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Clients with Clients with eating eating
disordersdisorders
•Underlying emotional conflicts – dealt with by destructive food related behavior
Nursing Dx.:Imbalanced nutrition <body Nursing Dx.:Imbalanced nutrition <body requirements r/t intake of nutrients requirements r/t intake of nutrients
insufficient to meet body needsinsufficient to meet body needs
Assessment characteristics: Wt loss Body wt 15% + under ideal body wt. Denial or loss of appetite,difficulty swallowing Inability to perceive accurately & respond to
internal stimuli r/t hunger or nutritional needs Epigastric distress,vomiting, Laxative abuse Concealing wt’s on body to wt .measurement
Anorexia characteristics Anorexia characteristics continuedcontinued::
Denial of illness or resistance of treatment
Denial of being too thinExcessive exerciseMultiple related physical problemsInterventions must be specific to client
physical and emotional problems and degree /severity of wt loss and anorexia
Examples of interventions:Examples of interventions:• If critically malnourished:Parenteral nutrition through a central
catheter may be indicated(adequate nutrition,electrolytes etc. can be provides parenterally,client cannot vomit this type of nutrition)
Tube feedings may be used alone or with oral parenteral nutrition(fortified liquid diets can be provided through tube feedings)
Severe anorexia Severe anorexia interventions:interventions:
Supervise client for specified time(90 minutes – decrease to 30 minutes after tube feeding or remove NG tube after feeding(supervision decreased clients opportunity to vomit or siphon feedings)
Offer client opportunity to eat food orally-use tube feeding if amount consumed is insufficient(client may prefer to eat food orally- however, physical health is priority)
Severe malnourishmentSevere malnourishmentIf N/G tube is used – be matter-of fact
re: insertion/use –DO NOT use as a threat!
DO NOT permit client to bargain!(limits & consistency essential in avoiding power struggles and decreasing manipulative behaviors)
Interventions for the Interventions for the non- non- criticallycritically malnourished clientmalnourished client
Initially do not allow client to eat with ither clients or visitors(other clients may repeat family patterns by urging client to eat or providing attention to client for not eating)
Provide structure to mealtime-state limits matter-of-factly (clear limits lets client know what is expected)
Interventions continuedInterventions continuedDo not bribe,coax,threaten or focus
on eating at all! Withdraw attention if client refuses
to eat.When meal is over remove food
without discussion(minimizes client’s secondary gains from not eating- does not reinforce issues of control which are central to client)
Interventions continuedInterventions continued Encourage client to seek out staff members after
eating to talk about feelings of anxiety or guilt or if urge to vomit exists.(speaking to staff promotes focus on emotional issues rather than food)
Supervise during & after meals start with 90 minutes gradually reduce to 30 minutes.Do not permit use of bathroom until at least 30 minutes after each meal (client may spill,hide or discard food-may use BR to vomit or dispose of concealed food)
Interventions continuedInterventions continued Gradually permit client increased choices
regarding food, mealtime etc.(develops independence in eating habits)
Monitor I&O in an unobtrusive and matter-of fact manner(minimizes direct attention to eating and removes emotional issues)
Weigh client daily,after client has voided and before morning meal; client should wear only hospital gown(consistency is necessary for accurate comparison of wt.over time)
Observe/record client overt/covert physical activity(client may exercise to excess to control wt.)
Review questions:Review questions:Eating disordersEating disorders
• The nurse should include which of the following interventions in the plan of care for a client with bulimia? (select all that apply)A.Encourage the client to avoid eating except at mealtime.B. Promote a weight gain of 3 to 5 pounds per week.C. Observe the client for one hour after meals.D. Encourage the client to identify foods that trigger a
binge.E. Instruct the client to keep laxatives and diuretics in a
locked area.F. Inform the client that there are no “forbidden” foods.
Review questionsReview questionsThe nurse is caring for a client with anorexia
nervosa. Even though client has been eating all her meals and snacks her weight is unchanged for one week. Which intervention would be indicated:
A. Close Obs.x’s2 hrs. p meals/snacksB. caloric intake from 1500 –2000
caloriesC. fluid intakeD. Request Rx for antianxiety med from
MD
• Which of the following nursing interventions should the nurse include in the plan of care for a client with anorexia nervosa who is hospitalized?
A.Encourage the client to talk about food during mealtime.
B.Ask the client if any food, laxatives, or diuretics have been brought back to the hospital after a pass.
C.Discourage the client from participating in nutritional counseling.
D.Provide highly structured mealtimes with regular meals.
• During a nutritional assessment of a client with binge eating disorder, which of the following does the nurse evaluate as most significant in contributing to binge eating?
A.A rigorous exercise planB.Periods of fastingC.Weighing too frequentlyD.Eating a diet low in carbohydrates.
• The nurse should assess a client suspected of having bulimia for which of the following clinical manifestations: (select all that apply)
A.ConstipationB.A20% loss of normal body weight C.Dental erosionD.LanguoE.A serum potassium of 3.0mEq/LF.Depression
The nurse is evaluating the progress of a The nurse is evaluating the progress of a client with bulimia. Which behavior indicates client with bulimia. Which behavior indicates the client is making progress?the client is making progress?
