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Difficulty: HardMental Health Concepts

An adolescent client is admitted to an inpatient eating disorder unit for the treatment of severe anorexia nervosa. During the client's first supervised lunch, the nurse observes the client cutting a piece of chicken into minuscule pieces, continuously rearranging them on the plate, and hiding small portions under a napkin. After the allotted 30-minute meal period, the client has consumed less than 15% of the food and states, 'I cannot eat another bite, this food is saturated in grease and makes me nauseous.' Which of the following is the most appropriate nursing response?

  1. Your meal time has ended. I will take your tray now and provide the prescribed liquid nutritional supplement to replace the remaining calories.Answer
  2. B
    Let me sit with you for an additional ten minutes to help encourage you to eat just the protein portion of your meal.
  3. C
    Why do you think the food is greasy? The facility dietitian specifically designed this meal to be healthy and balanced for you.
  4. D
    If you refuse to finish at least half of your meal, you will lose your telephone privileges for the remainder of the evening.

Answer

The most appropriate response is to inform the client that meal time has ended, remove the tray, and provide the prescribed liquid nutritional supplement.
The correct response adheres to established milieu therapy protocols for anorexia nervosa. Clients with eating disorders often utilize stalling tactics, food manipulation, and complaints about food quality to avoid caloric intake. The nurse must maintain strict, unemotional boundaries regarding meal time limits and objectively implement the prescribed alternative (such as a liquid supplement) without engaging in a debate, offering threats, or coaxing the client.

Step-by-Step Solution

1
Analyze the client's behavior and diagnosis.
The client has anorexia nervosa and is exhibiting classic food-avoidance rituals (cutting food into tiny pieces, rearranging, hiding food) and utilizing stalling tactics.
Understanding the pathology behind the behavior is required to choose an intervention that does not reinforce the eating disorder.
2
Evaluate the nursing priorities for inpatient eating disorder protocols.
The primary goals are physiological stabilization through adequate caloric intake and the establishment of a highly structured therapeutic milieu.
Clients with anorexia require strict, consistent boundaries to prevent manipulation of the environment and to separate their self-worth from their eating behaviors.
3
Select the response that enforces the protocol without hostility or negotiation.
Removing the tray exactly at the end of the 30-minute limit and objectively offering the liquid supplement is the correct action.
This prevents power struggles, avoids debates about the food's quality, and ensures the physiological need for calories is met in a clinical, matter-of-fact manner.

Key Concept

Therapeutic Milieu and Limit Setting for Eating Disorders
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Topics

Mental Health Concepts

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