# Situation: A 19-year-old female college student is admitted to a medical–psychiatric unit. For a year she has had eating binges several times a week, followed by self-induced vomiting and, at times, laxative use. Her body mass index (BMI) is 21 kg/m². She finishes her lunch tray at 12:30. Which action should the nurse take next?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 19-year-old female college student is admitted to a medical–psychiatric unit. For a year she has had eating binges several times a week, followed by self-induced vomiting and, at times, laxative use. Her body mass index (BMI) is 21 kg/m².

She finishes her lunch tray at 12:30. Which action should the nurse take next?

## 보기

1. Weigh her right after the meal to track her weight gain
2. Allow her to rest alone in her room to ease her discomfort
3. Have her brush her teeth at once to protect her tooth enamel
4. Keep her in view for an hour and supervise any bathroom use **✔ 정답**

**정답: 4**

## 해설

Clients who purge are observed for 1 to 2 hours after meals, with supervised bathroom access, to prevent vomiting. Being alone in her room or in the bathroom right after a meal gives her the opportunity to purge.

## 심화 해설

Core nursing action after a meal in bulimia nervosa

The priority after a patient with bulimia nervosa finishes a meal is to prevent the compensatory behavior that typically follows eating. In this clinical picture, the patient has a 1-year history of binge episodes followed by self-induced vomiting and intermittent laxative use, with a BMI of 21 kg/m² — a value that can remain within the normal range even while purging behaviors are active. The immediate nursing responsibility is therefore environmental and behavioral: the patient must remain within direct observation for 1 to 2 hours after eating, and any need to use the bathroom during that window must be supervised.

Watch out! Allowing the patient to be alone in her room or to enter the bathroom unobserved immediately after a meal creates the exact opportunity for self-induced vomiting. Privacy is not therapeutic in the early postprandial period for a patient with purging behavior.

The other options fail because they either do not address the risk of purging or actively enable it. Weighing the patient immediately after the meal measures food and fluid intake, not true tissue weight change, and does nothing to interrupt the purge cycle. Allowing rest alone in the room is unsafe because isolation after eating is a high-risk window. Brushing teeth right after vomiting or eating may seem protective for enamel, but sending the patient to the bathroom unsupervised at that moment is precisely what must be avoided; oral care can be provided later under observation.

Key point! The observation period is not punitive — it is a structured intervention that interrupts the binge–purge sequence. The nurse stays with the patient, engages her in distracting or supportive conversation, and documents any requests to use the bathroom.

The rationale for this level of vigilance extends beyond preventing vomiting as a behavior. The case report by Cai et al. describes a patient with long-standing bulimia nervosa who developed acute gastric dilatation (AGD) after a binge episode and progressed to cardiac arrest despite resuscitation efforts [1]. While that case involved a massive binge rather than a routine meal, it underscores that the postprandial period in bulimia nervosa is not benign. A patient who has just eaten may experience extreme abdominal fullness and distress, which can trigger both the urge to purge and, in severe cases, dangerous gastric complications. The nurse’s presence during the post-meal hour serves both to prevent purging and to monitor for signs of abdominal distension, pain, or hemodynamic instability.

The gastrointestinal burden after eating is also relevant to understanding why observation must be paired with support rather than simple surveillance. Forney et al. reported that individuals with bulimia nervosa frequently experience postprandial fullness and early satiation, and that these symptoms can improve with psychological treatment . In the inpatient setting, the nurse’s role is to help the patient tolerate the uncomfortable fullness that follows a meal without resorting to vomiting. Sitting with the patient, providing distraction, and normalizing the sensation of fullness are all part of making the observation period therapeutic.

| Post-meal nursing action | Purpose | Safety concern if omitted |
| --- | --- | --- |
| Keep patient in view for 1–2 hours | Interrupt the urge to purge; monitor for abdominal distress | Patient may vomit in private |
| Supervise bathroom use | Prevent self-induced vomiting or laxative use | Unobserved bathroom access enables purging |
| Provide distraction and support | Help patient tolerate postprandial fullness | Unmanaged fullness triggers purge urge |
| Delay oral care until observation period ends | Avoid sending patient to bathroom unsupervised | Brushing becomes an excuse for purging |

The clinical picture also points to a broader nursing responsibility: the patient’s BMI of 21 kg/m² does not rule out serious medical risk. Electrolyte imbalances, dental erosion, esophageal injury, and gastric complications can all occur at a normal weight. The nurse’s post-meal observation is therefore not only about preventing vomiting — it is part of ongoing assessment for the medical consequences of purging, including the rare but life-threatening progression to acute gastric dilatation described in the case report [1].References (research sources)

- [1]Cardiac arrest caused by acute gastric dilatation in a bulimia patient: a case report.Case reportCai Q, Song M, Peng H, Jiang H, Zhou P. (2026) · DOI: 10.3389/fmed.2026.1738665

## 임상 시나리오

Post-Meal Monitoring in Bulimia NervosaPreventing Purging After Meals
After a patient with bulimia nervosa finishes a meal, the priority nursing action is to keep the patient in direct observation for 1 to 2 hours and supervise any bathroom use during that window. This prevents the compensatory purging behaviors that typically follow eating.

A BMI of 21 kg/m² can remain within the normal range even while purging behaviors are active, so normal weight does not rule out the need for close monitoring.

CautionAllowing the patient to be alone in her room or to enter the bathroom unobserved immediately after a meal creates the exact opportunity for self-induced vomiting. Privacy is not therapeutic in the early postprandial period.

## 핵심 개념

- **Bulimia Nervosa** — An eating disorder characterized by recurrent binge eating followed by compensatory behaviors such as self-induced vomiting, laxative use, or excessive exercise.
- **Postprandial Observation** — Direct monitoring of a patient for 1-2 hours after meals to prevent purging behaviors in eating disorder treatment.
- **Purging** — Compensatory behavior to eliminate consumed food, including self-induced vomiting or misuse of laxatives, diuretics, or enemas.
- **Body Mass Index (BMI)** — A measure of body fat based on height and weight; a BMI of 21 kg/m² is within the normal range and does not rule out active purging behaviors.
- **Supervised Bathroom Access** — A nursing intervention requiring patients with purging behaviors to use the bathroom only under direct observation during high-risk post-meal periods.

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