A client is receiving nasogastric tube feedings as nutritional rehabilitation for anorexia nervosa. After a weigh-in, the client learns of gaining 2 lb (0.9 kg) and says to the nurse, "See what your force feeding has done to me? I'm fatter and uglier than ever." What is the best action by the nurse?

Question

Quizplus · Accepted Answer

Nutrition support (enteral tube feedings and total parenteral nutrition) is usually reserved for clients with anorexia nervosa who are severely ill and/or have not responded to oral nutritional therapy. Such clients are at high risk for medical complications from anorexia nervosa, including death. Criteria for nutrition support include: Severe weight loss that is life threatening Client's unwillingness to adhere to a treatment plan of oral feedings The priority nursing actions for this high-risk client include interventions to meet physiological and safety needs. Providing one-on-one supervision during the tube feeding will ensure that the client is actually receiving the feeding and prevent the client from stopping the feeding and/or pulling out the nasogastric tube. During the one-on-one contact with the client, the nurse can promote a therapeutic and trusting relationship with the client by: Being honest and accepting of the client Presenting the reality of the condition Acknowledging the client's feelings of loss of control and anger Encouraging the client to express feelings and fears (Option A) This is an appropriate intervention for a client with anorexia nervosa. Feelings related to lack of control are an underlying problem for these clients, who use food as a way to deal with them. Keeping a diary or journal of feelings will help the client recognize and express them more clearly. However, this is not the priority nursing action. (Option C) This may be a true statement; clients with anorexia nervosa are usually discharged to out-patient follow-up and treatment or to a residential treatment facility once an acceptable weight gain has been achieved and maintained. However, this is not the priority nursing action. (Option D) Clients with anorexia nervosa have a distorted body image and a morbid fear of being overweight; they perceive themselves as "fat and ugly" even when they are emaciated. Saying that the client is not "fat and ugly" will not change this perception. Educational objective: The priority nursing care for a client with anorexia nervosa is nutritional rehabilitation and prevention of medical complications, including death. Clients who are severely ill and/or resistant to oral refeeding may require nutrition support with intense monitoring to achieve adequate caloric intake and weight gain.

A Client Is Receiving Nasogastric Tube Feedings as Nutritional Rehabilitation