A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is unworthy of eating and that her children will die if she eats. Which nursing action would be most appropriate for this client?
A. Telling the client that she may become sick and die unless she eats.
B. Paying special attention to the client’s rituals and emotions associated with meals.
C. Restricting the client’s access to food except at specified meal and snack times.
D. Encouraging the client to express her feelings at meal times.
Correct Answer: C. Restricting the client’s access to food except at specified meal and snack times
Restricting access to food except at specified times prevents the client from eating when she feels anxious, guilty, or depressed; this, in turn, decreases the association between these emotions and food. Be consistent in setting expectations, enforcing rules, and so forth. Clear, consistent limits provide a secure structure for the patient.
Option A: Telling the client she may become sick or die may reinforce her behavior because illness or death may be her goal. Present reality concisely and briefly and do not challenge illogical thinking. Avoid vague or evasive remarks. Delusional patients are extremely sensitive about others and can recognize insincerity. Evasive comments or hesitation reinforces mistrust or delusions.
Option B: Paying special attention to rituals and emotions associated with meals also would reinforce undesirable behavior. Reduce provocative stimuli, negative criticism, arguments, and confrontations. This is to avoid triggering fight/flight responses. Identify specific conflicts that remain unresolved, and assist the patient to identify possible solutions. Unless these underlying conflicts are resolved, any improvement in coping behaviors must be viewed as only temporary.
Option D: Encouraging the client to express feelings at mealtimes would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times. Encourage the patient to verbalize true feelings. Avoid becoming defensive when angry feelings are directed at him or her. Verbalization of feelings in a non-threatening environment may help the patient come to terms with long-unresolved issues.