Psychiatric Mental Health Nursing by Videbeck

450 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

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The client may have become accustomed to judg-

ing himself or herself on accomplishments (often

food related) with no regard for feelings. Your sin-

cere praise can promote the client’s attempts to

deal openly and honestly with anxiety, anger, and

other feelings.

The client and significant others may have little

actual knowledge of the illness and of food, nutri-

tion, and so forth. Factual information can be

useful to dispel incorrect beliefs and to separate

food issues from emotional issues.

Antidepressant and other medications are some-

times prescribed for bulimia. The client needs to

be aware of the effects of the medications and

their safe use. Remember some antidepressant

medications may take several weeks to achieve

a therapeutic effect.

Successful use of the problem-solving process

can help increase the client’s self-esteem and

confidence.

You can help the client discover his or her

strengths. It will not be useful, however, for

you to list the client’s strengths—he or she

needs to identify them but may benefit from

your supportive expectation that he or she

will do so.

The client’s previous expectations or perception of

an ideal weight may have been unrealistic and

even unhealthy.

This will enhance the client’s sense of control of

overeating.

Many bulimic clients are passive and nonassertive

in interpersonal relationships. Assertiveness

training may foster a sense of increased control,

confidence, and healthy relationship dynamics.

Expression of feelings can help the client to iden-

tify, accept, and work through feelings in a direct

manner.

Give positive feedback for the client’s efforts.

*Teach the client and significant others about

bulimic behaviors, physical complications, nutri-

tion, food, and so forth. Refer the client to a dieti-

tian for further instruction if indicated.

*Teach the client and significant others about

the purpose, action, timing, and possible adverse

effects of medications, if any.

Teach the client about the use of the problem-

solving process.

Explore with the client his or her personal

strengths. Making a written list is sometimes

helpful.

Discuss with the client the idea of accepting a less

than “ideal” body weight.

Encourage the client to incorporate fattening (or

“bad”) foods into the diet as he or she can tolerate.

*Encourage the client to develop these skills and

use them in daily life. Refer the client to assertive-

ness training books or classes if indicated.

Encourage the client to express his or her feelings

about family members, significant others, and

their roles and relationships.

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