FEEDING & EATING DISORDERS

Psychological Integrity: The client completes 2 weeks of nasogastric feedings and gains 4 lbs (1.81 kgs) and is now tolerating oral feedings. The client becomes upset to learn that weight monitoring is occurring on a weekly basis instead of daily. What is the nurse's best response to the client's concern? "I hear your concern; however, let's focus on how you are feeling." "Don't worry. The nursing staff will weigh you daily if you prefer." "The physician has prescribed weekly weights for six months." "I don't know what you are worried about! You have only gained 4 pounds (1.81 kg)."

"I hear your concern; however, let's focus on how you are feeling." By not focusing on weight measurement and caloric intake, the nurse has a greater opportunity to explore the client's feelings and perceptions.

The client completes 24 hours of one-on-one nurse staffing and consistently reports to the nurses no feelings of self-harm. The primary HCP writes a prescription to discontinue one-on-one staffing. The client is now expected to participate in group therapies and has privileges to eat with the other clients in the cafeteria. The client is observed to experience difficulty communicating with peers and sits on the periphery of groups. Which nursing focus describes the client's current problem? Inability to interact socially. Feelings of hopelessness. Unable to cope with stress. Unable to perform roles in life.

Inability to interact socially. The client is demonstrating discomfort in social situations, which is impaired social interaction.

Which features are prominent in anorexia nervosa? (Select all that apply. One, some, or all options may be correct.) Select all that apply Amenorrhea for three cycles. Body mass index of 23. Perfectionism. Powerlessness. Rigid food rituals.

Amenorrhea for three cycles. Amenorrhea is caused by estrogen deficiencies.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Perfectionism. Clients with anorexia nervosa believe they will develop the "perfect body" by controlling food. Powerlessness. Clients with anorexia nervosa view themselves as inadequate and powerless.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Rigid food rituals. Clients with anorexia nervosa consume food in ritualistic ways, such as by using specific cutting and chewing mannerisms.

Health Promotion and Maintenance: The interprofessional team prepares the client to transition from the eating disorders unit to home after 8 weeks of hospitalization. The client demonstrates progress toward meeting the goals of weight restoration and self-acceptance and remains free from self-harm. Current weight is 98 lbs (44.45 kgs), approximately 85% of her ideal body weight (BMI 20.3). In total, a gain of 18 lbs (8.16 kgs) in 8 weeks. Laboratory values have normalized. Family therapy will continue on an outpatient basis, as progress has been slow. The client is now able to reconcile current and future challenges and is more realistic concerning a healthy self-concept, body image, and fear of gaining weight. The client will continue sessions with the cognitive-behavioral therapist, as well as completing the online self-help cognitive behavior therapy package. Which outcome criteria demonstrate the client's readiness to be discharged from the inpatient unit and continue treatment as an outpatient? (Select all that apply. One, some, or all options may be correct.) Select all that apply Client demonstrates three learned skills for managing triggers for relapse. Client has reached and maintained 80 to 85% of weight restoration. Client has remained free from self-directed harm. Client expresses the desire to discontinue family therapy as an outpatient. Client commits to continue individual and group therapies after discharge.

Client demonstrates three learned skills for managing triggers for relapse. The client can access improved coping strategies to recognize and manage triggers.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Client has reached and maintained 80 to 85% of weight restoration. The client has accomplished this challenge to allow the transition to an outpatient therapeutic setting.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Client has remained free from self-directed harm. The client has demonstrated the ability to cope more effectively and to refrain from self-destructive behaviors.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Client commits to continue individual and group therapies after discharge. This demonstrates the client's readiness to address the long-term challenges related to an eating disorder.

Which outcomes demonstrate the benefits of a cognitive-behavioral approach to treating eating disorders? (Select all that apply. One, some, or all options may be correct.) Select all that apply Clients identify and modify distorted perceptions of eating. Clients reinterpret body image perceptions. Clients utilize coping techniques to reduce anxiety. Clients engage family members in the discussion of their illness. Clients learn to predict recurrence of symptoms.

Clients identify and modify distorted perceptions of eating. Clients learn to question the validity of their belief systems. Clients reinterpret body image perceptions. Misperceptions are corrected. Clients utilize coping techniques to reduce anxiety. A cognitive-behavioral approach helps clients modify their experience with anxiety. Clients learn to predict recurrence of symptoms. Cognitive-behavioral therapy helps clients identify triggers for relapse.

