What is the best intervention to teach the client when she feels the need to starve?
A. Allow her to starve to relieve her anxiety.
B. Do a short-term exercise until the urge passes.
C. Approach the nurse and talk out her feelings.
D. Call her mother on the phone and tell her how she feels.
Correct Answer: C. Approach the nurse and talk out her feelings
The client with anorexia nervosa uses starvation as a way of managing anxiety. Talking out feelings with the nurse is adaptive coping. Establish a therapeutic nurse-patient relationship. Within a helping relationship, the patient can begin to trust and try out new thinking and behaviors. Encourage the patient to express anger and acknowledge when it is verbalized. Important to know that anger is part of self and as such is acceptable. Expressing anger may need to be taught to the patient because anger is generally considered unacceptable in the family, and therefore the patient does not express it.
Option A: Starvation should not be encouraged. Physical safety is a priority. Without adequate nutrition, a life-threatening situation exists. Assist the patient to assume control in areas other than dieting and weight loss such as management of their own daily activities, work, and leisure choices. Feelings of personal ineffectiveness, low self-esteem, and perfectionism are often part of the problem. The patient feels helpless to change and requires assistance to problem-solve methods of control in life situations.
Option B: The client with anorexia nervosa is preoccupied with losing weight due to disturbed body image. Limits should be set on attempts to lose more weight. Monitor exercise programs and set limits on physical activities. Chart activity and level of work (pacing and so on). Moderate exercise helps in maintaining muscle tone, weight and combating depression; however, the patient may exercise excessively to burn calories. 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.
Option D: The client may have a domineering mother which causes the client to feel ambivalent. The client will not discuss her feelings with her mother. Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge the competent actions of the patient. Each individual needs to develop their own internal sense of self-esteem. The individual often is living up to others’ (family’s) expectations rather than making their own choices. Acknowledgment provides recognition of self in positive ways.