentują wysoce złożony obraz kliniczny, charakteryzujący się mieszanką ostrych i długotrwałych objawów, które mają tendencję do pogarszania się z czasem. Zarządzanie takimi pacjentami wymaga podejścia multidyscyplinarnego, a także współpracy z partnerami sieciowymi na różnych poziomach opieki (podstawowym, wtórnym, trzeciorzędowym).1

Nie można przecenić znaczenia koordynacji i współpracy między wszystkimi zaangażowanymi pracownikami służby zdrowia, biorąc pod uwagę prawdopodobieństwo współistniejących stanów i zmieniających się priorytetów leczenia.1

Opieka paliatywna w jadłowstręcie psychicznym

Opieka paliatywna odnosi się do interwencji klinicznych, których celem jest ulga w cierpieniu, a nie leczenie podstawowej choroby pacjenta.1 Obecne badania w zakresie paliatywnej psychiatrii koncentrują się na redukcji szkód i poprawie jakości życia pacjentów z niektórymi stanami, takimi jak depresja oporna na leczenie i ciężki i długotrwały jadłowstręt psychiczny (SE-AN).1

Chociaż badania wykazały, że prawie dwie trzecie pacjentów z jadłowstrętem psychicznym wraca do zdrowia po 20 latach leczenia, co najmniej jedna trzecia z nich tego nie robi.1 Podejście paliatywne można wprowadzić jako alternatywę lub łącznie z leczeniem zorientowanym na powrót do zdrowia.1

Podejścia paliatywne mogą obejmować wykonanie zleceń medycznych dotyczących zakresu leczenia, które zabraniają przymusowego karmienia przez sondę, tym samym zmieniając cele opieki z przywrócenia masy ciała na poprawę codziennego życia oraz z powrotu do normalnych nawyków żywieniowych na suplementację diety.1

W przypadku jadłowstrętu psychicznego w fazie terminalnej, celem terapeutycznym jest złagodzenie cierpienia i uhonorowanie przeżytego życia.1 Wyznaczenie terminalnego jadłowstrętu psychicznego może łatwiej umożliwić pacjentom otrzymanie opieki paliatywnej, opieki hospicyjnej oraz emocjonalnych i praktycznych zasobów dla bliskich.1

Zapobieganie nawrotom i długoterminowa opieka

Ważne jest, aby pacjent otrzymywał stałe wsparcie po zakończeniu leczenia.1 Pacjenci powinni przechodzić kontrole masy ciała co najmniej raz w roku, a także kontrole zdrowia psychicznego i fizycznego.1

Dobra wiadomość jest taka, że jadłowstręt psychiczny można leczyć, a osoba z jadłowstrętem psychicznym może powrócić do zdrowej masy ciała i zdrowych wzorców żywieniowych. Niestety, ryzyko nawrotu jest wysokie, więc powrót do zdrowia w przypadku jadłowstrętu psychicznego zazwyczaj wymaga długoterminowego leczenia.1

Pacjenci powinni rozumieć, że powrót do zdrowia z jadłowstrętu psychicznego jest procesem, który wymaga czasu. Mogą oni wrócić do niejedzenia lub spożywania niewielkiej ilości kalorii, szczególnie w stresujących okresach. Jest to powszechne. Pacjenci powinni współpracować z członkami rodziny i świadczeniodawcami, aby powrócić na właściwy tor zdrowego odżywiania i zdrowego wysiłku fizycznego. Powinni starać się nie być źli na siebie z powodu epizodu.1

Pacjenci powinni koncentrować się na zdrowej samoocenie, myśląc o wszystkim, co im się w sobie podoba. Na przykład mogą być utalentowanymi artystami lub dobrze pisać. Powinni skupić się na tych umiejętnościach lub talentach zamiast na wyglądzie. Powinni prosić innych, aby nie komentowali ich wagi lub kształtu. Ich lekarz może im powiedzieć, jakie są zdrowe zakresy masy ciała dla ich wieku i wzrostu. Może upłynąć trochę czasu, zanim będą czuć się komfortowo, znając swoją wagę lub widząc swoją wagę jako zdrową.1

Wyzwania i trudności w leczeniu jadłowstrętu psychicznego

Jednym z największych wyzwań w leczeniu jadłowstrętu psychicznego jest to, że pacjent może nie chcieć być leczony.1 Ważne jest, aby zrozumieć, że osoby z jadłowstrętem psychicznym są znane z braku zainteresowania leczeniem.1

Z powodu niechęci pacjentów do zaakceptowania, że są anorektyczni, może to być również bardzo trudne, ponieważ opór przed jedzeniem jest trudny do przełamania, więc wymaga to sporo wysiłku, aby rozpocząć tę podróż, aby zaangażować ich w terapię.1 Poziom zaangażowania i chęć zaakceptowania problemu i wprowadzenia zmian przez daną osobę waha się od zerowego do pewnego, więc rozpoczęcie tej podróży wymaga dużego wysiłku.1

Powrót do zdrowia jest możliwy przy sprawdzonej terapii, która obejmuje osiągnięcie zdrowej masy ciała.1 Im wcześniej pacjent otrzyma leczenie, tym lepsze będą wyniki.1

Plan opieki pielęgniarskiej nad jadłowstrętem psychicznym jest zazwyczaj długoterminowy, a wycofanie i nawrót są realnymi możliwościami, dlatego wsparcie ze strony przyjaciół i rodziny jest konieczne dla trwałych i skutecznych wyników.1 Jeśli członkowie gospodarstwa domowego rozpoznają sygnały ostrzegawcze i mogą zrozumieć stan, mogą pomóc zapobiec nawrotom i mogą zawsze pozostać empatyczni i zachęcający dla swoich bliskich.1

Podsumowanie

Jadłowstręt psychiczny to poważne zaburzenie odżywiania, które wymaga kompleksowego i wrażliwego podejścia ze strony pracowników służby zdrowia, w tym pielęgniarek. Pielęgniarki odgrywają kluczową rolę w ocenie, monitorowaniu i leczeniu pacjentów z jadłowstrętem psychicznym, zapewniając zarówno opiekę fizyczną, jak i wsparcie emocjonalne.1

Skuteczna opieka pielęgniarska nad pacjentami z jadłowstrętem psychicznym wymaga kompleksowego, skoncentrowanego na pacjencie podejścia. Pielęgniarki mogą odgrywać kluczową rolę we wspieraniu pacjentów w ich podróży do powrotu do zdrowia, wdrażając te plany opieki pielęgniarskiej i współpracując z interdyscyplinarnym zespołem. Należy pamiętać, że powrót do zdrowia z jadłowstrętu psychicznego jest procesem, który wymaga cierpliwości, zrozumienia i stałego wsparcia.1

Pacjenci z zaburzeniami odżywiania wymagają nie tylko leczenia fizycznego, ale także wsparcia emocjonalnego, a rolą pielęgniarki jest zapewnienie obu tych aspektów. Poprzez zbiorowe wysiłki, pielęgniarki dążą do pomocy pacjentom w odzyskaniu kontroli nad ich życiem, osiągnięciu zdrowej relacji z jedzeniem i przyjęciu pozytywnego obrazu siebie.1