Physiological Integrity: The nurse recognizes the importance of collaborative practice to meet the client's nutritional needs during the acute phase of treatment Which member of the interprofessional team plays a major role in formulating the nasogastric feeding protocol? Pediatric Nurse Practitioner. Certified Nurse Assistant. Clinical Nutritionist. Health Care Practitioner.

Clinical Nutritionist. The clinical nutritionist has expertise in enteral dietary management and provides consultation to the interprofessional team.

Which nursing action has the highest priority during one-on-one staffing? Teach the client alternative coping strategies throughout the day. Assess the client's mood and affect, using therapeutic communication. Closely monitor the client and document the potential for self-harm. Provide educational interventions with videos and written materials.

Closely monitor the client and document the potential for self-harm. This is the priority during one-on-one staffing.

Physiological and Psychosocial Integrity: Student nurses have been assigned to the eating disorders unit. The clinical nursing instructor reviews the specific physiological and psychosocial features of anorexia nervosa and bulimia nervosa. Which features are prominent in bulimia nervosa? (Select all that apply. One, some, or all options may be correct.) Select all that apply Hyperkalemia. Erosion of tooth enamel. Excessive intake of food. Swollen salivary glands on palpation. The Russell sign is noted on assessment. Recurrent inappropriate compensatory behavior to prevent weight gain

Erosion of tooth enamel. Erosion of tooth enamel is caused by gastric acid from excessive vomiting.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Excessive intake of food. Excessive intake of food is a hallmark feature of bulimia nervosa.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Swollen salivary glands on palpation. Swelling of salivary glands is caused by frequent binging and purging.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. The Russell sign is noted on assessment. The Russell sign, callusing of the knuckles of the fingers used to induce vomiting, is also common.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Recurrent inappropriate compensatory behavior to prevent weight gain. Recurrent inappropriate compensatory behavior in order to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

Psychosocial Integrity: The primary HCP prescribes one-on-one nurse staffing for 24 hours. Safety measures are implemented, which include removing all contraband and being accompanied to meals and activities. Which nursing concern takes the highest priority for this client, according to Maslow's Hierarchy of Needs? Unable to cope with stress. A sense of feeling hopeless. Unable to function on a daily basis. Expressing feelings of self-harm.

Expressing feelings of self-harm. The client disclosed having thoughts of self-harm during periods of increased anxiety, and she stated that she is currently feeling overwhelmed. This demonstrates the need for safety measures to be implemented with greater monitoring and observance of behaviors.

Meet the Client An adolescent client presents to the ED with the parents and a therapist. The parents state that their child has been eating and then secretly vomiting and has become considerably more malnourished. In addition, the parents have found evidence of laxatives and diuretics in the client's room. The therapist expresses concerns that the client is physiologically unstable, losing excessive amounts of weight, and at this time needs medical care. The client has been lying to her parents and therapists about this behavior, which seems to be getting worse. The client currently weighs 84 pounds (38.10 kg) and is 5 feet tall. A BMI of 16.4 places the client in the moderate level of severity. The parents share that their child was sexually assaulted by a classmate a few years ago, which coincides with the start of binging and purging. The therapist expresses concern that the client has an unrealistic body image and has also been using cutting as a coping technique. The parents acknowledge that there is some conflict in the home, with one parent being overbearing, while the other parent is working long hours.

FEEDING & EATING DISORDER CASE STUDY. DO GREAT!

Case Outcome: The client gains 6 lbs (2.72 kgs) within one 1 month of discharge from the eating disorders unit and now weighs 104 lbs (47.17 kgs) and has a BMI of 21.1. A healthy BMI for adolescents is 18.5 and 24.9. The client continues to participate in outpatient therapy with the cognitive-behavioral therapist and in an online self-help cognitive behavior therapy package. The client attends an eating disorder group for people diagnosed with anorexia nervosa or bulimia nervosa. The parents and the client have committed to family therapy, which appears to be helping the family dynamics. The parents are also attending a community group that addresses bulimia nervosa. The client describes progress as "slow but worth the effort."

GOOD JOB!

