Nursing Interventions Rationale

For Bulimia Nervosa:

Supervise the patient during mealtimes and Prevents vomiting during or after eating.
for a specified period after meals (usually
one hour).

Identify the patient’s elimination patterns. To prevent self-induced vomiting.

Assess her suicide potential. Among patients with bulimia nervosa,

warning signs include having more co-
morbid psychiatric symptoms and
reporting a history of sexual abuse.

Outline the risks of laxative, emetic, and Bulimic patients may include abuse of
diuretic abuse for the patient laxatives, emetics, and diuretics.

For Bulimia and Anorexia:

Establish a minimum weight goal and daily Malnutrition is a mood-altering

nutritional requirements. condition, leading to depression and
agitation and affecting cognitive function
and decision making. Improved
nutritional status enhances thinking
ability, allowing initiation of
psychological work.

Use a consistent approach. Sit with the Patient detects urgency and may react to
patient while eating; present and remove pressure. Any comment that might be
food without persuasion and comment. seen as coercion provides focus on food.
Promote a pleasant environment and record When staff responds in a consistent
intake. 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.

Provide smaller meals and supplemental Gastric dilation may occur if refeeding is
snacks, as appropriate. too rapid following a period of starvation
dieting. Note: Patient may feel bloated
 for 3–6 weeks while the body adjusts to
food intake.

Make selective menu available, and allow Patient who gains confidence in self and
patient to control choices as much as feels in control of the environment is
possible. more likely to eat preferred foods.

Be alert to choices of low-calorie foods and Patient will try to avoid taking in what is
beverages; hoarding food; disposing of viewed as excessive calories and may go
food in various places, such as pockets or to great lengths to avoid eating.
wastebaskets.

Maintain a regular weighing schedule, such Provides an accurate ongoing record of

as Monday and Friday before breakfast in weight loss or gain. Also diminishes
the same attire, and graph results. obsessing about changes in weight.

Weigh with back to scale (depending on Although some programs prefer the
program protocols). patient to see the results of the weighing,
this can force the issue of trust in the
patient who usually does not trust others.

Avoid room checks and other control External control reinforces feelings
devices whenever possible. of powerlessness and therefore is usually
not helpful.

Provide one-to-one supervision and have a Prevents vomiting during and after
patient with bulimia remain in the day eating. Patient may desire food and use a
room area with no bathroom privileges for binge-purge syndrome to maintain
a specified period (2 hr) following eating, weight. Note: Patient may purge for the
if contracting is unsuccessful. first time in response to the establishment
of a weight gain program.

Monitor exercise program and set limits on Moderate exercise helps in maintaining
physical activities. Chart activity and level muscle tone, weight and combating
of work (pacing and so on). depression; however, patient may
exercise excessively to burn calories.

Maintain matter-of-fact, nonjudgmental Perception of punishment is

attitude if giving tube feedings, counterproductive to patient’s self-
hyperalimentation, and so on. confidence and faith in own ability to
control destiny.

Be alert to the possibility of the patient Sabotage behavior is common in an

disconnecting tube and emptying attempt to prevent weight gain.
hyperalimentation if used. Check
measurements, and tape tubing snugly.

Provide nutritional therapy within a Cure of the underlying problem cannot

hospital treatment program as indicated happen without improved nutritional
when the condition is life-threatening. status. Hospitalization provides a
controlled environment in which food
intake, vomiting and elimination,
medications, and activities can be
monitored. It also separates the patient
from SO (who may be contributing
factor) and provides exposure to others
with the same problem, creating an
atmosphere for sharing.

Involve patient in setting up or carrying out Provides structured eating situation while
a program of behavior modification. allowing the patient some control in
Provide a reward for weight gain as choices. Behavior modification may be
individually determined; ignore the loss. effective in mild cases or for short-term
weight gain.

Provide diet and snacks with substitutions Having a variety of foods available
of preferred foods when available. enables the patient to have a choice of
potentially enjoyable foods.

Administer liquid diet,  tube feedings, When caloric intake is insufficient to

hyperalimentation if needed. sustain metabolic needs, nutritional
support can be used to prevent
malnutrition and death while therapy is
continuing. High-calorie liquid feedings
may be given as medication, at preset
times separate from meals, as an
alternative means of increasing caloric
intake.

Blenderize and tube-feed anything left on May be used as part of a behavior

the tray after a given period of time if modification program to provide a total
indicated. intake of needed calories.

Administer supplemental nutrition as Total parenteral nutrition (TPN) may be

appropriate. required for life-threatening situations;
however, enteral feedings are preferred
because they preserve gastrointestinal
(GI) function and reduce atrophy of the
gut.
Avoid giving laxatives. Use is counterproductive because they
may be used by the patient to rid the
body of food and calories.

Administer medication as indicated:

 Cyproheptadine (Periactin) A serotonin and histamine antagonist that

may be used in high doses to stimulate
the appetite, decrease preoccupation with
food, and combat depression. Does not
appear to have serious side effects,
although decreased mental alertness may
occur.
 Tricyclic Lifts depression and stimulates the
antidepressants: amitriptyline appetite.
(Elavil), imipramine (Tofranil),
desipramine (Norpramin)
 selective serotonin reuptake SSRIs reduce binge-purge cycles and
inhibitors (SSRIs): fluoxetine may also be helpful in treating
(Prozac) anorexia. Note: Use must be closely
monitored because of potential side
effects, although side effects from SSRIs
are less significant than those associated
with tricyclics.
 Antianxiety agents: alprazolam Reduces tension, anxiety, nervousness
(Xanax) and may help the patient to participate in
treatment.
 Antipsychotic Promotes weight gain and cooperation
drugs: chlorpromazine (Thorazine) with the psychotherapeutic program;
however, used only when absolutely
necessary because of the possibility of
extrapyramidal side effects.
 Monoamine oxidase inhibitors May be used to treat depression when
(MAOIs): tranylcypromine sulfate other drug therapy is ineffective;
(Parnate) decreases urge to binge in bulimia.
Assist with electroconvulsive therapy In rare and difficult cases in which
(ECT) if indicated. Discuss reasons for use malnutrition is severe and life-
and help the patient understand this is not threatening, a short-term ECT series may
punishment. enable patient to begin eating and
become accessible to psychotherapy.