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether
    https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/
    Anorexia nervosa is a serious eating disorder that is potentially life-threatening if not recognized and treated appropriately. It is characterized by a very low body weight, an intense fear of gaining weight, and extreme habits to prevent weight gain. […] Nurses in medical settings may care for patients with anorexia when they are admitted for electrolyte imbalances, heart arrhythmias, and severe malnutrition. Psychiatric nurses may also care for patients with anorexia in instances of suicide attempts, depression, and anxiety. These patients require monitoring and management of complications, cautious refeeding treatment, and intense psychological therapy. […] Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions related to anorexia.
  • #1 Anorexia Nervosa: What It Is, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa
    Anorexia is an eating disorder that involves severe calorie restriction and often a low body weight. Treatment for anorexia is essential due to its life-threatening complications. […] Anorexia (anorexia nervosa) is an eating disorder in which you restrict the number of calories you consume, resulting in a nutrient deficit and often but not always a very low body weight. […] Anorexia is both a mental and physical condition. Without treatment, it can lead to malnutrition, serious health issues and even death. […] The biggest challenge in treating anorexia is helping the person recognize and accept that they have a serious condition. Many people with anorexia deny they have an eating disorder. […] The goals of anorexia treatment include: Stabilizing weight loss, Beginning nutrition rehabilitation to restore weight, Eliminating binge eating and/or purging behaviors and other problematic eating patterns, Treating psychological concerns, like low self-esteem and distorted thinking patterns, Developing long-term behavioral changes.
  • #1 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether
    https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/
    Patients with anorexia nervosa who are severely malnourished or psychologically at risk require treatment in an inpatient facility. The following are indications for hospital admission: Significant weight loss, Lack of any weight gain, Significant edema, Vital sign alterations, Severe electrolyte imbalance, Cardiac disturbances, Acute medical disorders, Altered mental status, Psychosis, High risk of suicide, Lack of a support system, Limited access to outpatient treatment, Nonadherence or continued purging behaviors. […] An essential component of treating anorexia is nutrition. Refeeding involves providing a set number of calories per day to achieve a goal weight. Refeeding must be administered gradually and with caution to prevent refeeding syndrome. […] Patients with anorexia may attempt to reduce weight through fasting or extreme calorie restriction, excessive exercise, self-inflicted vomiting (purging), and use of laxatives, enemas, diet supplements, appetite suppressants, or herbal remedies.
  • #1 Bulimia, Anorexia Nervosa, and Binge Eating Disorder – Mental Health
    https://leveluprn.com/blogs/psychiatric-mental-health/37-disorders-eating?srsltid=AfmBOoqqqu1IvLjk7YBATuu7bod53WwcwH1MbgOtBt3hftI5sAdImO9p
    Anorexia nervosa is an eating disorder characterized by restriction of calorie intake that results in a dangerously low body weight. […] The main anorexia nervosa risk factors you need to know for your nursing exams are patient sex (female), patient age (adolescence, early adulthood), and other psychiatric disorders. […] Signs and symptoms of anorexia nervosa include: Extreme thinness, Amenorrhea, Lanugo, Cold intolerance, Brittle hair and nails, Severe constipation, Lethargy, Decreased heart rate, Decreased blood pressure, Decreased respiratory rate. […] The criteria for hospitalizing a patient with anorexia nervosa includes: Inadequate response to outpatient therapy, Electrolyte abnormalities, Daytime heart rate under 50 bpm, Systolic blood pressure under 90 mmHg, Arrhythmias, Body temperature under 96, Body weight under 75% of ideal, Body fat under 10%, Refusal to eat.
  • #1 Nursing Assessment and Care for Patients with Eating Disorders – Mental Health
    https://www.naxlex.com/nursing/study-guides/nursing-assessment-and-care-for-patients-with-eating-disorders-1695388050
    – A nurse is conducting a comprehensive assessment of a patient with an eating disorder. Which aspects should the nurse assess to provide holistic care? D Both physical and psychological aspects. […] – A nurse is implementing a care plan for a patient with an eating disorder. Which nursing interventions are appropriate for this patient? Select all that apply. A Monitoring vital signs and weight. B Providing positive reinforcement for eating. C Teaching coping skills and stress management techniques. D Involving the family in the treatment process. […] – A nurse is caring for a patient with an eating disorder. Which nursing intervention is appropriate for this patient? A Monitoring vital signs and weight. […] – A nurse is assessing a patient with an eating disorder. The patient states, „I feel so fat and disgusting.” Which response by the nurse is appropriate? C „I understand how you feel. Many people with eating disorders struggle with body image.” […] – A client with an eating disorder has a distorted body image and irrational beliefs. What therapeutic approach should the nurse use to address this issue? C Address cognitive distortions and irrational beliefs.
  • #1 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether
    https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/
    The nurse should assess for thoughts of suicide as this is the second leading cause of death for patients with anorexia. […] The nurse must obtain a current height and weight to evaluate treatment effectiveness. Patients with anorexia often display a very low BMI. […] Patients with anorexia are often very self-critical and need to feel in control. They may withdraw from friends and family. […] Patients may report symptoms of headache, dizziness, fatigue, and difficulty concentrating, which can alert the nurse to hypovolemia. […] The nurse should use active listening and empathy when communicating with the patient and family. The nurse must not make comments, good or bad, about the patients weight or appearance and should instead focus on other qualities. […] Anorexia can cause complications that may affect every body system. Some signs of anorexia include thinning, brittle hair and nails, lanugo, edema, stomach pain or bloating, cold hands and feet, breast atrophy, loss of muscle mass, and arrhythmias.
  • #1 Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) | Free NURSING.com Courses
    https://nursing.com/lesson/nursing-care-plan-for-eating-disorders-anorexia-nervosa-bulimia-nervosa-binge-eating-disorder
    Eating disorders are complex mental health conditions that require a comprehensive and sensitive approach from healthcare professionals. […] Develop individualized care plans tailored to the specific needs and preferences of individuals with eating disorders. […] Gain proficiency in providing nutritional interventions that promote a balanced and healthy relationship with food. […] Cultivate effective therapeutic communication skills to establish rapport and trust with individuals experiencing eating disorders. […] Emphasize preventive strategies and health education to raise awareness about the risks and consequences of eating disorders. […] Conduct a thorough nutritional assessment, including dietary habits, food preferences, and any restrictive behaviors. […] Assess vital signs, hydration status, and signs of malnutrition.
  • #1 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts
    https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/
    Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses: Imbalanced Nutrition: Less Than Body Requirements, Risk for Electrolyte Imbalance, Risk for Imbalanced Fluid Volume, Impaired Body Image, Ineffective Coping, Interrupted Family Processes, Chronic Low Self-Esteem, Powerlessness, Risk for Spiritual Distress. […] These are the typical overall treatment goals for individuals with eating disorders: Restoring adequate nutrition, Bringing weight to a healthy level, Reducing excessive exercise, Stopping binge-purge and binge eating behaviors. […] After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling. […] Nurses individualize interventions based on the clients current clinical status and their phase of treatment.
  • #1 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs
    https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/
    Goals and expected outcomes may include: The client will verbalize understanding of nutritional needs. The client will establish a dietary pattern with caloric intake adequate to regain/maintain an appropriate weight. The client will demonstrate weight gain toward the individually expected range. The client will maintain/demonstrate improved fluid balance, as evidenced by adequate urine output, stable vital signs, moist mucous membranes, and good skin turgor. The client will verbalize understanding of causative factors and behaviors necessary to correct the fluid deficit. The client will display an improved ability to make decisions, and problem-solve. The client will establish a more realistic body image. […] Therapeutic interventions and nursing actions for patients with eating disorders may include: Patients with anorexia and bulimia nervosa may use laxatives to control their weight, leading to inadequate nutrient absorption and less than body requirements. Inadequate food intake in anorexia nervosa can also result in nutrient deficiencies and imbalanced nutrition. Both conditions can have significant physical and emotional consequences that require professional treatment.
