護理師正為一位神經性厭食症病人制定護理計畫。應包含下列哪些措施?(選所有適合的)
A nurse is developing a plan of care for a client with Anorexia Nervosa. Which interventions should be included? (Select all that apply.)
- ASet strict time limits for meal consumption✓ 正解設定嚴格的用餐時間限制
- BAllow the client to choose only low-calorie foods允許病人僅選擇低熱量食物
- CMonitor the client for one hour after each meal✓ 正解在每餐後監測病人一小時
- DWeigh the client daily in the same clothing✓ 正解每天在相同穿著下稱量病人體重
- EFocus conversation on the client's feelings rather than food or weight✓ 正解將對話重點放在病人的感受上,而非食物或體重
神經性厭食症的護理核心在於生理復原與心理支持的平衡。設定嚴格的用餐時間(Option A,通常為 30 分鐘)可減少病人玩弄食物或拖延進食的機會。餐後一小時內嚴密觀察(Option C)是為了防止其催吐或過度運動以消耗熱量。每日早晨在相同條件下測量體重(Option D)是監測進度的關鍵,但通常讓病人背對體重計以減少其對數字的焦慮。在溝通上,護理師應將焦點從「食物」轉移到「感受」(Option E),因為厭食症的核心問題是控制慾與心理衝突而非食慾。至於選項 B 是錯誤的,臨床上應提供營養均衡的菜單,不應由病人決定只選低熱量食物,否則無法達成復食目標。
Strict time limits for meals prevent ritualistic behaviors and delays, while post-meal monitoring for one hour is essential to prevent compensatory actions like self-induced vomiting. Daily weights in consistent clothing track physiological stabilization, and redirecting conversations to feelings addresses the underlying psychological issues rather than focusing on food or weight.
美國護理常使用「契約療法(Behavioral contract)」,明確規定體重增加多少可換取多少自由活動權;台灣則多由醫師或營養師主導菜單,護理師在餐後觀察的落實程度因病房人力而異,常需家屬配合監督。