The client has now been hospitalized for 3 weeks on the eating disorders unit and has gained a total of 13 lbs (5.90 kgs) during this 6-week hospital stay. The treatment plan includes behavioral, cognitive, family, and individual psychotherapies, plus an online self-help cognitive behavior therapy package. The client's parents are now actively participating in family therapy sessions and are attending an outpatient group for clients with bulimia nervosa. The client is experiencing discomfort during the family therapy sessions as evidenced by stating that they do not trust their parents at this point. The client is reliant on the parents' support. Which nursing concern is a priority at this time? Feelings of hopelessness. Poor self-esteem. Impaired family functioning. Potention for self-harm. Submit

Impaired family functioning. The family's ability to function is impaired related to eating disorders and ineffective problem-solving skills.

Physiological Adaptation: The nurse recognizes that the client's nutritional deficits lead to a high risk for medical complications. Which nursing problems have the highest priority during the acute phase of treatment? (Select all that apply. One, some, or all options may be correct.) Select all that apply Malnourishment. Inability to cope effectively. Distortion in body image. Chronic poor self-esteem. Deficiency in fluid volume.

Malnourishment. Clients with anorexia nervosa have insufficient nutritional intake to meet metabolic needs. Deficiency in fluid volume. Clients with anorexia nervosa present with inadequate fluid volume to support cardiac and vascular function.

What actions should the nurse take to implement the client's plan of care? (Select all that apply. One, some, or all options may be correct.) Select all that apply Monitor fluid and electrolytes. Supervise the client during and after feedings. Increase the client's exercise regime. Perform skin assessments each shift. Measure and document intake and output.

Monitor fluid and electrolytes. Deficient fluid volume is a major health risk in the client who is malnourished.Keltner, N., Steele, D. (2019) Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Supervise the client during and after feedings. Supervision is required to prevent the client from vomiting or siphoning off feedings.Keltner, N., Steele, D. (2019) Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Increase the client's exercise regime. The goal is to regain a healthy weight and prevent weight reduction through physical exertion. It is important to conserve calories and reduce energy expenditure.Keltner, N., Steele, D. (2019) Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Perform skin assessments each shift. Impaired skin integrity is a health risk for the client who is malnourished and dehydrated.Keltner, N., Steele, D. (2019) Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Measure and document intake and output. Maintenance of accurate fluid and caloric intake and output is an essential nursing function to evaluate the benefit of enteral feedings.

Physiological Integrity and Physiological Adaptation: The nasogastric feeding protocol is established and feedings are initiated. The nurse chooses to administer the feedings at night. Click for Image Which is the best rationale for the nurse's decision? The client is engaged in activities during the day. The client has trouble sleeping during the night. The nurse views this time schedule as being able to maintain control over the client's behavior. Night feedings can prevent reinforcing attention and sympathy from others. Submit

Night feedings can prevent reinforcing attention and sympathy from others. The nurse administers the feedings in a neutral manner, remaining focused on the client's safety and health status.

Which laboratory finding result reveals the finding of protein malnutrition? Albumin level 4.2 g/dL (4.2 gl/mL). Prealbumin level 5 mg/dL (5 mg/mL). Hematocrit level 38% (0.38 L/L). Hemoglobin level 13 g/dL (13 mg/mL).

Prealbumin level 5 mg/dL (5 mg/mL). Prealbumin is a sensitive indicator of malnutrition due to its short half-life of 2 days. The normal range is 15 to 36 mg/dL (15 to 36 mg/mL).

Physiological and Psychosocial IntegrityThe client completes 3 weeks of treatment and continues to express anxiety during mealtimes. The client now weighs 89 lbs (40.46 kgs), with a BMI of 17.4. The interprofessional team is preparing to transition the client to the eating disorders unit. What actions should the nurse take during this transitional phase? (Select all that apply. One, some, or all options may be correct.) Select all that apply Provide a supportive approach regarding the client's expressed anxiety. Continue to provide supervision during and after mealtimes. Actively listen to the client's concerns. Provide the client with greater flexibility and less structure. Discontinue meal supervision.

Provide a supportive approach regarding the client's expressed anxiety. Transition to the eating disorder unit can create additional fear and anxiety for the client.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Continue to provide supervision during and after mealtimes. It is important to maintain a structured plan of care with specific expectations during a period of transition.Keltner, N., Steele, D. (2019). Psychiatric Nursing, (8th edition, pp. 403-416), Elsevier. Actively listen to the client's concerns. The nurse demonstrates the use of therapeutic communication during this period of transition.