  • #1 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs
    https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/
    Patients with anorexia and bulimia nervosa are at risk of deficient fluid volume due to behaviors such as excessive fluid restriction or the use of diuretics or laxatives. These behaviors can lead to dehydration and electrolyte imbalances, which can have serious health consequences. It is important for patients with eating disorders to receive professional treatment to address these behaviors and prevent fluid volume deficits. […] Patients with eating disorders often experience distorted body image, perceiving themselves as overweight or unattractive, even when their weight is dangerously low. This distorted perception can significantly impact their self-esteem, leading to feelings of shame, worthlessness, and a negative self-concept. […] Positive coping for patients and their families dealing with eating disorders involves seeking professional help and support from a multidisciplinary team, including therapists, dietitians, and support groups, to address the emotional, psychological, and nutritional aspects of the disorder.
  • #1 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org
    https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/
    Nurses play an essential role in identifying destructive eating patterns and providing physical and emotional care for patients from detection to recovery. The goal is to have a manageable multidisciplinary, holistic approach to care. […] Monitoring nutritional status, electrolyte balance, weight, and activity, while keeping watch over diuretic/laxative use, make up important aspects of a nurses role. […] Patients also need emotional support, as they face deep pain and traumatic thoughts. Nurses can gain trust through active listening, empathy, and positive reinforcement. They can foster independence and educate patients and loved ones. […] Establishing goals to ensure the patient maintains awareness, practices healthy coping techniques, and adopts a positive body image and sense of self-worth is a priority.
  • #1 Bulimia, Anorexia Nervosa, and Binge Eating Disorder – Mental Health
    https://leveluprn.com/blogs/psychiatric-mental-health/37-disorders-eating?srsltid=AfmBOoqqqu1IvLjk7YBATuu7bod53WwcwH1MbgOtBt3hftI5sAdImO9p
    Treatment of bulimia nervosa and anorexia nervosa includes individual and group therapy, cognitive behavioral therapy, nutrition counseling, as well as medications to treat psychiatric comorbidities, for example, antidepressants to treat depression. […] In terms of nursing care, we need to maintain strict eyes and nose. We should weigh the patient every morning using the same scale. And then we need to stay with the patient during meals and for at least one hour after meals. We should also restrict strenuous activity, and we can provide privileges based on treatment compliance as well as weight gain. […] If a patient has inadequate oral intake, then two feedings may be ordered by the provider. As the nurse, you need to monitor the patient for something called refeeding syndrome. Refeeding syndrome can occur if nutrition is introduced too rapidly after prolonged starvation. Signs and symptoms of this disorder include severe electrolyte imbalances, arrhythmias, and seizures.
  • #1 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org
    https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/
    The goals of treatment for a patient with an eating disorder need to be patient-centered or patient-driven, meaning that the patient and the nurse work to formulate shared goals for recovery. […] Godzik states that treatment can involve family members or a patients friends to support the patient. It is a team effort. […] Risk factors vary, making ED detection a challenge. The role as a nurse is crucial in identifying the risks and clinical presentation of EDs and managing the patient through recovery. […] Continuing education helps nurses stay up to date on EDs. By applying knowledge and nursing tips in caring for patients with ED, nurses can play a significant role in a positive patient outcome.
  • #1 Anorexia Nervosa: What It Is, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa
    Treatment for anorexia most often involves a combination of: Individual and group psychotherapy (talk therapy), Medication, Hospitalization. […] Family support is very important to anorexia treatment success. Family members must understand the eating disorder and recognize its signs and symptoms. […] Hospitalization might be necessary to treat severe weight loss that has resulted in malnutrition and other serious mental or physical health complications. […] Without treatment, anorexia is potentially life-threatening. Eating disorders, including anorexia, are among the deadliest mental health conditions. […] The good news is that anorexia can be treated, and someone with anorexia can return to a healthy weight and healthy eating patterns. Unfortunately, the risk of relapse is high, so recovery from anorexia usually requires long-term treatment.
  • #1 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts
    https://wtcs.pressbooks.pub/nursingmhcc/chapter/13-4-applying-the-nursing-process-to-eating-disorders/
    The milieu of an eating disorder specialty unit is purposefully organized to assist the client in establishing healthy eating patterns and normalization of eating. […] The first priority is to establish a therapeutic relationship. […] Nurses should be aware that clients with bulimia nervosa typically establish a therapeutic nurse-client relationship more quickly than clients with anorexia nervosa. […] A significant part of the recovery process includes rebuilding relationships with family. […] Nurses refer clients and their loved ones to resources as part of discharge planning.
  • #1 Anorexia nervosa – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597
    If your healthcare professional thinks that you have anorexia nervosa, you may have several tests and exams to pinpoint a diagnosis, rule out medical causes for the weight loss and check for any related complications. […] It’s best to treat anorexia nervosa using a team approach. The team includes doctors, mental health professionals and other healthcare professionals all with experience in treating eating disorders. […] If your life is in danger now, you may need to be treated in a hospital emergency department. This may be needed for issues such as a heart rhythm problem, dehydration, electrolyte imbalances or a mental health emergency. […] The first goal of treatment is to get to a healthy weight based on your personal growth history. You can’t recover from anorexia without returning to a healthy weight and good eating habits.
  • #1 Multidisciplinary treatment: patients with anorexia nervosa | JMDH
    https://www.dovepress.com/a-retrospective-chart-review-suggests-that-coordinated-multidisciplina-peer-reviewed-fulltext-article-JMDH
    Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). […] This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting. […] Treatment recommendations for the care of individuals with anorexia nervosa recommend a coordinated, multidisciplinary approach that, at a minimum, includes the following healthcare professional groups: a medical provider, mental health professional, and registered dietitian. […] The multidisciplinary team includes, at a minimum, a medical provider (physician, advanced practice provider, psychiatrist, etc.), a mental health professional (psychologist, licensed clinical social worker), and a registered dietitian.
  • #1 Multidisciplinary treatment: patients with anorexia nervosa | JMDH
    https://www.dovepress.com/a-retrospective-chart-review-suggests-that-coordinated-multidisciplina-peer-reviewed-fulltext-article-JMDH
    In a coordinated care context, providers discuss treatment plan details for shared patients, collaborate in the delivery of consistent patient messaging, and update fellow providers on the patients physical, emotional, and psychological health. […] Our main objective of this study was to identify the difference in clinical outcomes between patients with AN who did and did not receive coordinated, multidisciplinary care by assessing the odds of achieving a normal BMI in adults and returning to baseline BMI percentile for pediatric patients. […] These findings provide preliminary support for healthcare systems to implement the coordinated, multidisciplinary approach more consistently.
  • #1 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs
    https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/
