護理師照顧一位 BMI 為 14.5 kg/m² 的神經性厭食症病人。下列哪些護理措施應優先執行，以處理病人的心理社會層面？（選所有適合的）
A nurse is caring for a client with anorexia nervosa who has a BMI of 14.5 kg/m². Which of the following nursing interventions should be prioritized to address the psychosocial aspects of the client's care? (Select all that apply.)
- AObserve the client for one hour after meals餐後觀察病人一小時正確答案
- BEstablish a structured weight gain contract with the client與病人建立結構化的體重增加合約正確答案
- CEncourage the client to lead discussions about food and recipes鼓勵病人主導關於食物和食譜的討論
- DLimit the client's access to mirrors in the initial phase在初期階段限制病人接觸鏡子正確答案
- EProvide praise for each pound of weight gained對每增加一磅體重給予讚美
- A餐後觀察病人一小時
- B與病人建立結構化的體重增加合約
- D在初期階段限制病人接觸鏡子
神經性厭食症的護理涉及生理穩定與心理重建。核心概念是控制病人的代償行為並減少對身體形象的過度關注。正確答案 A 是關鍵，因為厭食症病人常在餐後催吐或進行過度運動。B 選項的合約能讓病人參與治療過程，同時設定明確的行為期望。D 選項在初期能減少病人因看到體型變化而產生的焦慮。選項 C 錯誤，因為厭食症病人本身就對食物過度執迷，引導其討論食物會強化其強迫性思考。選項 E 也不妥，過度關注體重增加會加劇病人的恐懼，護理師應給予肯定的是病人「遵守治療計畫」的行為，而非僅僅是那個讓他們痛苦的數字。安全優先原則在此表現為防止營養不良併發症的同時，溫和地重塑認知。
- A · 正確答案餐後觀察病人一小時
餐後一小時的嚴密觀察是為了防止病人進行催吐或隱藏性的過度運動（如在廁所深蹲）。這是確保攝入熱量能被有效利用並打破病理性循環的必要手段。
- B · 正確答案與病人建立結構化的體重增加合約
建立體重合約能讓病人對自己的康復有參與感，並在行為與獎勵之間建立明確聯繫，減少病房內的權力鬥爭，對於重建健康的飲食習慣非常有幫助。
- C鼓勵病人主導關於食物和食譜的討論
厭食症病人通常已經對食物卡路里與食譜有病態的執著，護理師應引導其將興趣轉移到其他領域，而非繼續在病態的興趣點上打轉，這會阻礙心理康復。
- D · 正確答案在初期階段限制病人接觸鏡子
在住院初期限制照鏡子，可以減少病人因體型扭曲感所引發的極度焦慮，幫助他們將注意力從外表轉移到內在的感受與生理的恢復上。
- E對每增加一磅體重給予讚美
直接稱讚體重增加可能會適得其反，因為對病人來說增加體重等同於失去控制或變醜。護理師應讚揚病人的「努力」或「配合治療」等正向行為，而非單純的體重數字。
美國護理常強調「多專業團隊（MDT）」合作，並有專門的飲食障礙單位；台灣多半收治於一般精神科病房，護理師在餐後觀察的執行上，常需仰賴家屬或看護的協助，但在醫療自主權的界限設定上需更一致。
English explanation
Nursing care for anorexia nervosa addresses both physiological stabilization and psychological rebuilding. The core concept is to control the client's compensatory behaviors and reduce excessive focus on body image. The correct answer A is key because clients with anorexia often induce vomiting or engage in excessive exercise after meals. Option B's contract allows the client to participate in the treatment process while setting clear behavioral expectations. Option D in the early phase reduces the anxiety caused by the client seeing changes in body shape. Option C is incorrect because anorexic clients are already excessively preoccupied with food, and encouraging them to discuss food will reinforce their obsessive thinking. Option E is also inappropriate; excessive focus on weight gain intensifies the client's fears. The nurse should praise the client's adherence to the treatment plan rather than simply praising the very number that causes them distress. The safety-first principle is reflected here by preventing complications of malnutrition while gently reshaping cognition.
最近修訂：2026-05-17