A. The client identifies calorie content for each meal
B. The client identifies healthy ways of coping with anxiety
C. The client spends time resting in her room after meals
D. The client verbalizes knowledge of former eating patterns
• When assessing an adolescent female with anorexia nervosa, the nurse would identify the following physical findings to support the diagnosis: (select all that apply)
A.Temperature of 96.9 degrees B.Pulse rate of 48C.Sensitivity to heatD.Oily skinE.Facial lanugo
• If a client’s ideal body weight is 124 lbs., which current weight meets the diagnositic criteria for anorexia nervosa?
A.105 lbs.B.109 lbs.C.112 lbs.D.119 lbs.
• During an admission assessment for a client with bulimia, which of the following questions is a priority for the nurse?
A.“Do you ever become depressed?”B.“What has your weight been doing?”C.“How much do you binge?”D. “Do you ever cut yourself?
When teaching a group of adolescents about When teaching a group of adolescents about anorexia, the nurse would describe this anorexia, the nurse would describe this disorder as being characterized by which of disorder as being characterized by which of the following:the following:A. Excessive fear of becoming obese, near-
normal weight, and self-critical body image
B. Extreme concern about dieting, calorie counting, and an unrealistic body image
C. Intense fear of becoming obese, emaciation, and a disturbed body image
D. Obsession with the weight of others, chronic dieting, and an altered body image.
Which of the following nursing interventions Which of the following nursing interventions should the nurse include in the plan of care should the nurse include in the plan of care
for a client with anorexia nervosa in the for a client with anorexia nervosa in the outpatient setting? outpatient setting?
((select all that applyselect all that apply
A. Set minimum weight limits in which the client may continue treatment in the outpatient setting.
B. Avoid discussing the client’s irrational thoughts about food and weight with the client’s family.
C. Encourage the client to be weighed daily at the same time of day.
D. Instruct the client to avoid preparing one’s own meal.
E. Instruct the client to keep a food diary.F. Assist the client with meal planning.
• The nurse should assess a client suspected of having bulimia for which of the following clinical manifestations: (select all that apply)
A. ConstipationB. A 20% loss of normal body weight C. Dental erosionD. LanguoE.A serum potassium of 3.0mEq/LF.Depression
A nurse assesses personality traits of a client with an eating disorder. Which comment by the
client indicated bulimia nervosa rather than anorexia nervosa?
A.“I try to do what my parents want, but I usually don’t get things right.”
B.“I feel good. I feel just fine. I don’t have any problems.”
C.“I don’t look as good as most of my friends. That’s why I don’t have so many dates.”
D.“If I want to do something. I just do it. I don’t like to analyze things too much.”
• Which of the following nursing interventions should the nurse include in the plan of care for a client with
anorexia nervosa in the outpatient setting? (select all that apply)
A.Set minimum weight limits in which the client may continue treatment in the outpatient setting.
B.Avoid discussing the client’s irrational thoughts about food and weight with the client’s family.
C.Encourage the client to be weighed dailyat the same time of day.
D.Instruct the client to avoid preparing one’s own meal.E. Instruct the client to keep a food diary.F. Assist the client with meal planning.
• Prioritize the following diagnoses for a client with Bulimia Nervosa.
A.Imbalanced nutrition: less than body requirements
B.PowerlessnessC.Social IsolationD.Risk for imbalanced fluid volume
Mental Health Issues -Mental Health Issues -AdolescentsAdolescents
An effective nursing intervention for the An effective nursing intervention for the impulsive and aggressive behaviors that impulsive and aggressive behaviors that accompany conduct disorders is:accompany conduct disorders is:
A. Assertiveness training
B. Consistent limiting setting
C. Negotiation of rules
D. Open expression of feelings
The nurse would expect to see all of the The nurse would expect to see all of the following behaviors in a child with Attention following behaviors in a child with Attention
deficit hyperactivity disorder (AD/HD) deficit hyperactivity disorder (AD/HD) except:except:
A. Easily distracted and forgetful
B. Excessive running, climbing, fidgeting
C. Moody, sullen, pouting behavior
D. Interrupts others and cannot take turns
A 9 year old client with AD/HD tells the nurse A 9 year old client with AD/HD tells the nurse “no one in my class likes me because they “no one in my class likes me because they think I’m stupid !” The nurse would apply think I’m stupid !” The nurse would apply
the following nursing diagnosis to this child:the following nursing diagnosis to this child:
A. Anxiety
B. Impaired socialization
C. Ineffective coping
D. Low Self-Esteem
The nurse would identify which of the The nurse would identify which of the following children as being most at risk for following children as being most at risk for
an adjustment disorder?an adjustment disorder?
A. A 10 year old boy who has never liked school an has a few friends
B. A 16 year old boy who has been struggling in school, getting only C’s and D’s
C. A 13 year old girl who is upset about not being selected for a cheerleading squad
D. A 16 year old girl who recently moved to a new school after her parents’ divorce