    Anorexia nervosa is an illness of starvation, brought on by severe disturbance of body image and a morbid fear of obesity. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. […] Nursing care planning for patients with eating disorders: anorexia nervosa and bulimia nervosa include establishing adequate nutritional intake, correcting fluid and electrolyte imbalance, assisting the patient to develop realistic body images, and improving self-esteem. […] The following are the nursing priorities for patients with eating disorders: Provide nutritional support and guidance to restore healthy eating patterns. Offer individual therapy to address underlying psychological factors contributing to the eating disorder. Implement cognitive-behavioral therapy (CBT) or other evidence-based therapies to modify unhealthy thoughts and behaviors. Monitor and manage co-occurring mental health conditions, such as depression or anxiety. Involve family members or support systems in the treatment process, if appropriate. Educate patients and caregivers about the dangers and consequences of disordered eating behaviors.
  • #1 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    1.3.4 For adults with anorexia nervosa, consider one of: […] individual eating-disorder-focused cognitive behavioural therapy (CBTED) […] Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) […] specialist supportive clinical management (SSCM). Explain to the person what the treatments involve to help them choose which they would prefer. […] 1.3.5 Individual CBTED programmes for adults with anorexia nervosa should: […] typically consist of up to 40 sessions over 40 weeks, with twice-weekly sessions in the first 2 or 3 weeks […] aim to reduce the risk to physical health and any other symptoms of the eating disorder […] encourage healthy eating and reaching a healthy body weight […] cover nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self-esteem, and relapse prevention
  • #1 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    when the person is ready, cover nutrition, symptom management, and behaviour change […] encourage the person to develop a 'non-anorexic identity’ […] involve family members or carers to help the person: […] understand their condition and the problems it causes and the link to the wider social context […] change their behaviour. […] 1.3.7 SSCM for adults with anorexia nervosa should: […] typically consist of 20 or more weekly sessions (depending on severity) […] assess, identify, and regularly review key problems […] aim to develop a positive relationship between the person and the practitioner […] aim to help people recognise the link between their symptoms and their abnormal eating behaviour […] aim to restore weight […] provide psychoeducation, and nutritional education and advice
  • #1 Anorexia nervosa – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597
    Family-based treatment, sometimes called FBT, is the only proven outpatient treatment for teenagers with anorexia. […] Unfortunately, no medicines have been found to help treat anorexia nervosa. […] One of the biggest challenges in treating anorexia is that you may not want to be treated. […] Recovery is possible with proven treatment that includes reaching a healthy weight. […] When you have anorexia nervosa, it can be hard to take care of yourself properly. In addition to professional treatment, follow these steps: […] If you have anorexia nervosa, you may misuse dietary supplements, herbal products designed to make you lose weight or feel less hungry, stimulants or insulin. […] You may find it hard to cope with anorexia nervosa when media and culture and maybe your own family or friends give you mixed messages about what you should look like.
  • #1 Nursing Care Plan for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) | Free NURSING.com Courses
    https://nursing.com/lesson/nursing-care-plan-for-eating-disorders-anorexia-nervosa-bulimia-nervosa-binge-eating-disorder-2?quiz-view=open
    Monitor fluid balance and administer oral and IV fluids as appropriate. Failure to eat or drink and repeated purging through vomiting or excessive use of laxatives can cause a fluid imbalance and lead to dehydration. […] Record routine weights per facility protocol. Monitor progress of interventions and incorporate routine accountability checks for clients. […] Monitor skin for wounds, dryness, excoriation or deep tissue injuries. Lack of hydration and proper nutrition lead to decreased perfusion and poor circulation. […] Administer medications appropriately: SSRI antidepressants, Anti-anxiety medications, Psychostimulants. Medications may help relieve the underlying conditions that increase symptoms by improving mood and thinking. […] Provide education for clients and family members regarding disease, treatment and support resources. Help client and family members make informed decisions and reduce stress and anxiety about treatments.
  • #1 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    1.3.19 For people with anorexia who have declined or do not want treatment and who have severe or complex problems, eating disorder services should provide support as covered in the recommendation on providing support and care in the section on treating anorexia nervosa. […] 1.3.20 Only offer dietary counselling as part of a multidisciplinary approach. […] 1.3.21 Encourage people with anorexia nervosa to take an age-appropriate oral multi-vitamin and multi-mineral supplement until their diet includes enough to meet their dietary reference values. […] 1.3.22 Include family members or carers (as appropriate) in any dietary education or meal planning for children and young people with anorexia nervosa who are having therapy on their own. […] 1.3.23 Offer supplementary dietary advice to children and young people with anorexia nervosa and their family or carers (as appropriate) to help them meet their dietary needs for growth and development (particularly during puberty). […] 1.3.24 Do not offer medication as the sole treatment for anorexia nervosa.
  • #1 20.2 Anorexia Nervosa – Psychiatric-Mental Health Nursing | OpenStax
    https://openstax.org/books/psychiatric-mental-health/pages/20-2-anorexia-nervosa
    Establishing a therapeutic relationship with clients with anorexia nervosa is essential to help facilitate their recovery and provide support. […] Nurses reactions can affect therapeutic relationships with clients who suffer from eating disorders like anorexia. […] The American Nurses Associations essential standards for psychiatric nursing includes the responsibility of nurses to maintain a therapeutic milieu for clients to help aid in their recovery. […] Treatment of eating disorders can require different levels of care ranging from community treatment, day programs, residential facilities, or hospitalization. […] Clients with severe complications from anorexia nervosa may require hospital care. […] Caring for clients with anorexia requires teamwork. Delegation of tasks by nurses is essential to providing quality care and can help decrease the workload.
  • #1 Effective nursing care of adolescents with anorexia nervosa: a consumer perspective – PubMed
    https://pubmed.ncbi.nlm.nih.gov/23398386/
    Aims and objectives: To establish how nurses ensure weight gain and a positive inpatient experience for the treatment of adolescents with anorexia nervosa by considering consumer perspectives. […] Nurses were considered highly influential over the inpatient experience. The findings of this study are characterised by three overall themes regarding nursing practice: (1) ensuring weight gain, (2) maintaining a therapeutic milieu, and (3) the nursing relationship. […] Consumers have clear perspectives of how nurses effectively ensure weight gain and how nurses ensure a positive inpatient experience. The quality of relationships between consumers and nurses had implications for both weight gain and the perceived quality of the inpatient experience. By relying on the strength of positive, thoughtful and well-timed interactions, nurses may contribute to productive physical outcomes and a positive inpatient experience. Consumers indicated that motivation to adhere to care was derived from strong relationships with nurses. Ensuring both weight gain and a positive experience involves achieving a productive 'balance of restrictions’. Consumers also valued nurses that created a comfortable and productive environment.
  • #1 Effective nursing care of adolescents with anorexia nervosa: a consumer perspective – PubMed
    https://pubmed.ncbi.nlm.nih.gov/23398386/
    This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment and possibly enhance outcomes for consumers.
  • #1 Towards collaborative care for severe and enduring Anorexia Nervosa – a mixed-method approach | Journal of Eating Disorders | Full Text
    https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01091-z
    Within this model, nurses serve as collaborative care managers, ensuring optimal continuity and coordination of care. […] The main aim of this study was to define a model that can improve the quality and continuity of care for patients with SE-AN within the context of Dutch mental healthcare. […] The resulting model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. […] It cannot be overstated how crucial person-centered, personalized treatments, along with the consultation liaison role of the ED treatment center, are in addressing the profound complexity and scientific uncertainties surrounding SE-AN. […] This structured framework not only facilitates better care coordination, but also enhances understanding among caregivers, thereby reducing potential miscommunications and inefficiencies.
  • #1 Towards collaborative care for severe and enduring Anorexia Nervosa – a mixed-method approach | Journal of Eating Disorders | Full Text
