Eating Disorders

Eating disorders are serious psychiatric conditions involving disturbed eating behaviors, distorted body image, and maladaptive weight control, leading to life-threatening medical complications. They commonly affect adolescents and young adults but can occur at any age. Key disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder, with high exam focus on refeeding syndrome, electrolyte imbalance, cardiac risk, and therapeutic communication.

1️⃣ Core Features of Eating Disorders

🧠 Behavioral Pattern

🔷 Distorted body image → sees self as overweight despite low weight

🔷 Preoccupation with food, weight, calories, body shape

🔷 Maladaptive eating behaviors → restriction, bingeing, purging

🔷 Control issues → food used to manage stress or emotions

🔷 Denial of severity → lack of insight common

🔷 High mortality → especially anorexia nervosa

🔎 Assessment Findings

🔷 Weight changes → underweight, normal, or overweight

🔷 Eating patterns → restriction, binge episodes, purging behaviors

🔷 Psychological → anxiety, depression, perfectionism

🔷 Physical → fatigue, dizziness, weakness

🔷 Labs → electrolytes, CBC, glucose

🔷 Cardiac monitoring PRN → arrhythmia risk

💊 Management

🔷 Nutritional rehabilitation → gradual, structured

🔷 Psychotherapy → CBT, family-based therapy

🔷 SSRIs → fluoxetine (bulimia)

🔷 Monitor electrolytes → K⁺, Mg²⁺, phosphate

🔷 Treat comorbid depression/anxiety

🔷 Multidisciplinary approach required

🩺 Nursing Priorities

🔷 Monitor weight, intake, output daily

🔷 Prevent purging behaviors after meals

🔷 Assess for electrolyte imbalance

🔷 Provide structured meal support

🔷 Use nonjudgmental communication

🔷 Collaborate dietitian, psych, provider

2️⃣ Anorexia Nervosa

🧠 Core Pattern

🔷 Restriction → significantly low body weight

🔷 Intense fear of gaining weight

🔷 Distorted body image → denies seriousness

🔷 Types → restricting type vs binge/purge type

🔷 Often associated with perfectionism, control

🔷 Highest mortality among psychiatric disorders

🔎 Assessment Findings

🔷 BMI < normal, severe weight loss

🔷 Bradycardia, hypotension, hypothermia

🔷 Amenorrhea, infertility

🔷 Dry skin, brittle hair, lanugo

🔷 Electrolyte imbalance → low K⁺, Na⁺

🔷 ECG → arrhythmias possible

💊 Management

🔷 Controlled refeeding → avoid rapid caloric increase

🔷 Electrolyte monitoring → phosphate critical

🔷 SSRIs after weight stabilization

🔷 Hospitalization if severe malnutrition

🔷 Nutritional supplements PRN

🔷 Psychotherapy long-term

🩺 Nursing Priorities

🔷 Monitor daily weight same time, same scale

🔷 Supervise meals → prevent hiding food

🔷 Monitor for bradycardia and hypotension

🔷 Watch for refeeding syndrome

🔷 Limit excessive exercise

🔷 Provide calm, structured environment

3️⃣ Bulimia Nervosa

🧠 Core Pattern

🔷 Recurrent binge eating → large amount in short time

🔷 Loss of control during binge

🔷 Compensatory behaviors → vomiting, laxatives, exercise

🔷 Weight usually normal or slightly elevated

🔷 Guilt and shame after binge

🔷 Less visible than anorexia

🔎 Assessment Findings

🔷 Dental erosion → stomach acid exposure

🔷 Swollen parotid glands → “chipmunk cheeks”

🔷 Calluses on knuckles (Russell sign)

