A nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa and has a body mass index of 17.2. Which of the following actions should the nurse take? (Select all that apply.).
A.
Offer specific privileges for sustained weight gain.
B.
Monitor the client’s weight daily.
C.
Allow the client to choose the meals she will eat.
D.
Provide the client with small meals frequently.
E.
Stay with the client during meals and for 1 hr afterward.
The Correct answer and Explanation is:
In the care of a client with anorexia nervosa, particularly one with a body mass index (BMI) of 17.2, the nurse must implement strategies that support safe weight gain, monitor the client’s physical and psychological status, and prevent behaviors that might contribute to the continuation of the eating disorder. The correct actions the nurse should take include:
- A. Offer specific privileges for sustained weight gain.
- B. Monitor the client’s weight daily.
- D. Provide the client with small meals frequently.
- E. Stay with the client during meals and for 1 hour afterward.
Explanation:
- Offering specific privileges for sustained weight gain (Option A): This is a therapeutic strategy that uses positive reinforcement to encourage weight gain. Privileges might include increased visitation rights, participation in desired activities, or more freedom in meal choices. The idea is to motivate the client by linking healthy behavior with rewards, which can help in gradually altering the disordered eating patterns.
- Monitoring the client’s weight daily (Option B): Daily weight monitoring is critical to assess the client’s progress and ensure that the treatment plan is effective. It also helps in identifying any sudden changes that might indicate a health concern. However, this should be done in a manner that minimizes the client’s anxiety, such as conducting weigh-ins at the same time each day and without the client seeing the scale.
- Providing the client with small meals frequently (Option D): Small, frequent meals can help to prevent the client from feeling overwhelmed and to reduce gastrointestinal discomfort. It also aids in better digestion and nutrient absorption. This approach aligns with the body’s needs, especially when refeeding after a period of malnutrition, and can help prevent refeeding syndrome.
- Staying with the client during meals and for 1 hour afterward (Option E): This measure is essential to prevent purging behaviors, such as self-induced vomiting, which clients with anorexia nervosa might use to counteract the effects of eating. Supervision during and after meals ensures that the client consumes the food and does not engage in behaviors that undermine the treatment plan.
Incorrect Action:
- Allowing the client to choose the meals she will eat (Option C): Allowing clients with anorexia nervosa to choose their meals might reinforce their restrictive eating patterns and fear of certain foods. Instead, a structured meal plan created by a dietitian and followed under supervision is necessary to ensure balanced nutrition and gradual weight gain.
In summary, the management of anorexia nervosa in an inpatient setting requires a combination of supportive strategies, close monitoring, and controlled nutritional interventions to ensure the client’s safety and promote recovery.