7.18 Spotlight

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 caring for this client.

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 assessments, what NANDA nursing diagnosis applies?

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

3. What is an appropriate SMART outcome for this client?

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

4. What nursing interventions can the nurse 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 evaluating if the outcome and interventions were effective.

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

Evaluation:

The client reports feeling less anxious after participating in relaxation techniques.
The client verbalizes, “I am more than just my body” during a therapeutic discussion.
The client completes 50% or more of their meals during the week and expresses openness to trying foods on their meal plan.
Evaluation of Interventions:

The client participates in group therapy sessions and shares personal challenges.
The client identifies journaling as helpful for managing body image concerns.
The client adheres to hydration and nutritional plans but continues to experience anxiety during meal times.
Plan Adjustment:

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 to practice during meal times.