Care of Clients with Maladaptive Patterns of

Behavior, Acute and Chronic

INSTRUCTOR’S GUIDE BS NURSING / THIRD YEAR
Session # 21

LESSON TITLE: EATING DISORDERS Materials:

Textbook, Notebook, Bondpaper, Pen and Paper,
LEARNING OUTCOMES:
References
At the end of the lesson, the nursing student can:

1. Identify and differentiate the signs and symptoms of various Videbeck, S. L. (2014). Mental and Psychiatric
eating disorders Health Nursing. 6th Edition. Lippincott, Williams
2. Evaluate the psychological and physiological effects of and Wilkins. Philadelphia, PA.
eating disorders on patients
3. Demonstrate effective therapeutic communication Guarda, A. (2021). What are Eating Disorders?.
techniques when interacting with patients who have eating American Psychiatric Association. Retrieved from
disorders [Link]
4. Plan and implement evidence-based nursing interventions -disorders/what-are-eatingdisorders
for patients with eating disorders
5. Analyze and discuss ethical considerations in the care of Mayo Clinic (2021). Eating Disorders. Retrieved
patients with eating disorders from [Link]
conditions/eating-
disorders/symptomscauses/syc-20353603

Muhlheim, L. (2020). Medications Used to Treat

Eating Disorders. Retrieved from
[Link]
usedto-treat-eating-disorders-4153046

National Institute of Mental Health (n.d.). Eating

Disorders. Retrieved from
[Link]
disorders/[Link]

LESSON REVIEW / PREVIEW& HOOK ACTIVITY (15 minutes)

Instruction: Look at the pictures on the next page. Reflect on the images that are being displayed. Face your seatmate and
start sharing your insights about the photos that were shown. On the space provided, write your insights as well as your
seatmate’s insights.

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MAIN LESSON (50 minutes)
EATING DISORDERS
➢ Are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated
distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social
function.

Risk Factors
Certain factors may increase the risk of developing an eating disorder, including:
1. Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings
who've had an eating disorder.
2. Other mental health disorders. People with an eating disorder often have a history of an anxiety disorder,
depression or obsessive-compulsive disorder.
3. Dieting and starvation. Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and
influences mood changes, rigidity in thinking, anxiety, and reduction in appetite. There is strong evidence that
many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may
change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and
make it difficult to return to normal eating habits.
4. Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change
can bring stress, which may increase your risk of an eating disorder.

Types of Eating Disorders

A. Anorexia Nervosa
➢ A life-threatening eating disorder characterized by the client’s refusal or inability to maintain a minimally normal
body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size
of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one
exists.
➢ Clients with anorexia have a body weight that is 85% less than expected for their age and height, have experienced
amenorrhea for at least three consecutive cycles, and have a preoccupation with food and food-related activities.
➢ Anorexia nervosa typically begins between 14 to 18 years of age affecting mostly women.
➢ In the early stages, clients often deny that they have anxiety regarding their appearance or a negative body image.
They are very pleased with their ability to control their weight and may express this.

Signs and Symptoms

➢ Fear of gaining weight or becoming fat even when severely underweight
➢ Body image disturbance
➢ Amenorrhea
➢ Depressive symptoms such as depressed mood, social withdrawal, irritability, and insomnia
➢ Preoccupation with thoughts of food
➢ Feelings of ineffectiveness Inflexible thinking

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 ➢ Strong need to control environment
➢ Limited spontaneity and overly restrained emotional expression
➢ Complaints of constipation and abdominal pain
➢ Cold intolerance
➢ Lethargy
➢ Emaciation Hypotension, hypothermia, and bradycardia

NOTE: No medication has yet been FDA approved for the treatment of anorexia.

