A 19-year-old patient is admitted with severe anorexia nervosa: BMI 13.5, heart rate 38, BP 78/42, potassium 2.9, phosphorus 2.0. The team is initiating medical stabilization with cautious refeeding. Which nursing actions are appropriate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Severe anorexia nervosa with hemodynamic instability and electrolyte depletion is a medical emergency. Option 1 is correct: supervised meals, purging precautions, and blind weights in a gown at consistent times support safety and accurate trends. Option 2 is correct because profound bradycardia and electrolyte abnormalities increase the risk of dysrhythmia and cardiac arrest, requiring continuous monitoring. Option 3 is correct because phosphorus, potassium, and magnesium can fall rapidly during refeeding and require repletion and close monitoring. Option 4 is correct because the refeeding prescription must be individualized, advanced cautiously, and adjusted using daily electrolyte and fluid assessment. Option 5 is incorrect because street clothes can conceal objects or fluid loading, and a postmeal weight includes recent intake; weights should be obtained under a consistent protocol, commonly after voiding and before breakfast in a gown.
Refeeding syndrome is the high-yield trap: the body shifts phosphorus into cells when carbohydrates restart, dropping serum phosphorus and triggering cardiac failure. Start LOW calories, ADVANCE SLOW, MONITOR phosphorus DAILY for 1-2 weeks. Blind weighing prevents the patient from weight-checking and engaging in compensatory behaviors.
19-year-old with severe anorexia nervosa: BMI 13.5, HR 38 (bradycardia), BP 78/42, K+ 2.9, phosphorus 2.0. Medical stabilization with cautious refeeding initiated.
Refeeding syndrome — Hypophosphatemia, hypokalemia, hypomagnesemia, fluid shifts, and cardiac failure when calories are reintroduced too quickly in malnourished patients.
Anorexia bradycardia — Heart rate < 40 in severe AN signals cardiac instability and adaptive response to chronic starvation; medical emergency.
Blind weighing — Patient stands backward on the scale at consistent times in hospital gown to prevent obsessive weight focus and behavioral compensation.