Joan is a 17 year old who normally weighs 45 Kg She has lost 9 kg over past 3 months and has amenorrhea; Joan expresses an intense fear of gaining weight and is preoccupied with food. She is admitted with a diagnosis of anorexia nervosa. Joan's lunch consists of a small salad, a dinner roll and a bowl of soup and tea. What it is the responsibility of the nurse in order to assess intake?

Reasoning: Choice A reason: Being present only at the end of the meal is insufficient for a patient with anorexia nervosa. These patients are often highly skilled at concealing food, disposing of it in napkins, or hiding it in clothing. The nurse must witness the entire process to ensure the recorded intake is accurate and reflective of actual consumption. Choice B reason: Constant observation during mealtimes is a standard nursing intervention for eating disorders. This provides emotional support, prevents ritualistic eating behaviors, and ensures the patient does not hide or discard food. Maintaining a therapeutic presence helps reduce the anxiety associated with caloric intake and ensures the safety and accuracy of the nutritional plan. Choice C reason: Periodically checking in allows the patient opportunities to engage in disordered behaviors such as "pocketing" food or using compensatory measures like excessive water loading. For a patient who has lost 20% of her body weight in 3 months, high-level supervision is required to manage the acute physiological risk. Choice D reason: Self-reporting is highly unreliable in the acute phase of anorexia nervosa due to the patient's intense fear of weight gain and drive for thinness. Patients may intentionally under-report or over-report intake to avoid intervention. The responsibility for assessment rests with the clinical staff to ensure objective and valid data collection.