B. Bulimia Nervosa
➢ An eating disorder characterized by recurrent episodes (at least twice a week for 3 months) of binge eating followed
by inappropriate compensatory behaviors to avoid weight gain such as purging (self-induced vomiting or use of
laxatives, diuretics, enemas, or emetics), fasting, or excessively exercising.
➢ The weight of clients with bulimia usually is in the normal range, although some clients are overweight or
underweight. Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or 19 years is the typical
age of onset. Binge eating frequently begins during or after dieting.
➢ Clients with bulimia are aware that their eating behavior is pathologic and go to great lengths to hide it from others.
They may store food in their cars, desks, or secret locations around the house.

Signs and Symptoms

• Recurrent episodes of binge eating
• Compensatory behavior such as self-induced vomiting, misuse of laxatives, diuretics, enema or other medications,
or excessive exercise
• Self-evaluation overly influenced by body shape and weight
• Usually within normal weight range, possible underweight or overweight
• Restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived
to be fattening or likely to trigger a binge
• Depressive and anxiety symptoms
• Possible substance use involving alcohol or stimulants
• Loss of dental enamel
• Chipped, ragged, or moth-eaten appearance of teeth
• Increased dental caries
• Menstrual irregularities

Treatment: SSRI Antidepressants (Fluoxetine)

C. Binge Eating Disorder (BED)

➢ People with binge-eating disorder lose control over his or her eating
➢ Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a
result, people with binge-eating disorder often are overweight or obese
➢ Binge-eating disorder is the most common eating disorder in the U.S.

Signs and Symptoms

• Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
• Eating even when you're full or not hungry
• Eating fast during binge episodes
• Eating until you're uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

Treatment:
o Antidepressants (primarily the SSRIs, including Prozac)
o Antiseizure medications, especially Topiramate
o Vyvanse (an ADHD medication which suppresses appetite)

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Nursing Interventions
1. Establishing nutritional eating patterns: sit with the client during meals and snacks; offer liquid protein
supplement if unable to complete meal; adhere to treatment program guidelines regarding restrictions; observe
client following meals and snacks for 1 to 2 hours; weigh client daily in uniform clothing; be alert for attempts to hide
or discard food or inflate weight.
2. Helping the client identify emotions and develop nonfood-related coping strategies: ask the client to identify
feelings; self-monitoring using a journal; relaxation techniques; distraction; assist client to change stereotypical
beliefs.
3. Helping the client deal with body image issues: recognize benefits of a more near-normal weight; assist to view
self in ways not related to body image; identify personal strengths, interests, talents.

CASELET: Anorexia Nervosa

Background

In the humble city of Carcar City, a 23-year-old woman named Edna seeks treatment at a local hospital due to severe
weight loss and food avoidance behaviors. Edna comes from a middle-class family and works as a graphic designer. Her
case of Anorexia Nervosa presents with unique challenges to Edna and her family.

The Case of Edna

Edna's experience with Anorexia Nervosa is influenced by the following factors:

1. Body Image and Beauty Standards: Edna has been heavily influenced by the prevalent beauty standards in the
Philippines, which emphasize being slim and fair-skinned. She profoundly idolizes Liza Soberano, whose
appearance she tries to emulate.
2. Family Dynamics: Edna’s family is huge, and they have high expectations for her to succeed in her career. They
frequently comment on her appearance and weight, which has contributed to her body dissatisfaction.
3. Cultural Beliefs about Food and Eating: Being from a big family, Edna finds it challenging to navigate social
expectations around eating and often feels pressured to eat more than she is comfortable with, especially during
family gatherings.
4. Social Media Influence: Edna is active on social media platforms like TikTok, where she follows fitness
influencers and bloggers who promote extreme dieting and exercise regimens. This has further reinforced her
beliefs about dieting and weight loss.
5. Workplace Stress: As a graphic designer, Maria faces tight deadlines and high-pressure situations, which put
more strain on her anxiety and feelings of inadequacy.

Questions

1. How can psychiatric nurses assess and diagnose Anorexia Nervosa, considering Edna’s background?
2. What nursing interventions can be implemented to help Edna manage her food avoidance behaviors and
address her body image concerns?
3. How can psychiatric nurses collaborate with Edna's family to provide support and education about
Anorexia Nervosa?

