Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. Which action should nurse include in plan?

Correct Answer: B. Set-up a strict eating plan for the client

Establishing a consistent eating plan and monitoring the client’s weight are important to this disorder. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). To ensure compliance with the dietary treatment program. For a hospitalized patient with anorexia, food is considered a medication. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight.

• Option A: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games.
• Option C: Monitor exercise program 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, the patient may exercise excessively to burn calories.
• Option D: Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge the competent actions of the patient. Each individual needs to develop own internal sense of self-esteem. The individual often is living up to others’ (family’s) expectations rather than making his or her own choices. Acknowledgment provides recognition of self in positive ways.