🔷 Electrolyte imbalance → hypokalemia

🔷 GI symptoms → reflux, esophagitis

🔷 Normal BMI may mask disorder

💊 Management

🔷 Fluoxetine → first-line medication

🔷 CBT → address binge-purge cycle

🔷 Electrolyte correction → K⁺ replacement

🔷 Monitor for cardiac arrhythmias

🔷 Treat esophageal damage PRN

🔷 Nutritional counseling

🩺 Nursing Priorities

🔷 Monitor after meals → prevent purging

🔷 Assess electrolyte imbalance signs

🔷 Encourage regular eating pattern

🔷 Avoid discussing weight/appearance

🔷 Provide emotional support

🔷 Reinforce coping strategies

4️⃣ Binge-Eating Disorder

🧠 Core Pattern

🔷 Recurrent binge episodes without compensatory behaviors

🔷 Eating large amounts rapidly → loss of control

🔷 Eating when not hungry, eating alone

🔷 Feelings of guilt, shame, distress

🔷 Often associated with obesity

🔷 No purging behaviors

🔎 Assessment Findings

🔷 Weight gain or obesity

🔷 Emotional distress after binge episodes

🔷 Eating patterns → secretive eating

🔷 Comorbid depression/anxiety

🔷 Metabolic issues → diabetes, HTN

🔷 Labs → glucose, lipids

💊 Management

🔷 CBT → behavioral modification

🔷 SSRIs → depression/anxiety

🔷 Lisdexamfetamine → approved for binge eating

🔷 Nutritional counseling

🔷 Weight management programs

🔷 Treat comorbid conditions

🩺 Nursing Priorities

🔷 Encourage structured meals

🔷 Address emotional triggers

🔷 Avoid shaming language

🔷 Promote healthy coping strategies

🔷 Monitor metabolic health

🔷 Support long-term behavior change

5️⃣ Refeeding Syndrome

🧠 Critical Concept ⚠️

🔷 Occurs when malnourished patient begins refeeding

🔷 Sudden insulin release → electrolyte shift

🔷 Phosphate ↓ (hallmark), K⁺ ↓, Mg²⁺ ↓

🔷 Fluid retention → edema

🔷 Can cause cardiac failure, death

🔷 High exam priority

🔎 Assessment Findings

🔷 Weakness, fatigue, muscle pain

🔷 Arrhythmias, tachycardia

🔷 Edema, fluid overload

🔷 Confusion, neurologic changes

🔷 Labs → ↓ phosphate, ↓ K⁺, ↓ Mg²⁺

🔷 Occurs within first few days of refeeding

💊 Management

🔷 Slow caloric increase

🔷 Monitor electrolytes frequently

🔷 Replace phosphate, potassium, magnesium

🔷 Thiamine supplementation

🔷 Cardiac monitoring PRN

🔷 Adjust feeding plan

🩺 Nursing Priorities

🔷 Monitor labs closely during refeeding

🔷 Watch for cardiac changes

🔷 Prevent rapid calorie increase

🔷 Assess fluid status

🔷 Educate patient on gradual nutrition

🔷 Collaborate dietitian and provider

6️⃣ Medical Complications of Anorexia Nervosa

🧠 Starvation Effects

🔷 Starvation → metabolic slowing, muscle wasting, organ stress

🔷 Cardiac muscle loss → bradycardia, hypotension, arrhythmia risk

🔷 Fat loss → hypothermia, cold intolerance, lanugo growth

🔷 Estrogen ↓ → amenorrhea, infertility, bone loss

🔷 GI motility ↓ → constipation, bloating, abdominal pain

🔷 Immune function ↓ → infection risk, poor wound healing

🔎 Assessment Findings

🔷 HR ↓, BP ↓, temperature ↓ → physiologic instability

🔷 Dizziness, syncope, weakness, fatigue

🔷 Dry skin, brittle nails, hair thinning

🔷 Lanugo → fine body hair from malnutrition

🔷 Labs → glucose ↓, WBC ↓, mild anemia possible

🔷 ECG changes → QT prolongation, dysrhythmias

💊 Medical Management

🔷 Hospitalization PRN → unstable VS, severe malnutrition

🔷 Gradual nutrition restoration → prevent refeeding syndrome

🔷 Electrolyte correction → K⁺, Mg²⁺, phosphate

🔷 Calcium, vitamin D → bone support

🔷 SSRIs after partial weight restoration

🔷 Treat constipation cautiously → polyethylene glycol PRN

🩺 Nursing Priorities

🔷 Monitor VS, weight, intake, output consistently

🔷 Observe for dizziness, syncope, chest pain

🔷 Maintain warm environment and comfort measures

🔷 Prevent excessive exercise or calorie-burning behaviors

🔷 Support meal completion without power struggle

🔷 Collaborate provider, dietitian, therapy team

7️⃣ Purging Behaviors and Electrolyte Imbalance

🧠 Purging Effects

🔷 Vomiting → gastric acid loss, metabolic alkalosis

🔷 Laxative misuse → diarrhea, dehydration, electrolyte depletion

🔷 Diuretic misuse → fluid loss, K⁺ ↓, arrhythmia risk

🔷 Hypokalemia → muscle weakness, cardiac dysrhythmias