    https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01091-z
    Severe and Enduring Eating Disorders (SEED), in particular SEED-Anorexia Nervosa (SE-AN), may represent the most difficult disorder to treat in psychiatry. […] Meanwhile experts concur that effective care should be structured in a collaborative manner. […] The proposed model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. […] Importantly, the model operates across levels of care (primary, secondary, tertiary). […] This study, describing a collaborative care program for SE-AN, developed and implemented in a highly specialized treatment center for eating disorders, sets the stage for further explanatory/efficacy research to build on the findings in this study, with the following aims: addressing the critical gap in care for SEED/SE-AN, improving better healthcare organization, reducing relapse rates, and lowering costs for this often overlooked patient group.
  • #1 Towards collaborative care for severe and enduring Anorexia Nervosa – a mixed-method approach | Journal of Eating Disorders | Full Text
    https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-01091-z
    Patients with SE-AN present a highly complex clinical picture, characterized by a mix of acute and long-term symptoms that tend to worsen over time. Managing such patients necessitates a multidisciplinary team approach, as well as collaboration with network partners across various levels of care (primary, secondary, tertiary). […] The importance of coordination and collaboration among all healthcare professionals involved cannot be overstated, given the likelihood of comorbid conditions and evolving treatment priorities. […] While recognizing the necessity of a systematic approach to treating SE-AN and fostering collaboration among all stakeholders, there is a notable gap in implementing an organized treatment model for SE-AN. […] The Collaborative Care Model (CCM) offers valuable insights into the organization of care and a framework for collaboration.
  • #1 How Palliation Can Improve Care of Patients With Severe and Enduring Anorexia Nervosa | Journal of Ethics | American Medical Association
    https://journalofethics.ama-assn.org/article/how-palliation-can-improve-care-patients-severe-and-enduring-anorexia-nervosa/2023-09
    Palliative care refers to clinical interventions whose purpose is relief of suffering, not treatment of a patients underlying illness. […] This commentary on a case summarizes emerging themes in palliative psychiatry and explores its ethical feasibility in the care of patients with severe and enduring anorexia nervosa. […] Current palliative psychiatry research focuses on harm reduction and improving quality of life for patients with certain conditions, such as treatment-refractory depression and severe and enduring AN. […] Recently, criteria for the diagnosis of terminal anorexia nervosa were proposed to describe a subset of patients with SE-AN who feel further recovery-oriented treatment is futile, wish to stop trying to prolong their lives, and, in some cases, request aid in dying.
  • #1 How Palliation Can Improve Care of Patients With Severe and Enduring Anorexia Nervosa | Journal of Ethics | American Medical Association
    https://journalofethics.ama-assn.org/article/how-palliation-can-improve-care-patients-severe-and-enduring-anorexia-nervosa/2023-09
    Although studies have shown that almost two-thirds of patients with AN recover after 20 years of treatment, at least one-third of them do not. […] A palliative approach could be introduced as an alternative to or conjointly with recovery-oriented treatment. […] Palliative approaches can include completing medical orders for scope of treatment that forbid involuntary tube feeding, thereby shifting care goals from weight restoration to improving daily living and from a return to normal eating habits to dietary supplementation. […] By creating a clinical environment that gives Ms M agency and holds her in positive regard, her team will increase the likelihood of providing interventions that are both compassionate and effective.
  • #1 Terminal anorexia nervosa: three cases and proposed clinical characteristics | Journal of Eating Disorders | Full Text
    https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00548-3
    We hope that this proposal stimulates further expert consensus definitions and clinical guidelines for management of this population. […] In our view, these patients deserve the same attendant care and rights as all other patients with terminal illness, up to and including medical aid in dying in jurisdictions where such care is legal. […] There is growing recognition that palliative care may be appropriate for some patients, but the clinical characteristics for terminal anorexia nervosa have not been proposed. […] Designating terminal AN may more readily enable patients to receive palliative care, hospice care, and emotional and practical resources for loved ones, as well as access to medical aid in dying (MAID) where legal. […] Therapeutic goals in these situations are to ameliorate suffering and honor the life lived.
  • #1 Treatment – Anorexia nervosa – NHS
    https://www.nhs.uk/mental-health/conditions/anorexia/treatment/
    If youre very unwell, your meal plan may need to be supervised more closely. For some people this might mean a stay in hospital. […] It’s important that you receive ongoing support after your treatment is finished. […] You should have checks of your weight at least once a year, as well as of your mental and physical health.
  • #1 Anorexia – What You Need to Know
    https://www.drugs.com/cg/anorexia.html
    Be patient. Recovery from anorexia is a process that takes time. You may go back to not eating, or eating few calories, especially during stressful times. This is common. Work with family members and providers to get back on track with healthy eating and healthy exercise. Try not to be angry with yourself for the episode. […] Focus on a healthy self-esteem. Think about everything you like about yourself. For example, you may be a talented artist, or you may write well. Focus on those skills or talents instead of on appearance. Ask others not to comment on your weight or shape. Your provider can tell you healthy weight ranges for your age and height. It may take time before you are comfortable knowing your weight or seeing your weight as healthy. Remember your goals to build a healthy self-esteem. Be patient with yourself as you change your thinking.
  • #1 12: Eating Disorders | Nurse Key
    https://nursekey.com/12-eating-disorders/
    During hospitalization, treatment goals include weight restoration, normalization of eating behavior, change in the pursuit of thinness, and prevention of relapse. […] Therefore, Imbalanced Nutrition: Less Than Body Requirements is a primary nursing diagnosis. […] It is important to understand that individuals with anorexia nervosa are notoriously disinterested in treatment. […] Individual therapy and group therapy are essential in treating patients with eating disorders. […] Behavior therapy is often used to change the eating patterns of an anorexic patient who is seriously close to death. […] Monitor laboratory values, and report abnormal values to the primary clinician.
  • #1
    https://care24.co.in/nursing/anorexia/
    Nursing care plan for anorexia may involve medicine, psychotherapy, family therapy, and nourishment counseling. […] Due to the unwillingness of patients to accept that they are anorexic, it can also be very difficult since the resistance to food is tough to break, so it takes quite a lot of effort to get started on the journey to engage them in therapy. […] The individuals engagement levels and willingness to accept their problem and make changes keep vacillating from none to some so it takes quite an effort to get started on this journey. […] A strategy must be tailored to satisfy the requirements of the individual. […] Therapy goals are to do the following: To make the individual eat and restore a healthy and reasonable body weight; To address psychological problems, including reduced self-esteem and manage distorted thoughts about food and body image with very high maturity, high empathy and with real interest and wiliness to make a difference to the individual being supported; To assist the patient, create behavioral adjustments which will persist in the Long-term.
  • #1 Diagnosis of Eating Disorders in Primary Care | AAFP
    https://www.aafp.org/pubs/afp/issues/2003/0115/p297.html
    Eating disorders, particularly anorexia nervosa and bulimia nervosa, are significant causes of morbidity and mortality among adolescent females and young women. […] The family physician can play an important role in diagnosing these illnesses and can coordinate the multi-disciplinary team of psychiatrists, nutritionists, and other professionals to successfully treat patients with eating disorders. […] Early diagnosis with intervention and earlier age at diagnosis are correlated with improved outcomes in patients who have eating disorders. […] The hallmark of anorexia is a refusal to maintain body weight at or above 85 percent of expected weight, as defined by age-appropriate body mass index charts. […] Treatment intensity and setting depend on the severity of the illness. Patients with mild illness can be managed on an outpatient basis. Patients who are medically or psychiatrically unstable require inpatient treatment.
  • #1
    https://care24.co.in/nursing/anorexia/
