Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral rapy unit?

Correct Answer: C. Help establish a plan using privileges and restrictions based on compliance with refeeding.

Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished through behavioral therapy, which uses a system of rewards and reinforcements to assist in establishing weight restoration. Treatment for anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding, nutritional plans, and weight restoration are crucial parts of the medical stabilization process which is necessary in order to proceed with treatment and eventually achieve recovery. There are many serious and deadly complications that arise during the refeeding process which is why medical supervision is of the utmost importance.

• Option A: Anorexia nervosa is a serious eating disorder which has a very high morbidity. The disorder is usually managed with an interprofessional team that consists of a psychiatrist, dietitian, social worker, internist, endocrinologist, gastroenterologist, and nurses. The disorder cannot be prevented and there is no cure. Hence patient and family education is key to preventing the high morbidity. The dietitian should educate the family on the importance of nutrition and limiting exercise.
• Option B: The nurse needs to assess the client’s mealtime behavior continually to evaluate treatment effectiveness. Remission in AN varies. Three-fourths of patients treated in out-patient settings remit within 5 years and the same percentage experience intermediate-good outcomes (including weight gain). Relapse is more common in patients who are older with a longer duration of disease or lower body fat/weight at the end of treatment, have comorbid psychiatric disorders, or receive therapy outside of a specialized clinic. Patients who achieve partial remission often develop another form of the eating disorder (ex. bulimia nervosa or unspecified eating disorder).
• Option D: Emphasizing nutrition and teaching the client about the long-term physical consequences of anorexia may be appropriate at a later time in the treatment program. For adults, cognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — has been shown to help. The main goal is to normalize eating patterns and behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that maintain restrictive eating.