Anorexia
Anorexia, a lack of appetite in the presence of a physiologic need for food, is a common symptom of GI and endocrine disorders and is characteristic of certain psychological disturbances such as anorexia nervosa. It can also result from such factors as anxiety, chronic pain, poor oral hygiene, increased blood temperature due to hot weather or fever, and changes in taste or smell that normally accompany aging. Anorexia can also result from drug therapy or abuse. Short-term anorexia rarely jeopardizes health, but chronic anorexia can lead to life-threatening malnutrition and electrolyte disorders.
History and physical examination
Take the patient's vital signs and weight. Find out previous minimum and maximum weights. Ask about involuntary weight loss greater than 10 lb (4.5 kg) in the past month. Explore dietary habits such as when and what the patient eats. Ask what foods he likes and dislikes and why. The patient may identify tastes and smells that nauseate him and cause loss of appetite. Ask about dental problems that interfere with chewing, including poor-fitting dentures. Ask if he has difficulty or pain when swallowing or if he vomits or has diarrhea after meals. Ask the patient how frequently and intensely he exercises.
Check for a history of stomach or bowel disorders, which can interfere with the ability to digest, absorb, or metabolize nutrients. Find out about changes in bowel habits. Ask about alcohol use and drug use and dosage.
If the medical history doesn't reveal an organic basis for anorexia, consider psychological factors. Ask the patient if he knows what's causing his decreased appetite. Situational factors—such as a death in the family or problems at school or at work—can lead to depression and a subsequent loss of appetite. Be alert for signs of malnutrition, consistent refusal of food, and a 7% to 10% loss of body weight in the preceding month. (See Is your patient malnourished?)
Medical causes
Acquired immunodeficiency syndrome.An infection or Kaposi's sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.
Adrenocortical hypofunction.With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.
Alcoholism.Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.
Anorexia nervosa.Chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition and electrolyte disorders, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, decreased libido, and cardiac arrhythmias. Paradoxically, the patient typically exhibits extreme restlessness and vigor and may exercise compulsively. He may have complicated food preparation and eating rituals.
Appendicitis.Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting cause by appendicitis. It can continue as pain localizes in the right lower quadrant (McBurney's point), and other signs and symptoms appear, such as abdominal rigidity, rebound tenderness, constipation (or diarrhea), a slight fever, and tachycardia.
Cancer.Chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia.
Chronic renal failure.With chronic rental failure,chronic anorexia is common and insidious. It's accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.
Cirrhosis.Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, leg edema, gynecomastia, and right upper quadrant pain.
Crohn's disease.With Crohn's disease, chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion, but may include diarrhea, abdominal pain, fever, an abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms—right lower quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools—mimic those of appendicitis.
Gastritis.With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress after a meal, accompanied by nausea, vomiting (commonly with hematemesis), fever, belching, hiccups, and malaise.
Hepatitis.With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, a mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right upper quadrant pain and, possibly, irritability and severe pruritus.
Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.
Hypothyroidism.Anorexia is common and usually insidious in patients with a thyroid hormone deficiency. Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, a dull facial expression, and slow reflex relaxation time.
Ketoacidosis.Anorexia usually arises gradually and is accompanied by dry, flushed skin; a fruity breath odor; polydipsia; polyuria and nocturia; hypotension; a weak, rapid pulse; a dry mouth; abdominal pain; vomiting, and altered level of consciousness.
Pernicious anemia.With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of a burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski's and Romberg's signs; diplopia and blurred vision; irritability; head-ache; malaise; and fatigue.
Other causes
Drugs.Anorexia results from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also signals digoxin toxicity.
Radiation therapy.Radiationtreatments can cause anorexia, possibly as a result of metabolic disturbances.
Total parenteral nutrition (TPN).Maintenance of blood glucose levels by I.V. therapy may cause anorexia.
Nursing considerations
▪ Because the causes of anorexia are diverse, diagnostic procedures may include thyroid function studies, endoscopy, upper GI series, gallbladder series, barium enema, liver and kidney function tests, hormone assays, computed tomography scans, ultrasonography, blood studies to assess the patient's nutritional status and, possibly, a mental health evaluation.
▪ Promote protein and calorie intake by providing high-calorie snacks or frequent, small meals.
▪ Encourage the patient's family to supply his favorite foods to help stimulate his appetite.
▪ Because the patient may consistently exaggerate his food intake (common in the patient with anorexia nervosa), you'll need to maintain strict calorie and nutrient counts for the patient's meals.
▪ In severe malnutrition, provide supplemental nutritional support, such as TPN or oral nutritional supplements.
▪ Because anorexia and poor nutrition increase the patient's susceptibility to infection, monitor his vital signs and white blood cell count and closely observe any wounds.
Patient teaching
▪ Explain the patient's condition and treatment plan to him and his family.
▪ Stress the importance of proper nutrition.
▪ Instruct the patient to perform oral hygiene before meals.
▪ Teach the patient techniques to help manage the disorder, including establishing a target weight, recording his weight daily, and maintaining a record of his progress by keeping a weight log.
▪ Encourage the patient to seek psychological and nutritional counseling.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
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