Nurse Trish is working in a mental health facility; nurse’s priority nursing intervention for a newly admitted client with bulimia nervosa would be:

Correct Answer: D. Monitor client continuously

These clients often hide food or force vomiting; therefore they must be carefully monitored. Supervise the patient during mealtimes and for a specified period after meals (usually one hour) to prevent vomiting during or after eating. Identify the patient’s elimination patterns to prevent self-induced vomiting.

• Option A: 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. 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.
• Option B: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situation while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.
• Option C: 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 (2 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.