    Nursing care plan for anorexia nervosa is generally long-term, and withdrawal and relapse are real possibilities and hence support from friends and family are contingent to lasting and effective results. […] If household members identify the danger signs and can understand the status, they can help prevent relapse and could always remain empathic and encouraging for their loved ones. […] Nursing Intervention for Eating Disorders: Set nutrient requirements and a weight target because malnutrition is an illness affecting and resulting in depression, agitation and having the right nutrition enriches thinking capability, and enhances the ability to work right. […] Engage with the patient in helping them understand the problem and identify a target weight, chart out a system of behavior modification and set rewards for weight gains in a staggered fashion.
  • #1 Nursing Care Plan For Eating Disorder Patients – Made For Medical
    https://www.madeformedical.com/nursing-care-plan-for-eating-disorder-patients/
    Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, are complex mental health conditions characterized by disordered eating behaviors and distorted body image perceptions. […] A nursing care plan for eating disorder patients focuses on providing holistic care that addresses the unique challenges associated with these conditions. […] Nurses play a critical role in the assessment, monitoring, and management of eating disorder patients. […] The care plan encompasses various aspects of care, including nutritional assessment, psychotherapy, behavioral interventions, and family involvement. […] It emphasizes the need for a compassionate, non-judgmental, and patient-centered approach to help individuals regain control of their lives and achieve sustainable recovery from eating disorders.
  • #1 Anorexia Nursing Diagnosis & Care Plan – NurseStudy.Net
    https://nursestudy.net/anorexia-nursing-diagnosis/
    Effective nursing care for patients with anorexia nervosa requires a comprehensive, patient-centered approach. Nurses can play a crucial role in supporting patients through their recovery journey by implementing these nursing care plans and working collaboratively with an interdisciplinary team. Remember that recovery from anorexia is a process that requires patience, understanding, and consistent support.
  • #1 Nursing Care Plan For Eating Disorder Patients – Made For Medical
    https://www.madeformedical.com/nursing-care-plan-for-eating-disorder-patients/
    By fostering a collaborative and patient-centered approach, nurses can support individuals on their path to recovery, promoting overall well-being and a healthier relationship with food and body image. […] Eating disorder patients require not only physical healing but also emotional support, and our role as nurses is to provide both. […] Through our collective efforts, we aspire to help individuals regain control of their lives, achieve a healthy relationship with food, and embrace a positive self-image.
  • #2 Anorexia nervosa in adults and adolescents: Medical complications and their management – UpToDate
    https://www.uptodate.com/contents/anorexia-nervosa-in-adults-and-adolescents-medical-complications-and-their-management
    Anorexia nervosa is associated with numerous general medical complications that are directly attributable to weight loss and malnutrition. The complications involve most major organ systems and often include physiologic disturbances such as hypotension, bradycardia, hypothermia, and amenorrhea. Medical complications account for approximately half of all deaths in anorexia nervosa, which has one of the highest mortality rates of any psychiatric disorder. […] The medical complications of low weight in anorexia nervosa and the management of these complications are reviewed here. The evaluation for medical complications and criteria for hospitalizing patients with anorexia nervosa; epidemiology and pathogenesis; clinical features, assessment, and diagnosis; treatment of anorexia nervosa; and the refeeding syndrome are discussed separately. […] In addition, the medical complications of binge eating and purging (which can occur in anorexia nervosa) are discussed in the context of the topic that reviews the medical complications of bulimia nervosa and binge eating disorder.
  • #2 Anorexia nervosa | Better Health Channel
    https://www.betterhealth.vic.gov.au/health/healthyliving/anorexia-nervosa
    Anorexia nervosa is a psychological illness that has serious physical, emotional and social consequences. […] Early treatment from a mixed team of health professionals is the best chance of making a full recovery. […] Recognising the signs early and getting help can reduce the impact of anorexia nervosa and support a faster and full recovery. It is possible to recover from this eating disorder with the right support, even if you have been living with it for many years. […] Once anorexia nervosa is diagnosed, your doctor will organise a team to help you on your way to recovery. This might involve establishing a healthcare team of different professionals, including psychiatrist, psychologist, dietitian, family therapist, social worker, occupational therapist. […] Treatment needs to address both physical and psychological health.
  • #2 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts
    https://ecampusontario.pressbooks.pub/mentalhealth/chapter/13-4-applying-the-nursing-process-to-eating-disorders/
    Common nursing diagnoses for individuals diagnosed with anorexia nervosa or bulimia nervosa include these diagnoses: Imbalanced Nutrition: Less Than Body Requirements, Risk for Electrolyte Imbalance, Risk for Imbalanced Fluid Volume, Impaired Body Image, Ineffective Coping, Interrupted Family Processes, Chronic Low Self-Esteem, Powerlessness, Risk for Spiritual Distress. […] These are the typical overall treatment goals for individuals with eating disorders: Restoring adequate nutrition, Bringing weight to a healthy level, Reducing excessive exercise, Stopping binge-purge and binge eating behaviors. […] Planning depends on the acuity of the clients situation. As previously discussed, clients are hospitalized for stabilization. Common criteria for hospitalization include extreme electrolyte imbalance, weight below 75% of healthy body weight, arrhythmias, hypotension, temperature less than 98 degrees Fahrenheit, or risk for suicide. After a client is medically stable, the treatment plan includes a combination of psychotherapy, medications, and nutritional counseling.
  • #2 Anorexia: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether
    https://www.nursetogether.com/anorexia-nursing-diagnosis-care-plan/
    Patients with anorexia may exhibit orthostatic hypotension, bradycardia, and hypothermia due to inadequate caloric intake. […] Anorexia nervosa shares similarities with other eating disorders. Avoidant/Restrictive food intake disorder, for example, can occur in children and causes extreme pickiness or disinterest in eating, which could worsen into anorexia. […] The dietician should be well-versed in treating patients with eating disorders to provide the most helpful and unbiased nutritional support.
  • #2 Anorexia Nervosa: What It Is, Causes, Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/9794-anorexia-nervosa
    Anorexia is an eating disorder that involves severe calorie restriction and often a low body weight. Treatment for anorexia is essential due to its life-threatening complications. […] Anorexia (anorexia nervosa) is an eating disorder in which you restrict the number of calories you consume, resulting in a nutrient deficit and often but not always a very low body weight. […] Anorexia is both a mental and physical condition. Without treatment, it can lead to malnutrition, serious health issues and even death. […] The biggest challenge in treating anorexia is helping the person recognize and accept that they have a serious condition. Many people with anorexia deny they have an eating disorder. […] The goals of anorexia treatment include: Stabilizing weight loss, Beginning nutrition rehabilitation to restore weight, Eliminating binge eating and/or purging behaviors and other problematic eating patterns, Treating psychological concerns, like low self-esteem and distorted thinking patterns, Developing long-term behavioral changes.
  • #2 Nursing Care Plan for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) | Free NURSING.com Courses
    https://nursing.com/lesson/nursing-care-plan-for-eating-disorders-anorexia-nervosa-bulimia-nervosa-binge-eating-disorder-2?quiz-view=open
    Client will verbalize understanding of nutritional needs. Client will improve weight toward normal range. Client will establish more realistic body image. Client will demonstrate compliance with therapy and treatment. […] Nursing Interventions and Rationales: Perform complete nursing assessment noting skin, muscle tone and neurological status; include weight (BMI) and vital sign assessment. Get a baseline for effectiveness of interventions. Note any deficits or other issues that may need to be prioritized. […] Assess nutritional status and set a weight goal. […] Assess client for depression and suicide potential. Clients with eating disorders often have accompanying depression with suicidal thoughts. Monitor for safety. […] Supervise client during meals and for at least one hour after eating (in inclient treatment). Determine clients eating habits and prevent purging after meals.
