7.18 Spotlight Application

This spotlight application will demonstrate how a nurse on a medical surgical unit provides care for a client with a mental health disorder.

Situation/Background

A nurse is caring for a 22-year-old client admitted to the medical-surgical unit for complications related to anorexia nervosa. The client reports feelings of low self-esteem, anxiety about eating, and difficulty coping with body image concerns. The nurse plans to apply principles of mental health nursing and nutritional rehabilitation when developing a nursing care plan for this client.

Critical Thinking Questions

1. What assessment data should the nurse collect?

• Physical health: Body weight and BMI, vital signs, hydration status, electrolyte levels, signs of malnutrition (e.g., brittle hair, dry skin, lanugo).
• Behavioral patterns: Eating habits, food intake, exercise routines, and evidence of purging behaviors (e.g., laxative use, vomiting).
• Psychosocial factors: Self-esteem, anxiety, mood, and body image perception.
• Coping mechanisms: Maladaptive strategies (e.g., food restriction, over-exercising) vs. adaptive strategies (e.g., therapy, relaxation techniques).
• Support system: Relationships with family, friends, or other support networks.
• Knowledge: Awareness of the physical and psychological impacts of the eating disorder and willingness to participate in treatment.

2. Based on the assessment data, what NANDA nursing diagnosis apply to this client?

• Disturbed Body Image
• Imbalanced Nutrition: Less than Body Requirements
• Ineffective Coping

3. What are some examples of SMART outcome criteria for this client?

• The client will verbalize one positive affirmation about their body after the teaching session.
• The client will demonstrate willingness to eat at least 50% of their meals daily by the end of the week.

4. What nursing interventions can the nurse plan to implement?

Physical Interventions

• Monitor the client’s food intake and hydration status.
• Collaborate with a dietitian to create a balanced meal plan that supports nutritional rehabilitation.
• Weigh the client daily under consistent conditions (e.g., same time of day, same clothing) to monitor progress without triggering anxiety.

Psychosocial Interventions

• Establish trust by building a non-judgmental, supportive rapport.
• Explore the client’s feelings about body image and self-esteem in a therapeutic manner.
• Provide education on the physiological effects of malnutrition and the benefits of balanced nutrition.

Coping Strategies

• Teach relaxation techniques such as mindfulness, deep breathing, and progressive muscle relaxation to manage anxiety.
• Encourage participation in therapeutic activities like art therapy or journaling to express emotions safely.
• Identify and reinforce adaptive coping strategies for stress and body image concerns.

Collaboration

• Involve mental health professionals for counseling or psychotherapy (e.g., cognitive-behavioral therapy).
• Engage family members or support systems to create a safe environment for recovery.

5. Give an example of how the nurse evaluates if the interventions were effective.

The nurse reviews the identified outcome criteria:

• The client will verbalize one positive affirmation about their body.
• The client will demonstrate willingness to eat at least 50% of their meals daily by the end of the week.

The nurse gathers data to evaluate if these outcome criteria were met:

• The client reported feeling less anxious after participating in relaxation techniques.
• The client verbalized, “I am more than just my body” during a therapeutic discussion.
• The client ate approximately 33% of their meals this week.
• The client participated in daily group therapy sessions and shared personal challenges.
• The client identified journaling as helpful for managing body image concerns.
• The client adhered to hydration plans but continued to experience anxiety during meal times.

The nurse evaluates the outcome criteria and determines they are “partially met” an makes the following modifications to the client’s nursing care plan:

• Continue current interventions, adding guided support during meals to reduce anxiety.
• Incorporate exposure therapy techniques to address fear of eating specific foods.
• Provide additional education about mindfulness techniques during therapy sessions.