Situation: A 17-year-old gymnast is admitted to the hospital due to weight loss and dehydration secondary to starvation. Which of the following nursing diagnoses will be given priority for the client?
A. Altered self-image
B. Fluid volume deficit
C. Altered nutrition less than body requirements
D. Altered family process
Correct Answer: B. Fluid volume deficit
Fluid volume deficit is the priority over altered nutrition since the situation indicates that the client is dehydrated. Supervise the patient during mealtimes and for a specified period after meals (usually one hour) to ensure compliance with the dietary treatment program. For a hospitalized patient with anorexia, food is considered a medication. Liquids are more acceptable than solid. Fluids eliminate the need to choose between foods – something the patient with anorexia may find difficult.
Option A: Promote self-concept without moral judgment. Patient sees herself as weak-willed, even though part of a person may feel a sense of power and control (dieting, weight loss). Suggest disposing of “thin” clothes as weight gain occurs. Recommend consultation with an image consultant; provides an incentive to at least maintain and not lose weight. Removes visual reminder of thinner self. Positive image enhances a sense of self-esteem.
Option C: Provide smaller meals and supplemental snacks, as appropriate. Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: the patient may feel bloated for 3–6 weeks while the body adjusts to food intake. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Be alert to choices of low-calorie foods and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets. The patient will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.
Option D: Identify patterns of interaction. Encourage each family member to speak for self. Do not allow two members to discuss a third without that member’s participation. Helpful information for planning interventions. The enmeshed, over-involved family members often speak for each other and need to learn to be responsible for their own words and actions. Encourage and allow expression of feelings (crying, anger) by individuals. Often these families have not allowed free expression of feelings and need help and permission to learn and accept this.