  • #2 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org
    https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/
    Nurses play an essential role in identifying destructive eating patterns and providing physical and emotional care for patients from detection to recovery. The goal is to have a manageable multidisciplinary, holistic approach to care. […] Monitoring nutritional status, electrolyte balance, weight, and activity, while keeping watch over diuretic/laxative use, make up important aspects of a nurses role. […] Patients also need emotional support, as they face deep pain and traumatic thoughts. Nurses can gain trust through active listening, empathy, and positive reinforcement. They can foster independence and educate patients and loved ones. […] Establishing goals to ensure the patient maintains awareness, practices healthy coping techniques, and adopts a positive body image and sense of self-worth is a priority.
  • #2 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org
    https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/
    Godzik identifies the role of the nurse when caring for patients with EDs to include: Active listening, Availability and being present, Open, honest communication, Time for the patients to reflect on the best approach for recovery, Multidisciplinary approach to care and serving as an advocate, Staying nonjudgmental. […] Best practices for nurses include the following. […] Nurses must be conscientious when communicating with patients with ED. Refrain from commenting about their weight, appearance, and food/intake. […] The nurse case/care manager promotes autonomy and accountability by offering guidance to allow the patient to play an active part in managing their ED. […] Nurses provide a safe environment with active listening, open communication, and empathy. As an advocate, nurses ensure a multidisciplinary and holistic team approach.
  • #2 13.4 Applying the Nursing Process to Eating Disorders – Nursing: Mental Health and Community Concepts
    https://ecampusontario.pressbooks.pub/mentalhealth/chapter/13-4-applying-the-nursing-process-to-eating-disorders/
    Nurses individualize interventions based on the clients current clinical status and their phase of treatment. Effective therapeutic techniques for clients with depression can promote hope and positive self-esteem. The first priority is to establish a therapeutic relationship. […] If the client is exhibiting risk for suicide, a safety plan should be immediately implemented. Severely malnourished clients may require therapeutic enteral nutrition. After resolving acute symptoms, clients with anorexia begin a weight restoration program for incremental weight gain with a treatment goal set for 90% of ideal body weight. […] Outpatient partial hospitalization is an option for clients who have been medically stabilized. A significant part of the recovery process includes rebuilding relationships with family. The nurse helps with this recovery process by providing education to the client and their loved ones about the illness, treatment, and meal planning.
  • #2 Anorexia Treatment in New Jersey
    https://www.rwjbh.org/treatment-care/mental-health-and-behavioral-health/conditions/eating-disorders/anorexia-nervosa/
    Anorexia is a treatable mental illness that requires the help of trained medical professionals to recover. […] Treatment for anorexia involves helping those affected normalize their eating and weight control behaviors and restore their weight. Effective treatment for anorexia starts early and involves a combination of psychotherapy and medical attention to the patients dietary needs and overall health. […] At RWJBarnabas Health, we are pleased to provide comprehensive and stigma-free treatment throughout New Jersey for anyone suffering from anorexia. Treatment may include: Individual, group and family therapy, Medication management and education, Nutritional counseling and education, Self-help groups, Occupational therapy, Recreational therapy, Specialized sessions on topics such as body image, spirituality and womens issues.
  • #2 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    include physical health monitoring […] establish a weight range goal […] encourage reaching a healthy body weight and healthy eating […] allow the person to decide what else should be included as part of their therapy. […] 1.3.8 If individual CBTED, MANTRA or SSCM is unacceptable, contraindicated or ineffective for adults with anorexia nervosa, consider: […] one of these 3 treatments that the person has not had before or […] eating-disorder-focused focal psychodynamic therapy (FPT). […] 1.3.9 FPT for adults with anorexia nervosa should: […] typically consist of up to 40 sessions over 40 weeks […] make a patient-centred focal hypothesis that is specific to the individual and addresses: […] what the symptoms mean to the person […] how the symptoms affect the person […] how the symptoms influence the person’s relationships with others and with the therapist
  • #2 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    create a personalised treatment plan based on the processes that appear to be maintaining the eating problem […] explain the risks of malnutrition and being underweight […] enhance self-efficacy […] include self-monitoring of dietary intake and associated thoughts and feelings […] include homework, to help the person practice in their daily life what they have learned. […] 1.3.6 MANTRA for adults with anorexia nervosa should: […] typically consist of 20 sessions, with: […] weekly sessions for the first 10 weeks, and a flexible schedule after this […] up to 10 extra sessions for people with complex problems […] base treatment on the MANTRA workbook […] motivate the person and encourage them to work with the practitioner […] be flexible in how the modules of MANTRA are delivered and emphasised
  • #2 8 Eating Disorders: Anorexia & Bulimia Nervosa Nursing Care Plans – Nurseslabs
    https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa-nursing-care-plans/
    Patients with eating disorders may experience compromised skin integrity due to nutritional deficiencies, such as insufficient intake of essential vitamins and minerals, which can impair wound healing and increase the risk of skin breakdown. […] Patients with eating disorders may exhibit disordered thought processes characterized by distorted beliefs and preoccupations related to food, body image, and weight. These distorted thoughts can lead to obsessive thinking, rigid cognitive patterns, and difficulty in perceiving reality accurately, highlighting the need for therapeutic interventions aimed at challenging and restructuring these maladaptive thought patterns to support recovery and promote a healthier mindset. […] Medications are not typically the first-line treatment for eating disorders, but they may be used as part of a comprehensive treatment plan. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), may be prescribed to help manage co-occurring anxiety or depression, while appetite stimulants, such as cyproheptadine (Periactin), may be used in some cases to address weight loss or appetite suppression.
  • #3 Eating disorders and nursing care | PPT
    https://www.slideshare.net/slideshow/eating-disorders-and-nursing-care/108894516
    3. Recovery Interventions include Tube Feeding with consent, Treat the compounding psychiatric condition, Individual counseling, psychotherapy, Group Therapy, Family Therapy, Support Groups, Art/Expression Therapy, Culinary/Nutrition Sessions. […] […] 4. NURSING CARE PLANS FOR EATING DISORDERS include Assessment, Diagnosis, Planning, Implementation, Evaluation. […] […] 5. SOME NURSING DIAGNOSIS include Risk for Imbalanced Nutrition: less than body requirements, Low self concept, Self-care deficit, Impaired communication, Sleep disturbance. […] […] 6. Treatment Modalities include Behavior Modification: Issues of control are central to the etiology of these disorders. For the program to be successful, the client must perceive that he or she is in control of the treatment. […]
  • #3 Nursing Care Plan for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) | Free NURSING.com Courses
    https://nursing.com/lesson/nursing-care-plan-for-eating-disorders-anorexia-nervosa-bulimia-nervosa-binge-eating-disorder-2?quiz-view=open
    Monitor fluid balance and administer oral and IV fluids as appropriate. Failure to eat or drink and repeated purging through vomiting or excessive use of laxatives can cause a fluid imbalance and lead to dehydration. […] Record routine weights per facility protocol. Monitor progress of interventions and incorporate routine accountability checks for clients. […] Monitor skin for wounds, dryness, excoriation or deep tissue injuries. Lack of hydration and proper nutrition lead to decreased perfusion and poor circulation. […] Administer medications appropriately: SSRI antidepressants, Anti-anxiety medications, Psychostimulants. Medications may help relieve the underlying conditions that increase symptoms by improving mood and thinking. […] Provide education for clients and family members regarding disease, treatment and support resources. Help client and family members make informed decisions and reduce stress and anxiety about treatments.
  • #3 Nursing Care Plan for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder) | Free NURSING.com Courses
    https://nursing.com/lesson/nursing-care-plan-for-eating-disorders-anorexia-nervosa-bulimia-nervosa-binge-eating-disorder-2?quiz-view=open