🔷 Chronic purging → esophagitis, dental erosion, parotid swelling

🔷 Purging may occur despite normal weight

🔎 Assessment Findings

🔷 Russell sign → knuckle calluses from induced vomiting

🔷 Dental enamel erosion, mouth sores, sore throat

🔷 Swollen parotid glands, facial puffiness

🔷 Dizziness, weakness, palpitations

🔷 Labs → K⁺ ↓, chloride ↓, bicarbonate ↑ with vomiting

🔷 ECG → prolonged QT, U waves PRN hypokalemia

💊 Management

🔷 Potassium replacement → oral/IV depending severity

🔷 IV fluids PRN dehydration

🔷 Fluoxetine → bulimia binge-purge symptom reduction

🔷 Stop laxative/diuretic misuse gradually with monitoring

🔷 Dental and GI referral PRN complications

🔷 CBT → purge trigger identification and behavior change

🩺 Nursing Priorities

🔷 Monitor bathroom access after meals

🔷 Assess for hidden laxatives, diuretics, diet pills

🔷 Observe for purging cues → excuses, secrecy, urgency

🔷 Monitor electrolytes and cardiac symptoms

🔷 Use supportive, nonpunitive approach

🔷 Educate purging risks → arrhythmia, esophageal injury

8️⃣ Body Image Disturbance

🧠 Cognitive Distortion

🔷 Body image disturbance → distorted perception of size/shape

🔷 Patient may feel “fat” despite severe underweight

🔷 Self-worth tied to weight, control, appearance

🔷 Perfectionism → rigid food and exercise rules

🔷 Weight gain fear drives restriction and purging

🔷 Denial of seriousness common in anorexia nervosa

🔎 Assessment Findings

🔷 Frequent body checking, mirror avoidance, scale fixation

🔷 Expresses fear of gaining weight

🔷 Distorted statements → “I am huge” despite emaciation

🔷 Ritualistic food behaviors → cutting, counting, sorting

🔷 Avoids social eating and body exposure

🔷 Anxiety rises around meals and weigh-ins

💊 Therapeutic Support

🔷 CBT → challenge distorted beliefs and body checking

🔷 Family-based therapy for adolescents

🔷 SSRIs PRN depression/anxiety after nutrition improves

🔷 Group therapy PRN when medically stable

🔷 Avoid appearance-based praise or criticism

🔷 Structured care plan reduces bargaining and anxiety

🩺 Nursing Priorities

🔷 Focus on health, function, strength, safety

🔷 Avoid arguing about perceived body size

🔷 Do not say “you look better” → may trigger fear

🔷 Encourage expression of feelings behind food control

🔷 Reinforce non-weight-based identity and coping

🔷 Document body image statements and triggers

9️⃣ Meal Supervision and Behavioral Management

🧠 Structured Eating

🔷 Meal structure reduces avoidance, bargaining, purging

🔷 Eating disorder behaviors may be secretive or ritualized

🔷 Anxiety peaks before, during, after meals

🔷 Control struggles can worsen resistance

🔷 Consistency prevents manipulation and splitting

🔷 Recovery requires predictable expectations and support

🔎 Assessment Findings

🔷 Hiding food, cutting food into tiny pieces

🔷 Excessive napkin use, food smearing, slow eating

🔷 Negotiating portions, refusing fear foods

🔷 Bathroom urgency after meals → purging risk

🔷 Exercise attempts immediately after eating

🔷 Emotional distress → crying, anger, panic

💊 Care Measures

🔷 Prescribed meal plan → calories, exchanges, supplements

🔷 Liquid supplements if meal incomplete

🔷 Antiemetics PRN nausea → ondansetron

🔷 Anxiety support PRN → coping skills before meals

🔷 Bathroom restriction/supervision per unit protocol

🔷 Weighing protocol → same time, gown, blinded PRN

🩺 Nursing Priorities

🔷 Supervise meals calmly and consistently

🔷 Observe 30–60 min after meals per protocol

🔷 Set clear limits around exercise and bathroom use

🔷 Avoid food debates or calorie bargaining

🔷 Praise effort, not weight gain or appearance

🔷 Communicate behaviors to team during handoff

🔟 Therapeutic Communication in Eating Disorders

🧠 Communication Goals

🔷 Trust-building essential due shame, secrecy, ambivalence

🔷 Direct confrontation may increase resistance

🔷 Patient often fears losing control

🔷 Nonjudgmental language reduces guilt and defensiveness

🔷 Focus on feelings, safety, and function

🔷 Consistency supports treatment alliance

🔎 Helpful Responses

🔷 “What was happening before the urge to purge?”

