Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
Correct Answer: C. Set up a strict eating plan for the client.
Establishing a consistent eating plan and monitoring the client’s weight is important for this disorder. 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. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in himself and feels in control of the environment is more likely to eat preferred foods.
Option A: The family should be included in the client’s care. Involve patients in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. It provides a structured eating situation while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.
Option B: The client should be monitored during meals — not given privacy. Provide one-to-one supervision and have a patient with bulimia remain in the day room area with no bathroom privileges for a specified period (2 hr) following eating, if contracting is unsuccessful. Prevents vomiting during and after eating. Patients may desire food and use a binge-purge syndrome to maintain weight. Note: Patients may purge for the first time in response to the establishment of a weight gain program.
Option D: Exercise must be limited and supervised. 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, patients may exercise excessively to burn calories.