Question

You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the psychiatric unit last night after assessment and treatment at a local hospital emergency department for "blacking out at school." She has been given a preliminary diagnosis of anorexia nervosa. As you begin to assess her, you notice that she has very loose clothing, she is wrapped in a blanket, and her extremities are very thin. She tells you, "I don't know why I'm here. They're making a big deal about nothing:' She appears to be extremely thin and pale, with dry and brittle hair, which is very thin and patchy, and she constantly com-
plains about being cold. As you ask questions pertaining to weight and nutrition, she becomes defensive and vague, but she does admit to losing "some" weight after an appendectomy 2 years ago. She tells you that she used to be fat, but after her surgery she didn't feel like eating and everybody started commenting on how good she was beginning to look, so she just quit eating for a while. She informs you that she is eating lots now, even though everyone keeps "bugging me about my weight and how much I eat." She eventually admits to a weight loss of "about 40 pounds and I'm still fat."

1.Provide two nursing diagnosis and interventions along with objective data and short term and long term goals.

2.sbar

Answer 1

(1)Nursing diagnosis

• To observe patients’ nutritional status as eating disorders can be life-threatening. It is also important to ensure they maintain adequate nutrition and electrolyte balance. If an eating disorder has been identified, the nurse must monitor weight on a regular basis.
• To monitor patients’ elimination pattern as excessive use of diuretics and laxatives is common among patients with eating disorders. As a consequence, patients may require intervention to treat constipation.
• Monitoring skin condition for breakdown and poor healing is an important part of the nurse’s role. A lack of protein, needed to aid tissue repair, makes the skin more likely to break down. In addition, it is vital that good oral hygiene is achieved as recurrent vomiting may cause dental problems.

Short term Goals:

• To be non-judgemental and accepting of patients with eating disorders. This can be achieved by building a trusting relationship and by encouraging patients to talk about their concerns.
• To be non-judgemental and accepting of patients with eating disorders. This can be achieved by building a trusting relationship and by encouraging patients to talk about their concerns.

Long term Goals:

• To ensure that patients take some responsibility for treatment of their condition. This can be achieved by establishing a contract with them over the amount and type of food to be eaten at each meal. By ensuring that positive feedback is given, compliance with the eating regimen can be maintained and patients’ self-esteem promoted.
• To educate family and carers about a patient’s eating disorder. The family can then be encouraged to participate in the patient’s care and provide support. Observing for potential suicide risk must also be considered.