🔷 “How can we support you through this meal?”

🔷 “Your safety is the priority right now.”

🔷 “Let’s focus on the next step, not the whole day.”

🔷 “I hear this feels scary; the plan remains the same.”

🔷 Avoid “just eat,” “you look fine,” or weight praise

💊 Supportive Interventions

🔷 Motivational interviewing → explore ambivalence

🔷 CBT skills → thought record, trigger mapping

🔷 DBT skills → distress tolerance, emotion regulation

🔷 Family sessions PRN → reduce blame, improve support

🔷 Relaxation techniques → breathing, grounding

🔷 Medication education if SSRIs or supplements ordered

🩺 Nursing Priorities

🔷 Use calm, firm, compassionate tone

🔷 Validate emotion without changing unsafe limits

🔷 Avoid power struggles around food

🔷 Encourage patient to verbalize anxiety

🔷 Maintain confidentiality and therapeutic boundaries

🔷 Document triggers, statements, coping attempts, response

1️⃣1️⃣ Pica

🧠 Eating Pattern

🔷 Pica → persistent eating nonnutritive, nonfood substances ≥1 month

🔷 Substances → soil, clay, paper, chalk, hair, paint, ice

🔷 Must be inappropriate to developmental level

🔷 Not culturally supported or socially normative practice

🔷 May occur with pregnancy, autism, intellectual disability, schizophrenia

🔷 Risk factors → iron deficiency, zinc deficiency, neglect, food deprivation

🔎 Assessment Findings

🔷 Ask type, amount, frequency, duration of nonfood intake

🔷 Assess abdominal pain, constipation, obstruction symptoms

🔷 Check poisoning risk → lead paint, chemicals, contaminated soil

🔷 Labs → CBC, iron studies, zinc, lead level PRN

🔷 Imaging → abdominal x-ray/ultrasound if obstruction suspected

🔷 Assess developmental history, supervision, family environment

💊 Management

🔷 Treat deficiency → iron supplementation, zinc replacement PRN

🔷 Behavioral therapy → reduce unsafe ingestion

🔷 Environmental control → remove access to harmful substances

🔷 Treat poisoning or infection as indicated

🔷 Manage obstruction urgently if present

🔷 Coordinate nutrition and mental health support

🩺 Nursing Priorities

🔷 Do not shame patient or caregiver

🔷 Assess safety and ingestion risks directly

🔷 Teach supervision and environmental modification

🔷 Monitor for GI obstruction, toxicity, infection

🔷 Encourage nutrient-rich meals and follow-up labs

🔷 Collaborate provider, dietitian, psych, family

1️⃣2️⃣ Rumination Disorder

🧠 Eating Pattern

🔷 Rumination disorder → repeated regurgitation of swallowed food

🔷 Regurgitated food may be rechewed, reswallowed, or spit out

🔷 Not due to GI condition alone

🔷 May occur in infants, children, adults, intellectual disability

🔷 Can cause malnutrition, weight loss, dental erosion

🔷 Behavior may be automatic, soothing, or stress-related

🔎 Assessment Findings

🔷 Observe regurgitation after meals without nausea or retching

🔷 Assess weight trends, hydration, nutrition intake

🔷 Check dental erosion, halitosis, mouth irritation

🔷 Rule out GERD, vomiting disorder, GI obstruction

🔷 Assess stress, neglect, stimulation needs, developmental level

🔷 Monitor aspiration risk if regurgitation frequent

💊 Management

🔷 Behavioral therapy → habit reversal, competing response

🔷 Diaphragmatic breathing after meals

🔷 Treat comorbid anxiety or developmental needs

🔷 Nutrition support if weight loss present

🔷 Dental referral PRN enamel damage

🔷 GI evaluation if medical cause suspected

🩺 Nursing Priorities

🔷 Monitor meals and post-meal behavior calmly

🔷 Teach diaphragmatic breathing technique

🔷 Maintain nonpunitive approach

🔷 Assess hydration, weight, aspiration signs

🔷 Support structured mealtime routine

🔷 Collaborate provider, therapist, dietitian, caregiver

1️⃣3️⃣ Avoidant/Restrictive Food Intake Disorder

🧠 Restrictive Pattern

🔷 ARFID → restricted intake without body image disturbance

🔷 Causes → sensory sensitivity, fear of choking/vomiting, low interest

🔷 Leads to weight loss, nutritional deficiency, psychosocial impairment

🔷 Common with autism, anxiety, developmental conditions

🔷 Food avoidance may be texture, color, smell, temperature based

🔷 Differs from anorexia → no fear of weight gain

🔎 Assessment Findings