    Encourage liquid intake over solid foods. Eliminates the need to choose foods, provides hydration and is more easily digested. […] Provide small meals and snacks appropriately. Prevents bloating and discomfort in clients following starvation and encourages eating more appropriate portions. […] Monitor for signs of food hoarding or disposing of food. Clients may try to hoard food for secretive eating or dispose of food to avoid calories. […] Monitor exercise program and set limits and goals accordingly. Moderate exercise helps maintain muscle strength and tone, but excessive exercise burns too many calories and contributes to clients disorder. […] Administer TPN supplemental nutrition as appropriate. In cases of severe malnourishment and life-threatening situations, TPN may be used to maintain gastric function and provide nourishment.
  • #3 Nurse’s Guide To Caring For Patients With Eating Disorders | NurseJournal.org
    https://nursejournal.org/resources/caring-for-patients-with-eating-disorders/
    The goals of treatment for a patient with an eating disorder need to be patient-centered or patient-driven, meaning that the patient and the nurse work to formulate shared goals for recovery. […] Godzik states that treatment can involve family members or a patients friends to support the patient. It is a team effort. […] Risk factors vary, making ED detection a challenge. The role as a nurse is crucial in identifying the risks and clinical presentation of EDs and managing the patient through recovery. […] Continuing education helps nurses stay up to date on EDs. By applying knowledge and nursing tips in caring for patients with ED, nurses can play a significant role in a positive patient outcome.
  • #3 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    when the person is ready, cover nutrition, symptom management, and behaviour change […] encourage the person to develop a 'non-anorexic identity’ […] involve family members or carers to help the person: […] understand their condition and the problems it causes and the link to the wider social context […] change their behaviour. […] 1.3.7 SSCM for adults with anorexia nervosa should: […] typically consist of 20 or more weekly sessions (depending on severity) […] assess, identify, and regularly review key problems […] aim to develop a positive relationship between the person and the practitioner […] aim to help people recognise the link between their symptoms and their abnormal eating behaviour […] aim to restore weight […] provide psychoeducation, and nutritional education and advice
  • #3 Eating disorders and nursing care | PPT
    https://www.slideshare.net/slideshow/eating-disorders-and-nursing-care/108894516
    7. Psychopharmacology for anorexia nervosa includes Fluoxetine (Prozac), Clomipramine (Anafranil), Cyproheptadine (Periactin), Chlorpromazine (Thorazine), Olanzapine (Zyprexa). […] […] 8. Evaluation involves assessing whether goals have been partially or fully met and describing in terms of the outcome criteria.
  • #4 Bulimia, Anorexia Nervosa, and Binge Eating Disorder – Mental Health
    https://leveluprn.com/blogs/psychiatric-mental-health/37-disorders-eating?srsltid=AfmBOoqqqu1IvLjk7YBATuu7bod53WwcwH1MbgOtBt3hftI5sAdImO9p
    Treatment of bulimia nervosa and anorexia nervosa includes individual and group therapy, cognitive behavioral therapy, nutrition counseling, as well as medications to treat psychiatric comorbidities, for example, antidepressants to treat depression. […] In terms of nursing care, we need to maintain strict eyes and nose. We should weigh the patient every morning using the same scale. And then we need to stay with the patient during meals and for at least one hour after meals. We should also restrict strenuous activity, and we can provide privileges based on treatment compliance as well as weight gain. […] If a patient has inadequate oral intake, then two feedings may be ordered by the provider. As the nurse, you need to monitor the patient for something called refeeding syndrome. Refeeding syndrome can occur if nutrition is introduced too rapidly after prolonged starvation. Signs and symptoms of this disorder include severe electrolyte imbalances, arrhythmias, and seizures.
  • #4 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    include physical health monitoring […] establish a weight range goal […] encourage reaching a healthy body weight and healthy eating […] allow the person to decide what else should be included as part of their therapy. […] 1.3.8 If individual CBTED, MANTRA or SSCM is unacceptable, contraindicated or ineffective for adults with anorexia nervosa, consider: […] one of these 3 treatments that the person has not had before or […] eating-disorder-focused focal psychodynamic therapy (FPT). […] 1.3.9 FPT for adults with anorexia nervosa should: […] typically consist of up to 40 sessions over 40 weeks […] make a patient-centred focal hypothesis that is specific to the individual and addresses: […] what the symptoms mean to the person […] how the symptoms affect the person […] how the symptoms influence the person’s relationships with others and with the therapist
  • #5
    https://care24.co.in/nursing/anorexia/
    Nursing care plan for anorexia nervosa is generally long-term, and withdrawal and relapse are real possibilities and hence support from friends and family are contingent to lasting and effective results. […] If household members identify the danger signs and can understand the status, they can help prevent relapse and could always remain empathic and encouraging for their loved ones. […] Nursing Intervention for Eating Disorders: Set nutrient requirements and a weight target because malnutrition is an illness affecting and resulting in depression, agitation and having the right nutrition enriches thinking capability, and enhances the ability to work right. […] Engage with the patient in helping them understand the problem and identify a target weight, chart out a system of behavior modification and set rewards for weight gains in a staggered fashion.
  • #5 Recommendations | Eating disorders: recognition and treatment | Guidance | NICE
    https://www.nice.org.uk/guidance/ng69/chapter/recommendations
    in the first phase, focus on developing the therapeutic alliance between the therapist and person with anorexia nervosa, addressing pro-anorexic behaviour and ego-syntonic beliefs (beliefs, values and feelings consistent with the person’s sense of self) and building self-esteem […] in the second phase, focus on relevant relationships with other people and how these affect eating behaviour […] in the final phase, focus on transferring the therapy experience to situations in everyday life and address any concerns the person has about what will happen when treatment ends. […] 1.3.10 Consider anorexia-nervosa-focused family therapy for children and young people (FTAN), delivered as single-family therapy or a combination of single- and multi-family therapy. Give children and young people the option to have some single-family sessions:
  • #6
    https://care24.co.in/nursing/anorexia/
    Use a consistent strategy whilst eating, sit with the customer gently take food servings for self and help the client without being judgemental and promoting a good and pleasant environment and note down the food ingested. […] Provide smaller meals and add supplemental snacks and dishes suitably. […] Make menu suiting the tastes and choice of the client, so that the client remains in command. […] Maintain a ritual, for example, take weights before breakfast on Mondays and Fridays and chart results. […] Consult with therapy staff as this is beneficial in determining proper and good sources and dietary requirements. […] If life-threatening, transfer the patient for therapy to the medical setting if the problem cannot be treated without hospitalization which provides a controlled environment where vomiting, food consumption, drugs, and actions can be tracked.
  • #6 Anorexia nervosa | Better Health Channel
    https://www.betterhealth.vic.gov.au/health/healthyliving/anorexia-nervosa
    Common approaches include: Family Based Treatment (FBT) has been shown to be the most effective treatment for children and adolescents. […] Cognitive Behaviour Therapy (CBT) works on helping a person to overcome the unhelpful thoughts and behaviours that are causing and maintaining the eating disorder. […] Most people with anorexia nervosa are treated outside a hospital setting. However, if the condition is severe, temporary treatment in a hospital might be needed. Outpatient treatment and day programs can also be very helpful in supporting people as they make changes to behaviour, thinking and eating patterns. […] People with anorexia nervosa who have also experienced physical, emotional or sexual abuse are encouraged to seek help for the trauma they have experienced, as well as their eating disorder.

Zobacz więcej

próba samobójcza olanzapina stan nawodnienia zawroty głowy zniekształcony obraz ciała równowaga elektrolitowa stan odżywienia problem zdrowotny zaburzenie elektrolitowe środek przeczyszczający hipowolemia jadłowstręt psychiczny depresja oporna na leczenie niedożywienie motywacja pacjenta terapia poznawczo-behawioralna amenorrhea cyproheptadyna niedociśnienie ortostatyczne zespół ponownego odżywienia chlorpromazyna lanugo selektywny inhibitor wychwytu zwrotnego serotoniny fluoksetyna klomipramina sojusz terapeutyczny zniekształcone postrzeganie opieka paliatywna