13 clients with eating disorders

8/10/2019 13 Clients With Eating Disorders

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Clients with

eatingdisorders


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Underlying emotionalconflicts dealt with by

destructive food relatedbehavior


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Nursing Dx.:Imbalanced nutrition


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Anorexia characteristicscontinued:

Denial of illness or resistance oftreatment

Denial of being too thin

Excessive exercise

Multiple related physical problems

Interventions must be specific to client

physical and emotional problems anddegree /severity of wt loss andanorexia


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Examples of interventions:

If critically malnourished:

Parenteral nutrition through a centralcatheter may be indicated(adequate

nutrition,electrolytes etc. can be providesparenterally,client cannot vomit this typeof nutrition)

Tube feedings may be used alone or with

oral parenteralnutrition(fortified liquiddiets can be provided through tubefeedings)


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Severe anorexiainterventions:

Supervise client for specified time(90minutes decrease to 30 minutes aftertube feeding or remove NG tube after

feeding(supervision decreased clientsopportunity 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 foodorally- however, physical health is priority)


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Severe malnourishment

If N/G tube is used be matter-offact re: insertion/use DO NOT useas a threat!

DO NOT permit client to bargain!(limits& consistency essential in avoidingpower struggles and decreasing

manipulative behaviors)


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Interventions for the non-criticallymalnourished client

Initially do not allow client to eatwith ither clients or visitors(otherclients may repeat family patterns by

urging client to eat or providingattention to client for not eating)

Provide structure to mealtime-state

limits matter-of-factly (clear limitslets client know what is expected)


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Interventions continued

Do not bribe,coax,threaten or focuson eating at all!

Withdraw attention if client refuses

to eat.When meal is over remove food

without discussion(minimizes clients

secondary gains from not eating-does not reinforce issues of controlwhich are central to client)


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Encourage client to seek out staff members aftereating to talk about feelings of anxiety or guilt orif urge to vomit exists.(speaking to staffpromotes focus on emotional issues rather than

food)

Supervise during & after meals start with 90minutes gradually reduce to 30 minutes.Do notpermit use of bathroom until at least 30 minutes

after each meal (client may spill,hide or discardfood-may use BR to vomit or dispose ofconcealed food)


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Gradually permit client increased choicesregarding food, mealtime etc.(developsindependence in eating habits)

Monitor I&O in an unobtrusive and matter-of factmanner(minimizes direct attention to eating andremoves emotional issues)

Weigh client daily,after client has voided andbefore morning meal; client should wear onlyhospital gown(consistency is necessary foraccurate comparison of wt.over time)

Observe/record client overt/covert physicalactivity(client may exercise to excess to controlwt.)


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Review questions:Eating disorders

The nurse should include which of the followinginterventions in the plan of care for a client withbulimia? (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 abinge.

E. Instruct the client to keep laxatives and diuretics in a

locked area.F. Inform the client that there are no forbidden foods.


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Review questionsThe nurse is caring for a client with anorexia

nervosa. Even though client has beeneating all her meals and snacks her weightis unchanged for one week. Which

intervention would be indicated:A. Close Obs.xs2 hrs. p meals/snacksB. caloric intake from 1500 2000

calories

C. fluid intakeD. Request Rx for antianxiety med from

MD


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Which of the following nursing interventionsshould the nurse include in the plan of care for aclient 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 apass.

C.Discourage the client from participating innutritional counseling.

D.Provide highly structured mealtimes with regularmeals.


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During a nutritional assessment of aclient with binge eating disorder,which of the following does the nurse

evaluate as most significant incontributing to binge eating?

A.A rigorous exercise plan

B.Periods of fastingC.Weighing too frequently

D.Eating a diet low in carbohydrates.


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The nurse should assess a clientsuspected of having bulimia for which ofthe following clinical manifestations:(select all that apply)

A.Constipation

B.A20% loss of normal body weight

C.Dental erosion

D.LanguoE.A serum potassium of 3.0mEq/L

F.Depression


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The nurse is evaluating the progress of aclient with bulimia. Which behavior indicatesthe client is making progress?