🔷 Limited food variety, refusal of whole food groups

🔷 Weight loss, growth delay, fatigue, dizziness

🔷 Fear after choking/vomiting event

🔷 Nutritional labs → iron, B12, vitamin D, electrolytes PRN

🔷 Assess mealtime anxiety and sensory triggers

🔷 Evaluate family accommodation patterns

💊 Management

🔷 Nutritional rehabilitation → correct deficiencies gradually

🔷 Exposure therapy → gradual food expansion

🔷 CBT-AR → anxiety and avoidance reduction

🔷 Supplements → iron, vitamin D, multivitamins PRN

🔷 Feeding therapy or OT for sensory issues

🔷 Enteral nutrition PRN severe malnutrition

🩺 Nursing Priorities

🔷 Avoid labeling as picky eating only

🔷 Assess nutritional risk and medical instability

🔷 Support gradual exposure without force-feeding

🔷 Reinforce safe swallowing if fear-based avoidance

🔷 Teach family structured, low-pressure meals

🔷 Collaborate dietitian, therapist, OT, provider

1️⃣4️⃣ Amenorrhea, Bone Loss, and Endocrine Effects

🧠 Hormonal Effects

🔷 Low weight → hypothalamic suppression, estrogen ↓

🔷 Amenorrhea may occur with severe restriction

🔷 Estrogen ↓ → bone density ↓, osteoporosis risk ↑

🔷 Thyroid changes → metabolic slowing, cold intolerance

🔷 Cortisol ↑ → bone loss and mood effects

🔷 Fertility and sexual health may be affected

🔎 Assessment Findings

🔷 Menstrual history → missed periods, irregular cycles

🔷 Stress fractures, bone pain, height loss PRN

🔷 Cold intolerance, bradycardia, fatigue

🔷 Labs PRN → TSH, estrogen, LH/FSH, vitamin D

🔷 DEXA scan → bone density evaluation

🔷 Assess calcium/vitamin D intake and exercise pattern

💊 Management

🔷 Weight restoration → primary hormonal recovery intervention

🔷 Calcium and vitamin D supplementation

🔷 Treat vitamin D deficiency as ordered

🔷 Avoid excessive exercise during medical instability

🔷 Endocrinology referral PRN persistent amenorrhea

🔷 Hormonal therapy individualized, not substitute for nutrition

🩺 Nursing Priorities

🔷 Educate bone loss risk without using fear/shame

🔷 Monitor fractures, dizziness, weakness, falls

🔷 Reinforce nutrition as endocrine treatment foundation

🔷 Discourage compulsive exercise

🔷 Coordinate provider, dietitian, endocrinology PRN

🔷 Document menstrual and bone-health concerns

1️⃣5️⃣ Eating Disorders and Comorbid Psychiatric Risks

🧠 Psychiatric Links

🔷 Depression, anxiety, OCD traits common

🔷 Trauma history may contribute to food/body control

🔷 Substance misuse may occur → appetite suppression, purging support

🔷 Self-harm and suicide risk ↑, especially anorexia and bulimia

🔷 Perfectionism and rigidity reinforce symptoms

🔷 Shame and secrecy delay treatment

🔎 Assessment Findings

🔷 Screen mood, anxiety, trauma, self-harm, suicidality

🔷 Ask substance use → laxatives, stimulants, alcohol, diet pills

🔷 Assess compulsive rituals → calorie counting, body checking

🔷 Monitor hopelessness, withdrawal, irritability

🔷 Identify triggers → conflict, criticism, weigh-ins, social eating

🔷 Evaluate support system and family dynamics

💊 Management

🔷 SSRIs → fluoxetine, sertraline PRN mood/anxiety

🔷 Fluoxetine especially useful in bulimia after stabilization

🔷 Treat OCD symptoms with CBT/ERP, SSRIs PRN

🔷 Safety plan for self-harm or suicide risk

🔷 Trauma therapy when medically stable

🔷 Substance treatment referral if misuse present

🩺 Nursing Priorities

🔷 Ask suicide risk directly and privately

🔷 Maintain safety precautions if risk present

🔷 Avoid reinforcing secrecy or bargaining

🔷 Encourage coping skills during urges

🔷 Include family/supports when appropriate

🔷 Collaborate psych, therapy, dietitian, provider

1️⃣6️⃣ Family Dynamics and Eating Disorders

🧠 Family Role

🔷 Family may unintentionally reinforce symptoms through conflict or control

🔷 Overfocus on weight can increase shame and resistance

🔷 Adolescents benefit from family-based treatment

🔷 Caregiver burnout occurs with repeated meal conflict

🔷 Blame worsens alliance and treatment engagement

🔷 Supportive structure improves recovery consistency

🔎 Assessment Findings

🔷 Family conflict during meals or weigh-ins

🔷 Parents/caregivers unsure how to respond to refusal

🔷 Accommodation → preparing only “safe foods”

