Patient with Anorexia nervosa taking food correctly as per her diet plan, but there was no increase in weight observed. What will be the nursing intervention for the above patient?

Appeared in: AIIMS Delhi NO- 2019

Explanation

The correct intervention is to observe the patient during meals and for up to two hours afterward.
This action is a form of assessment to verify if the patient is truly consuming and, importantly, retaining the food provided.
Patients with anorexia nervosa may engage in secretive behaviors like hiding food, self-induced vomiting (purging), or excessive exercise immediately after eating to prevent weight gain.
Direct observation allows the nurse to gather accurate data about the patient's intake and behaviors before making changes to the care plan, such as increasing calories.
This intervention directly addresses the discrepancy between the patient's reported intake and the lack of weight gain, which is the central problem in the scenario.

Option B: Increasing the calorie count is premature. If the patient is not consuming the current 1500 calories, providing 2000 calories will be ineffective and may increase the patient's anxiety and resistance.
Option C: While vitamin supplementation is often necessary for malnourished patients, it does not address the primary problem of absent weight gain. It is a supportive measure, not the primary intervention for this specific issue.
Option D: Engaging the patient in activities is a therapeutic goal, but it must be carefully managed. Unsupervised activity could be used by the patient as a compensatory behavior to burn calories, which would be counterproductive to weight gain.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing interventions for Anorexia Nervosa, specifically addressing discrepancies between reported food intake and weight changes to guide bedside assessment, documentation, and the next nursing action.
In managing eating disorders, a nurse's primary role is to ensure patient safety and establish a therapeutic environment. This includes creating trust while maintaining firm, consistent boundaries.
Monitoring for refeeding syndrome is critical when nutritional rehabilitation begins. This potentially fatal condition can cause severe fluid and electrolyte shifts, especially in severely malnourished patients.
What if? If the patient was gaining weight as expected, the nursing intervention would shift from observation to providing positive reinforcement and continuing to monitor for any signs of distress or relapse.

How to Approach the Question

First, identify the core clinical problem: a patient with Anorexia Nervosa reports eating but isn't gaining weight.
Recognize that this discrepancy is a classic sign of hidden compensatory behaviors common in this disorder.
Apply the nursing process: Assessment is the first step. Before implementing a new intervention (like changing the diet), you must assess the situation to understand why the current plan is failing.
Evaluate the options based on the principle of 'assess before you act'.
Option A (Observe) is an assessment action. It seeks to gather data to verify the problem.
Options B, C, and D are implementation actions. They are inappropriate until a thorough assessment confirms the nature of the problem.

Concept Tested & Keywords

Concept Tested: Nursing interventions for Anorexia Nervosa, specifically addressing discrepancies between reported food intake and weight changes.
Stem keywords: Anorexia nervosa, no increase in weight, diet plan, nursing intervention
Lead-in keywords: What will be
Clinical cues: The key cue is the conflict between the patient's stated compliance ('taking food correctly') and the objective data ('no increase in weight'). This points towards a hidden issue.

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E6 Nursing Fundamentals Taylor p. 506-508

Practise the full AIIMS Delhi NO- 2019

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