Anxiety Disorders and Stress Q 7
Marlyn is diagnosed with anorexia nervosa and is admitted to the special eating disorder unit. The initial treatment priority for her is:
A. To determine her current body image.
B. To identify family interaction patterns.
C. To initiate a refeeding program.
D. To promote the client's independence.
Correct Answer: C. To initiate a refeeding program.
The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia. 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. 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 A: 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. 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.
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 situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.
Option D: 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.