🔷 Excessive reassurance or criticism about appearance

🔷 Family history → mood disorders, eating disorders, substance use

🔷 Assess safety, resources, understanding, caregiver stress

💊 Supportive Measures

🔷 Family-based therapy → caregiver-supported nutrition restoration

🔷 Psychoeducation → illness model, relapse signs, meal support

🔷 Parent/caregiver coaching → calm, firm meal expectations

🔷 Family therapy PRN communication and boundary issues

🔷 Support groups for caregivers

🔷 Crisis plan for refusal, purging, self-harm risk

🩺 Nursing Priorities

🔷 Teach family avoid weight/appearance comments

🔷 Reinforce consistent meal plan support

🔷 Validate caregiver stress without blaming patient

🔷 Encourage calm, united response to resistance

🔷 Provide written warning signs and follow-up plan

🔷 Collaborate family, therapist, dietitian, provider

1️⃣7️⃣ Hospitalization Criteria and Medical Instability

🧠 Admission Triggers

🔷 Severe malnutrition → unstable VS, organ risk

🔷 Bradycardia, hypotension, hypothermia → admission concern

🔷 Electrolyte imbalance → arrhythmia and seizure risk

🔷 Acute food refusal → rapid deterioration

🔷 Syncope, chest pain, dehydration → urgent evaluation

🔷 Suicide risk or uncontrolled purging requires higher care

🔎 High-Risk Findings

🔷 HR very low, orthostatic BP changes, fainting

🔷 K⁺ ↓, phosphate ↓, Mg²⁺ ↓, glucose ↓

🔷 ECG changes → QT prolongation, arrhythmias

🔷 Rapid weight loss or BMI severely low

🔷 Dehydration → BUN ↑, concentrated urine

🔷 Inability to stop purging despite outpatient care

💊 Medical Stabilization

🔷 Cardiac monitoring if unstable electrolytes or bradycardia

🔷 Electrolyte replacement → phosphate, K⁺, Mg²⁺

🔷 Controlled nutrition plan → avoid refeeding syndrome

🔷 IV fluids cautiously → fluid overload risk

🔷 Thiamine supplementation before/with refeeding

🔷 Psychiatric evaluation if self-harm or suicide risk

🩺 Nursing Priorities

🔷 Monitor VS, orthostatics, ECG, labs frequently

🔷 Implement meal supervision and activity restrictions

🔷 Watch for edema, dyspnea, arrhythmias during refeeding

🔷 Enforce bathroom and exercise limits consistently

🔷 Maintain calm structured unit environment

🔷 Communicate changes rapidly to provider/team

1️⃣8️⃣ Patient Education and Relapse Prevention

🧠 Recovery Concepts

🔷 Recovery is gradual → relapse risk persists

🔷 Triggers include stress, comments, weigh-ins, social media

🔷 Restriction often leads to binge-purge cycle

🔷 Regular meals reduce biologic binge pressure

🔷 Coping skills replace food/weight control behaviors

🔷 Support system improves accountability and safety

🔎 Warning Signs

🔷 Skipping meals, calorie obsession, food rituals returning

🔷 Increased body checking or scale use

🔷 Secretive bathroom trips after meals

🔷 Excessive exercise or guilt after eating

🔷 Mood withdrawal, irritability, perfectionism spike

🔷 Laxative, diuretic, diet pill use

💊 Recovery Support

🔷 Continue therapy → CBT, DBT, family-based therapy

🔷 Medication adherence if prescribed → fluoxetine, sertraline PRN

🔷 Nutrition appointments → meal plan adjustment

🔷 Support groups → eating disorder recovery communities

🔷 Crisis plan → self-harm, purging relapse, food refusal

🔷 Follow-up labs/ECG as ordered

🩺 Nursing Priorities

🔷 Teach relapse signs to patient and family

🔷 Encourage regular meals and snacks

🔷 Promote coping list for urges and distress

🔷 Discourage diet culture and appearance-focused goals

🔷 Use teach-back for safety plan

