Anxiety Disorders and Stress Q 6
Nurse Kerrick observes Toni who is hospitalized on an eating disorder unit during mealtimes and for 1 hour after eating. An explanation for this intervention is:
A. To develop a trusting relationship.
B. To maintain focus on the importance of nutrition.
C. To prevent purging behaviors.
D. To reinforce the behavioral contact.
Correct Answer: C. To prevent purging behaviors.
Toni may experience increased anxiety during treatment and, therefore, may resume behaviors designed to prevent weight gain, such as vomiting or excessive exercise. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). This prevents vomiting during or after eating. Avoid room checks and other control devices whenever possible. External control reinforces feelings of powerlessness and therefore is usually not helpful.
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 B: Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision-making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods.
Option D: 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. Weigh with back to scale (depending on program protocols). Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others.