A. The client identifies caloriecontent for each meal

B. The client identifies healthy waysof coping with anxiety

C. The client spends time resting inher room after meals

D. The client verbalizes knowledge offormer eating patterns


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When assessing an adolescent female withanorexia nervosa, the nurse would identifythe following physical findings to supportthe diagnosis: (select all that apply)

A.Temperature of 96.9 degrees

B.Pulse rate of 48

C.Sensitivity to heat

D.Oily skinE.Facial lanugo


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If a clients ideal body weight is 124lbs., which current weight meets thediagnositic criteria for anorexia

nervosa?

A.105 lbs.

B.109 lbs.

C.112 lbs.

D.119 lbs.


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During an admission assessment fora client with bulimia, which of thefollowing 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?


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When teaching a group of adolescents aboutanorexia, the nurse would describe thisdisorder as being characterized by which ofthe following:A. Excessive fear of becoming obese, near-

normal weight, and self-critical bodyimage

B. Extreme concern about dieting, caloriecounting, 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 bodyimage.

Which of the following nursing interventions


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Which of the following nursing interventionsshould the nurse include in the plan of carefor a client with anorexia nervosa in the

outpatient setting?

(select all that apply

A. Set minimum weight limits in which the clientmay continue treatment in the outpatient setting.

B. Avoid discussing the clients irrational thoughtsabout food and weight with the clients family.

C. Encourage the client to be weighed daily at thesame time of day.

D. Instruct the client to avoid preparing ones ownmeal.

E. Instruct the client to keep a food diary.

F. Assist the client with meal planning.


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The nurse should assess a client

suspected of having bulimia for which ofthe following clinicalmanifestations: (select all that apply)

A. Constipation

B. A 20% loss of normal body weight

C. Dental erosion

D. Languo

E. A serum potassium of 3.0mEq/LF. Depression


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A nurse assesses personality traits of a client withan eating disorder. Which comment by the

client indicated bulimia nervosa ratherthan anorexia nervosa?

A.I try to do what my parents want, but I usuallydont get things right.

B.I feel good. I feel just fine. I dont have anyproblems.

C.I dont look as good as most of my friends.Thats why I dont have so many dates.

D.If I want to do something. I just do it. I dontlike to analyze things too much.


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Which of the following nursing interventionsshould the nurse include in the plan of care for aclient with anorexia nervosa in theoutpatient setting? (select all that apply)

A. Set minimum weight limits in which the clientmay continue treatment in the outpatient setting.

B.Avoid discussing the clients irrational thoughtsabout food and weight with the clients family.

C. Encourage the client to be weighed dailyat thesame time of day.

D. Instruct the client to avoid preparing onesown meal.E. Instruct the client to keep a food diary.F. Assist the client with meal planning.


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Prioritize the following diagnoses fora client with Bulimia Nervosa.

A.Imbalanced nutrition: less than bodyrequirements

B.Powerlessness

C.Social Isolation

D.Risk for imbalanced fluid volume


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M t l H lth I


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Mental Health Issues -Adolescents

i l i d i b h i h


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impulsive and aggressive behaviors thataccompany conduct disorders is:

A. Assertiveness training

B. Consistent limiting setting

C. Negotiation of rules

D. Open expression of feelings

f ll i b h i i hild ith Att ti


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following behaviors in a child with Attention

deficit hyperactivity disorder (AD/HD)except:

A. Easily distracted and forgetful

B. Excessive running, climbing, fidgeting

C. Moody, sullen, pouting behavior

D. Interrupts others and cannot take turns

th thi k I t id ! Th ld


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they think Im stupid ! The nurse would

apply the following nursing diagnosis to thischild:

A. Anxiety

B. Impaired socialization

C. Ineffective coping

D. Low Self-Esteem

Th ld id tif hi h f th


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The nurse would identify which of thefollowing children as being most at risk for

an adjustment disorder?

A. A 10 year old boy who has never likedschool an has a few friends

B. A 16 year old boy who has been

struggling in school, getting only Cs andDs

C. A 13 year old girl who is upset about notbeing selected for a cheerleading squad

D. A 16 year old girl who recently moved toa new school after her parents divorce

13 clients with eating disorders

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