🔷 Document education and outpatient referrals

1️⃣9️⃣ Therapeutic Environment for Eating Disorders

🧠 Unit Structure

🔷 Predictable routine reduces anxiety and bargaining

🔷 Team consistency prevents splitting and mixed messages

🔷 Privacy protects dignity during weighing and meals

🔷 Nonappearance-based feedback supports recovery

🔷 Safety monitoring balances autonomy and medical risk

🔷 Milieu should reduce competition among patients

🔎 Environmental Risks

🔷 Food hiding, swapping, discarding, excessive condiment use

🔷 Comparing weights/calories with other patients

🔷 Secret exercise → pacing, standing, bathroom workouts

🔷 Access to laxatives, diuretics, diet pills

🔷 Triggering comments from staff or peers

🔷 Family bringing unapproved food or scales

💊 Structure Supports

🔷 Meal plan posted/communicated to staff

🔷 Activity restrictions based on medical status

🔷 Post-meal observation protocol

🔷 Bathroom access schedule per care plan

🔷 Approved supplements for incomplete meals

🔷 PRN anxiety tools before meals → grounding, breathing

🩺 Nursing Priorities

🔷 Maintain consistent rules without punishment

🔷 Observe behaviors discreetly and respectfully

🔷 Avoid staff debate about meal plan at bedside

🔷 Redirect comparison talk and calorie discussion

🔷 Communicate triggers and behaviors during handoff

🔷 Coordinate dietitian, therapist, provider, family

2️⃣0️⃣ Nursing Priorities in Eating Disorders

🧠 Core Focus

🔷 Preserve life → cardiac stability, electrolytes, nutrition

🔷 Address distorted body image and maladaptive control

🔷 Prevent refeeding syndrome, purging, self-harm, relapse

🔷 Support structured meals and therapeutic consistency

🔷 Treat psychiatric comorbidities and family stress

🔷 Promote long-term recovery and coping skills

🔎 High-Yield Monitoring

🔷 Weight trends, VS, orthostatics, intake/output

🔷 Labs → phosphate, K⁺, Mg²⁺, glucose, CBC

🔷 ECG → QT prolongation, arrhythmias, bradycardia

🔷 Purging signs → dental erosion, Russell sign, hypokalemia

🔷 Refeeding signs → edema, weakness, confusion, tachycardia

🔷 Suicide/self-harm risk, exercise, food-hiding behaviors

💊 Clinical Support

🔷 Fluoxetine → bulimia, depression/anxiety symptoms

🔷 Electrolytes → phosphate, potassium, magnesium replacement

🔷 Thiamine → refeeding protection

🔷 Ondansetron PRN nausea, PEG PRN constipation

🔷 Calcium, vitamin D → bone health support

🔷 Lisdexamfetamine PRN binge-eating disorder

🩺 Nursing Actions

🔷 Supervise meals and post-meal period per protocol

🔷 Weigh consistently using ordered procedure

🔷 Enforce bathroom/exercise limits respectfully

🔷 Avoid appearance or weight-based comments

🔷 Use calm, firm, compassionate communication

🔷 Collaborate dietitian, psychiatrist, therapist, provider, family

🏁 Conclusion

Eating disorders require medically vigilant and psychologically sensitive nursing care because patients may develop life-threatening malnutrition, electrolyte imbalance, arrhythmias, refeeding syndrome, purging complications, bone loss, depression, and suicide risk. Nurses must prioritize structured nutrition, consistent monitoring, therapeutic communication, safety precautions, family education, relapse prevention, and interdisciplinary collaboration with psychiatry, dietitians, therapy teams, providers, and caregivers. Effective care focuses on physiologic stabilization, restoration of healthy eating patterns, emotional regulation, and long-term recovery without shame or appearance-centered reinforcement.