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct rationale. Superimpositions or erasures in your answer/rationale are not
allowed. You are given 20 minutes for this activity:

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Multiple Choice

1. Nurse Gigi is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia
is to:
A. Avoid shopping for large amounts of food
B. Control eating impulses
C. Identify anxiety-causing situations
D. Eat only three meals per day
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
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2. During postprandial glucose monitoring, a female client with bulimia nervosa tells the nurse, “You can sit with me, but
you’re just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.”
What is the nurse’s best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.”
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
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3. For a female client with anorexia nervosa, Nurse Brad is aware that which goal takes the highest priority?
A. The client will establish adequate daily nutritional intake
B. The client will make a contract with the nurse that sets a target weight
C. The client will identify self-perceptions about body size as unrealistic
D. The client will verbalize the possible physiological consequences of self-starvation
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
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_________________________________________________________________________________________________

4. For a female client with anorexia nervosa, Nurse Irene plans to include the parents in therapy sessions along with the
client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?
A. They tend to overprotect their children
B. They usually have a history of substance abuse
C. They maintain emotional distance from their children
D. They alternate between loving and rejecting their children
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. Nurse Jackie is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is
also important?
A. Fill out the client’s menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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6. A 27-year-old client with anorexia nervosa tells the nurse, “When I look in the mirror, I hate what I see. I look so fat and
ugly.” Which strategy should the nurse use to deal with the client’s distorted perceptions and feelings?
A. Avoid discussing the client’s perceptions and feelings
B. Focus discussions on food and weight
C. Avoid discussing unrealistic cultural standards regarding weight
D. Provide objective data and feedback regarding the client’s weight and attractiveness
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. Nurse Angelo is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the
plan?
A. Restrict visits with the family until the client begins to eat
B. Provide privacy during meals
C. Set up a strict eating plan for the client
D. Encourage the client to exercise, which will reduce her anxiety
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. A 19-year-old client was brought to the clinic by her mother. Her mother expresses concern about her daughter’s weight
loss and constant dieting. Nurse Kathleen conducts a health history interview. Which of the following comments indicates
that the client may be suffering from anorexia nervosa?
A. “I like the way I look. I just need to keep my weight down because I’m a cheerleader.”
B. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my friends.”
C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.”
D. “I do diet around my periods; otherwise, I just get so bloated.”
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate
for this client?
A. Providing one-on-one supervision during meals and for one (1) hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

10. A client diagnosed with binge eating disorder has been attending a mental health clinic for several months. Which
medication should a nurse identify as an appetite suppressing agent?
A. Prozac
B. Haloperidol
C. Vyvanse
D. Chlorpromazine
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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11. A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this
assessment finding?
A. The emesis produced during purging is acidic and corrodes the tooth enamel.
B. Purging causes the depletion of dietary calcium.
C. Food is rapidly ingested without proper mastication.
D. Poor dental and oral hygiene leads to dental caries.
ANSWER: _____
RATIONALE: ______________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: _____
RATIONALE: __________________________________________________________________________________
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2. ANSWER: _____
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3. ANSWER: _____
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6. ANSWER: _____
RATIONALE: __________________________________________________________________________________
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7. ANSWER: _____
RATIONALE: __________________________________________________________________________________
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8. ANSWER: _____
RATIONALE: __________________________________________________________________________________
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 _____________________________________________________________________________________________

9. ANSWER: _____
RATIONALE: __________________________________________________________________________________
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10. ANSWER: _____

RATIONALE: __________________________________________________________________________________
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11. ANSWER: _____

RATIONALE: __________________________________________________________________________________
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LESSON WRAP-UP (30 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: PATIENT EDUCATION PLAN

Instructions:
1. You are to select and create a Client Teaching Plan for a client diagnosed with ANOREXIA NERVOSA, BULIMIA
NERVOSA, AND BINGE EATING DISORDER using the format below:
Topic:

General Objective:

Specific Objectives Teaching Strategies Teaching Resources Evaluative Method

2. The patient education plan must be written in a short bondpaper using the required format provided above and
attached to the SAS during submission.

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