Page 85 Complete Your CE Test Online - Click Here Gastrointestinal problems Gastrointestinal manifestations of the disease include[12] : ● ● Delay in gastric emptying. ● ● Bloating. ● ● Constipation (can be severe). ● ● Abdominal pain. ● ● Flatulence. ● ● Diarrhea. ● ● Enlargement of salivary glands. ● ● Enlarged and inflamed pancreas. Dermatologic manifestations Manifestations of anorexia nervosa evident in the dermatologic system include[9,12] : ● ● Dry, cracked skin and loss of turgor due to dehydration. ● ● Edema. ● ● Lanugo. ● ● Acrocyanosis (bluish hands and feet). Reproductive system manifestations Anorexia nervosa can have an impact on the reproductive system, affecting ovulation and fertility. Estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels decrease. This may lead to amenorrhea, failure to ovulate, and infertility[2,9,12] . Lab studies Abnormal lab study results include[2,9,12] : ● ● Increased blood urea nitrogen (BUN). ● ● Abnormal liver function tests. ● ● Decreased albumin levels. ● ● Decreased white blood cell count (leucopenia). ● ● Decreased hematocrit and red blood cell (RBC) count leading to anemia. Neuropsychiatric problems Persons with anorexia nervosa may exhibit memory and other cognitive problems, difficulty concentrating, sleep disturbances, apathy, and abnormal taste sensations[12] . There may also be significant problems with interpersonal relationships and difficulty functioning at home, work, and/or school. The family unit may be in jeopardy as family members attempt to deal with the diagnosis of anorexia nervosa and initiate interventions to help the client ingest a proper nutrition. Research indicates that persons with anorexia nervosa often have a family history of eating disorders, and/or other mental health problems[9,12] . COMPLICATIONS OF ANOREXIA NERVOSA Some of the potentially life-threatening complications of anorexia nervosa include[1,2,9,12] : ● ● Suicide: There is a significant risk of suicide associated with anorexia nervosa. Suicide rates of 12 per 100,000 annually have been reported. Clients must be monitored for suicidal ideation and actions. It is also important that they be evaluated for co-existing mental health problems, such as major depressive disorder. ● ● Malnutrition and near-starvation: Lack of proper nutrition may lead to electrolyte imbalances, arrhythmias, and renal failure. If laxative abuse occurs, changes in the bowel can be similar to those in chronic inflammatory bowel disease. ● ● Cardiovascular compromise: Possibly fatal cardiovascular complications include a decrease in left ventricular muscle mass and heart muscle mass. Cardiac output may be reduced. ECG may show a prolonged PR interval. Heart failure and sudden death may occur, perhaps due to ventricular arrhythmias. Nursing consideration: Nurses must be alert to signs and symptoms of complications and promptly report any signs and symptoms that require prompt medical intervention. Diagnostic criteria The following statements summarize the diagnostic criteria for anorexia nervosa as identified in the DSM-5[1] : ● ● Restriction of energy intake relative to requirements. This leads to a significantly low weight for age, sex, developmental trajectory, and physical health. β€œSignificantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected.” ● ● Intense fear of gaining weight or becoming overweight or ongoing behaviors that interfere with weight gain. ● ● Disturbance in the way in which one’s weight or shape is experienced. There is undue influence of body weight or shape on self-evaluation, or ongoing lack of recognition of just how serious the client’s low body weight is. The DSM-5 identifies two subtypes of anorexia nervosa. These are[1] : ● ● Restricting type: During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. ● ● Binge-eating/purging type: During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior. Treatment A multidisciplinary clinical approach that includes nurses, physicians, nutritionists, and psychologists is essential for the implementation of a successful treatment program. Client and family involvement in the development, implementation, and evaluation of treatment are also essential if treatment initiatives are to work[2,9,12] . Clients with anorexia nervosa often vigorously resist treatment. They deny they have a problem and are often interested only in continuing to lose weight[12] . There are a variety of treatment settings for clients with anorexia nervosa. Regardless of the setting, treatment should be initiated by