Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

Correct Answer: A. Providing one-on-one supervision during meals and for one (1) hour afterward.

Because the client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour afterward. 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 (1 hr) following eating, if contracting is unsuccessful. Prevents vomiting during and after eating. The patient may desire food and use a binge-purge syndrome to maintain weight. Note: The patient may purge for the first time in response to the establishment of a weight gain program.

• Option B: This wouldn’t be therapeutic because other clients may urge the client to eat and give attention for not eating. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). It prevents vomiting during or after eating.
• Option C: This would reinforce control issues, which are central to this client’s underlying psychological problem. 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 D: Instead of giving the client unlimited time to eat, the nurse should set limits and let the client know what is expected. 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. Be alert to choices of low-calorie foods and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets. Patients will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.