Health Promotion and Maintenance: The client transfers to the eating disorders unit. During the nurse's admission assessment, the client discloses thoughts of self-harm when feeling increasingly anxious and overwhelmed. The client denies having any intent for self-harm currently and does not have a plan, but admits to feeling vulnerable due to the transfer. Which nursing action should have the highest priority? Report this data to the primary HCP and the interprofessional team. Call the acute medical unit to discuss the client's history. Allow the client to freely engage in unit activities. Firmly ask the client why this information was withheld.

Report this data to the primary HCP and the interprofessional team. New data concerning the client's safety is immediately communicated to the primary HCP and the interprofessional team.

Which clinical manifestations should the nurse observe as indicators of hypophosphatemia? (Select all that apply. One, some, or all options may be correct.) Shallow respirations. Weak cardiac contractions. Increased bone density. Seizure activity. Altered mental status.

Shallow respirations. Respiratory changes can occur due to the electrolyte and musculoskeletal changes.Potter, P., Perry, A., Stochert, P., Hall, A. (2020) Clinical Companion for Fundamentals of Nursing. (10th ed., p. 319), Elsevier. Weak cardiac contractions. Cardiac contractions can occur due to insufficient energy in myocardial cells.Potter, P., Perry, A., Stochert, P., Hall, A. (2020) Clinical Companion for Fundamentals of Nursing. (10th ed., p. 319), Elsevier. Increased bone density. With hypophosphatemia, a decrease, rather than an increase, in bone density is caused by loss of bone calcium.Potter, P., Perry, A., Stochert, P., Hall, A. (2020) Clinical Companion for Fundamentals of Nursing. (10th ed., p. 319), Elsevier. Seizure activity. Central nervous system changes can occur with severe hypophosphatemia.Potter, P., Perry, A., Stochert, P., Hall, A. (2020) Clinical Companion for Fundamentals of Nursing. (10th ed., p. 319), Elsevier. Altered mental status. Confusion and hallucinations are common presenting features of hypophosphatemia.

Physiological Integrity and Physiological Adaptation: Upon initiation of nasogastric feedings during the client's acute care hospital stay, the nurse assessed the client as being at high risk for refeeding syndrome. When developing the plan of care for initiation of nasogastric feedings, the nurse recognizes which nursing intervention as having the highest priority? Slow enteral feedings at the start of therapy. Measure electrolytes on a weekly basis. Increase the caloric rate of feedings. Advance oral feedings as tolerated.

Slow enteral feedings at the start of therapy. Nasogastric feedings should be started at a reduced caloric rate (25 to 50% of estimated requirements) to reduce the risk of refeeding syndrome.

Which evaluative measure demonstrates improvement in the client's ability to socially interact with peers? The client verbalizes one way in which an eating disorder has affected the health of the family. The client eats breakfast and lunch with select peers. The client remains free from self-harm during hospitalization. The client recognizes distorted perceptions of body image.

The client eats breakfast and lunch with select peers. This demonstrates an improvement in socialization skills.

Which client behavior demonstrates progress towards positive change? The client identifies her parents as dysfunctional and the primary cause of the eating disorder. The client identifies two healthy coping behaviors the family can use to improve their relationship. The client expresses the need to forego family therapy at this time, due to feeling uncomfortable. The client sits silently during family therapy sessions, unable to speak up with the parents there.

The client identifies two healthy coping behaviors the family can use to improve their relationship. The client's behavioral changes address the family system to produce positive change.

Which short-term goal promotes safety measures when refeeding the client? The client will gain no more than 1 to 2 lbs (0.45 to 0.91 kgs) during the initial week of refeeding. The client will exercise 30 minutes each day during the first week of refeeding. The client will gain at least 5 lbs (2.27 kgs) during the first week of refeeding. The client will demonstrate a willingness to take oral foods during the first week.

The client will gain no more than 1 to 2 lbs (0.45 to 0.91 kgs) during the initial week of refeeding. Refeeding is started slowly to prevent adverse effects from fluid and electrolyte shifts.

During the initial 8 hours of one-on-one nurse staffing, the client is able to verbally contract with the primary nurse to disclose any thoughts of self-harm. What is the nurse's primary purpose for establishing a treatment contract with the client? To focus on the client's anxiety in relation to oral nutrition. To allow the client to decide whether or not thoughts of self-harm will be disclosed. To relieve the nurse of frequently assessing the client for suicidal ideation. To provide the client with greater control over the expression of feelings.

To provide the client with greater control over the expression of feelings. Enhancing the client's involvement in the decision-making process builds trust and a therapeutic relationship between the nurse and client.