Protocol For Anorexia Nervosa For Patient

Protocol For Anorexia Nervosa For Patient

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Protocol For Anorexia Nervosa For Patient

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Protocol For Anorexia Nervosa For Patient

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Discuss About The Treatment Protocol For Anorexia Nervosa For Patient Lizzie.


The case review entails patient Lizzie, who is 24 years woman, admitted at the acute mental health unity for her third time in the 18 months. She has a 10 year history of anxorexia nervosa and although she has spent most of the last 10 years in and out of hospital she has completed her university studies, she has not been able to achieve a healthy weight since she was first diagnosed. Lizzie has been having individual psychotherapy on and off for the past 5 years and is estranged from her family. Two years ago Lizzie was sexually assaulted on the way home from the library one night. She has been extremely unwell since that time.
Patient Case

Eating disorder

Setting of the patient
Inpatient – the patient is admitted at the health facility.
A treatment plan for patient Lizzie
 This treatment protocol entails nursing diagnosis and goals for the recovery process for anorexia nervosa for the patient. Further biological, psychosocial and social intervention for the patient has been laid as well as the expected outcomes.

Nursing diagnoses identified and goals

Biological, psychological, social intervention proposed and rational

Expected outcome and evaluation approach

Improving overall nutritional status
Nursing intervention include;
– Supervising the patient during meal times to ensure compliance of the dietary treatment
– Encouraging the intake of liquids as it is acceptable for the patient more than the solids.
(Bodell et al, 2014)

Application of pharmacotherapy plan for the patient. Administration of Cyproheptadine is effective as a serotonin and histamine antagonists which is essential for stimulating food appetite and combat depression state. The drug is effective as it has no side effects.
Further administration of antipsychotic drugs such as chlorpromazine. This drug promoters improved weight gain and ensure cooperation for the psychotherapeutic program.
(Hay et al, 2014)

Expected outcome and evaluation tools
– The patient to verbalize and understand the nutritional needs
Establishment of an effective dietary plan with an adequate caloric intake which ensures that there is the maintenance of the required body weight gain.
(Bodell et al, 2014)
– Good body mass index
– Stable weight gain
– -positive score on appetite scale

Nursing diagnoses identified and goals
Improved low self-esteem
Nursing diagnosis
The patient has chronic self-esteem with prolong period of negative self-image, feelings and capabilities.
The underlying diagnosis is linked to distort ted body image, expression of being powerless to make changes and overcoming of shame

Psychological nursing intervention for this patient includes allowing the patient to draw self-picture.
Encouraging personal development through personal grooming and make.
Changing body image through changing thin clothes and wearing appropriate clothes as a result of weight gain.
Offering assistance to the patient in confronting body changes as to pertaining to encountered sexual fears and providing sex education on recovery from past trauma.
Establishing a therapeutic nurse-patient relationship and promoting self-concept through moral judgment approaches.
(Zainal et al, 2016)  

Expected outcome and evaluation tools
Expected outcomes for the patient include the establishment of realistic body image, self-acknowledgment as an individual and accepting responsibility for personal actions
These aspects will evaluate through positive body image Assesment, expression of shame and guilt and expression of little concern and denial statements.
– 5-item “self-enhancement” dimension
–  5-item “self-deprecation” dimension

Nursing diagnoses identified and goals
Ensuring guaranteed Family support
Family therapy
– Encouraging and linking with the family support is key to ensure removal of isolation.

Exposing the patient to the family support systems is key in ensuring that adequate care is achieved and the support system is provided.
Further care support by caregivers at her social and personal cycles goes a long way in ensuring that the patient recovers from anorexia nervosa.
Patients with anorexia nervosa such patient Lizzie can have poor interpersonal relationships which affect their well being and social status. 
(Pisetsky, Utzinger & Peterson, 2016)

Expected outcome and evaluation tools
Expected outcomes of this intervention are geared towards the patient having positive social life and being able to communicate well with other persons close to her environment.
Close family support ensures that other members of the family can offer support when the symptoms of anorexia nervosa are hazardous.
Key screening tools in this category include conducting self-assessment questionnaire tool which gauges on the social aspect of the patient and how she relates with her close acquaintances.

Rationale for interventions
Anorexia nervosa is a devastating eating disorder which causes impairment and disability to the quality of life. It is one of the common psychiatric disorder affecting patients. Health impacts are diverse and affect the patients negatively thus having direct mental and physical health effects. Assessment and early diagnosis are key in managing the effects of anorexia nervosa.
A biological intervention of anorexia nervosa entails appropriate setting for psychological and physical management. Many victims of anorexia nervosa often find it hard to acknowledge that they have a serious problem, this leads to reluctance to engage in the early treatment process, whereas condition for successful recovery is adherence to successful treatment plans for the patient, (Dooley et al, 2012).
Offering psychological treatment to the patient ensures that there are weight gain and adoption of healthy eating patterns which aim to reduce eating disorder symptoms and enabling psychology recovery process. For eating disorders to be effective, the treatment plan must align to the required levels of care. Among patients with an enduring psychological treatment plan, there is need to ensure modest goals of treatment are put in place which ensures that the patient recovers well with an aim of improving quality of life, (Knowles, Anokhina & Serpell, 2012).
Administration of Cycloheptadaine to the patient ensures that the histamine antagonist offers appetite stimulation and lowers food preoccupation and mitigates depression.
Social intervention to the patient allows for self-opportunity to focus and discussion of patient perception on the disease progress and self-image view. There is a need to also encourage the patients to have an enhanced personal appearance which offers help to self-esteem ad image outlook. Improvement of the choice of clothes for the patient ensures that an incentive not to lose weight is enhanced. Further it improves the sense of self-worth on the patient, (Collu et al, 2016).
Due to the current of sexual history of the patient, offering sexual education and counseling is key in curbing prolong post-traumatic stress which might be linked to anorexia nervosa. Ensuring that the patient doesn’t feel powerless and loss of control is key in promoting self-worth and ability, (Zipfel et al, 2015).
The treatment plan for Patient Lizzie entails a critical review of service setting and offering psychological, biological and social management approach towards care delivery. For the patient psychological treatment is of the essence as it could be the enabling factor and impediment to the recovery process. Offering nutritional support through nursing care support system is crucial in ensuring that the patient walks on a recovery plan effectively.
Bodell, L. P., Keel, P. K., Brumm, M. C., Akubuiro, A., Caballero, J., Tranel, D., … & McCormick, L. M. (2014). Longitudinal examination of decision-making performance in anorexia nervosa: before and after weight restoration. Journal of psychiatric research, 56, 150-157.
Collu, R., Scherma, M., Satta, V., Bratzu, J., Castelli, M. P., Boi, M. F., … & Fratta, W. (2016). The endocannabinoid system: possible new pharmacological target in the treatment of anorexia nervosa. European Neuropsychopharmacology, 26, S129.
Dooley?Hash, S., Lipson, S. K., Walton, M. A., & Cunningham, R. M. (2013). Increased emergency department use by adolescents and young adults with eating disorders. International Journal of Eating Disorders, 46(4), 308-315.
Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., … & Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11), 977-1008.
Knowles, L., Anokhina, A., & Serpell, L. (2013). Motivational interventions in the eating disorders: what is the evidence?. International Journal of Eating Disorders, 46(2), 97-107.
Pisetsky, E. M., Utzinger, L. M., & Peterson, C. B. (2016). Incorporating Social Support in the Treatment of Anorexia Nervosa: Special Considerations for Older Adolescents and Young Adults. Cognitive and behavioral practice, 23(3), 316-328.
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: etiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111

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