Psychiatric Medications Q 50
Nurse Mickey is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Be mindful of the patient’s distorted thinking ability. This allows the caregiver to have more realistic expectations of the patient and provide appropriate information and support. Listen to or avoid challenging irrational, illogical thinking. Present reality concisely and briefly. It is difficult to respond logically when thinking ability is physiologically impaired. The patient needs to hear reality, but challenging the patient leads to distrust and frustration. Even though the patient may gain weight, she or he may continue to struggle with attitudes or behaviors typical of eating disorders, major depression, or alcohol dependence for a number of years.
Option A: Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain.
Option B: Supervise the patient during mealtimes and for a specified period after meals (usually one hour). This prevents vomiting during or after eating. Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games.
Option D: Provide smaller meals and supplemental snacks, as appropriate. Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: The patient may feel bloated for 3–6 weeks while the body adjusts to food intake. Be alert to choices of low-calorie foods and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets. The patient will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating.