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BULIMIA - Coggle Diagram
BULIMIA
PATHOPHYSIOLOGY
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They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories)
There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance and cheerleading, figure skating.
Bulimia is more prevalent among Caucasians, but is increasing among African Americans and Hispanics.
In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduce cravings for fat and suga.
MEDICATION
Electrolyte supplements. Electrolyte repletion is necessary in patients with profound malnutrition, dehydration, and purging behaviors; repletion may be done orally or parenterally, depending on the patient’s clinical state.
Fat-soluble vitamins. Vitamins are used to meet necessary dietary requirements. They are utilized in metabolic pathways, as well as in deoxyribonucleic acid (DNA) and protein synthesis.
Antidepressants, SSRIs. These agents have been reported to reduce binge eating, vomiting, and depression and to improve eating habits, although their impact on body dissatisfaction remains unclear. fluoxetine (Prozac)
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NURSING INTERVENTIONS
Supervise the patient during mealtimes and for a specified period after meals, usually 1 hour. Set a time limit for each meal.
Provide a pleasant, relaxed environment for eating.
Using behavior modification techniques, reward the patient for satisfactory weight gain. Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control. Identify the patient’s elimination patterns. Assess the patient’s suicide potential.
Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.
BEHAVIORAL INTERVENTIONS
Establish a trusting relationship with the patient. When nutritional status has improved, begin to explore with client the feelings associated with his or her extreme fear of gaining weight, Explore family dynamics. Help client to identify his or her role contributions and their appropriateness within the family system Initially, allow client to maintain dependent role. To deprive the individual of this role at this time could cause his or her anxiety to rise to an unmanageable level.
Give Positive reinforcement to increase self-esteem and encourage the client to use behaviors that are more acceptable.
Explore with client ways in which he or she may feel in control within the environment, without resorting to maladaptive eating behaviors.
PATIENT EDUCATION
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Teach about risks of abuse of laxative, emetic, and diuretic to the patient. To help the patient gain control over her behavior and achieve a realistic and positive self-image
Provide assertiveness training. If the patient is taking a prescribed tricyclic antidepressant, instruct her to take the drug with food. Warn her to avoid consuming alcoholic beverages; exposing herself to sunlight, heat lamps, or tanning beds; and discontinuing the medication unless she has notified the physician.