PEDS Chapter 42
An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client? removing the stressors from life that caused this helping the client return to a healthy weight for height family therapy as this is linked to family disturbances restoring nutritional balance and a healthy self-image
restoring nutritional balance and a healthy self-image Explanation: Treatment focused on restoring nutritional balance and keeping a structured nutritional intake is key for bulimia nervosa. Cognitive-behavior therapy concentrates on improving the person's distorted self-image, uncontrollable and excessive eating, and guilt and embarrassment associated with binging and purging.
According to the American Psychiatric Association (DSM-5, 2013), a client with anorexia nervosa has a body image disturbance in which one's body weight or shape is not experienced realistically. Which statement by a client would best validate this criterion? "When I see myself in the mirror, I can see my ribs." "Being this skinny really isn't a good idea for my health." "My stomach really sticks out and looks fat." "I realize I am a quite thin, but I am trying to gain weight."
"My stomach really sticks out and looks fat." Explanation: A client with anorexic nervosa does not accurately view body weight or shape. Verbalizing that the stomach "sticks out" and viewing it as fat validates the disturbance in body image associated with anorexia nervosa. The other statements acknowledge that the client is underweight and that being extremely underweight is not healthy.
The nurse is working with a group of parents of children who are obese. What action would the nurse include in her teaching plan for this group to aid them in helping their children to lose weight? Select all that apply. Help the child get involved in an enjoyable activity such as bike riding or swimming for exercise, and make it a family adventure. Recommend that the child eat all meals at the table with the family. Set a goal of weight loss of at least 3 to 5 pounds per week. Weigh every day, at the same time, on the same scale, in the same clothing. Keep a supply of healthy low-calorie snacks around the house, such as carrot sticks and raw vegetables.
Keep a supply of healthy low-calorie snacks around the house, such as carrot sticks and raw vegetables. Recommend that the child eat all meals at the table with the family. Help the child get involved in an enjoyable activity such as bike riding or swimming for exercise, and make it a family adventure. Explanation: Teaching the families of obese children includes tips for supporting the child and interventions to aid in weight loss and becoming healthy. The child needs access to low-calorie snacks such as raw vegetables instead of sweets and high sodium, high fat products like potato chips. It is also recommended that the child eat at the table for meals, not on the run or in front of the TV. The child should weigh only once a week, not daily, and the goal of weight loss is 1 to 2 pounds a week (with some periods of remaining the same weight). Exercising, especially with family members, is a great way for the child to lose weight and feel supported at the same time.
The nurse has been working for several days with an adolescent who has anorexia nervosa. What is an indication that the adolescent is developing trust in the nurse? The adolescent stating "You're the best nurse on the unit." The adolescent telling the nurse purging occurs after each meal. The adolescent stating the desire to eat again. Saying which nurse's orders the adolescent will follow.
The adolescent telling the nurse purging occurs after each meal. Explanation: The adolescent with anorexia tends to have many fears and a high need for acceptance. Therefore, trust is difficult for this adolescent. Trust has to be gianed from an adult before the adolescent can share confidences. Purging after every meal with anorexia is common and one of the goals of therapy is to stop the purging. It is often done in secret. When the adolescent has gained trust in the nurse then the adolescent will begin to share the number of times purging has been happening. When the adolescent is making statements such as liking one nurse more than another or following one nurse's instructions and not the others, this is manipulation. It is not healthy. The adolescent stating a desire to eat again could be interpreted two ways. The adolescent could be getting healthier with therapy or it could also be seen as manipulation and a way to purge more often. Either way, it is not a sign that trust has developed.
An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting. Administer antiemetics on a regular basis to reduce the urge to vomit after eating. Monitor the adolescent constantly to ensure that she is not binge eating. Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals.
Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Explanation: Developing a contract with the adolescent, as part of a behavior modification program, lays out clearly defined behaviors and the child's responsibilities related to bulimia and its management. Parents need to be aware and report any verbalizations about being overweight or altered body image. Antiemetics are not appropriate for this disorder since there is not nausea associated with it and it is impossible to monitor the adolescent continually.
