18 EATINGDISORDERS 451
cycle. Clients need encouragement to set realistic
goals for eating throughout the day (Muscari, 2002).
Eating only salads and vegetables during the day
may set up clients for later binges as a result of too
little fat and carbohydrates.
For clients who purge, the most important goal
is to stop. Teaching should include information about
the harmful effects of purging by vomiting and laxa-
tive abuse. The nurse explains that purging is an in-
effective means of weight control and only disrupts
the neuroendocrine system. In addition, purging pro-
motes binge eating by decreasing the anxiety that
follows the binge. The nurse explains that if clients
can avoid purging, they may be less likely to engage in
binge eating. The nurse also teaches the techniques of
distraction and delay, because they are useful against
both binging and purging. The longer clients can delay
either binging or purging, the less likely they are to
carry out the behavior.
The nurse explains to family and friends that
they can be most helpful by providing emotional sup-
port, love, and attention. They can express concern
about the client’s health, but it is rarely helpful to
focus on food intake, calories, and weight.Evaluation
The nurse can use assessment tools such as the Eat-
ing Attitudes Test to detect improvement for clients
with eating disorders. Both anorexia and bulimia are
chronic for many clients. Residual symptoms such as
dieting, compulsive exercising, and discomfort eating
in a social setting are common. Treatment is consid-continued from page 450Treatment for eating disorders often is a long-term
process. The client may be more likely to engage
in ongoing therapy if he or she has contracted
to do this.Dysfunctional relationships with family members
or significant others are thought to be a primary
issue with clients experiencing eating disorders.These groups can offer support, education, and
resources to clients and their families or signif-
icant others.Substance use is common among clients with
bulimia.*Refer the client to long-term therapy if indicated.
Encourage the client to follow through with ther-
apy on an outpatient basis. Use of contracting
with the client may be helpful to promote follow
through.*Ongoing therapy may need to include family
members or significant others to sustain and con-
tinue the client’s non–food-related coping skills.*Refer the client and family and significant others
to support groups in the community or via the
Internet (e.g., Anorexia Nervosa and Associated
Disorders, Overeaters Anonymous).*Refer the client to a substance dependence treat-
ment program or substance dependence support
group (e.g., Alcoholics Anonymous), if appropriate.◗ CLIENT ANDFAMILYTEACHING:
EATINGDISORDERS
CLIENT- Basic nutritional needs
- Harmful effects of restrictive eating, dieting,
purging - Realistic goals for eating
- Acceptance of healthy body image
FAMILY AND FRIENDS- Provide emotional support.
- Express concern about client’s health.
- Encourage client to seek professional help.
- Avoid talking only about weight, food intake,
calories. - Become informed about eating disorders.
- It is not possible for family and friends to force the
client to eat. The client needs professional help
from a therapist or psychiatrist.
Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.