The nurse is evaluating nutritional outcomes for a with anorexia nervosa. Which data best indicates that the plan of care is effective?
A. The client selects a balanced diet from the menu.
B. The client’s hemoglobin and hematocrit improve.
C. The client’s tissue turgor improves.
D. The client gains weight.
Correct Answer: D. The client gains weight.
The client with anorexia shows the most improvement by weight gain. Expect weight gain of about 1 lb (0.5 kg) per week to see the effectiveness of the treatment regimen. Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work.
Option A: Selecting a balanced diet does little good if the client will not eat. 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.
Option B: The hematocrit might improve by several means, such as blood transfusion, but that does not indicate improvement in the anorexic condition. Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games.
Option C: The tissue turgor indicates fluid stasis, not an improvement of anorexia. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight.