In the management of bulimic patients, the following nursing interventions will promote a therapeutic relationship except:
A. Establish an atmosphere of trust.
B. Discuss their eating behavior.
C. Help patients identify feelings associated with binge-purge behavior.
D. Teach the patient about bulimia nervosa.
Correct Answer: B. Discuss their eating behavior.
The client is often ashamed of her eating behavior. Discussion should focus on feelings. Promote self-concept without moral judgment. Patient sees herself as weak-willed, even though part of a person may feel a sense of power and control (dieting, weight loss). Let the patient know that it is acceptable to be different from family, particularly mother. Developing a sense of identity separate from family and maintaining a sense of control in other ways besides dieting and weight loss is a desirable goal of therapy and program.
Option A: Establish a therapeutic nurse-patient relationship. Within a helping relationship, the patient can begin to trust and try out new thinking and behaviors. State rules clearly regarding weighing schedule, remaining in sight during medication and eating times, and consequences of not following the rules. Without undue comment, be consistent in carrying out rules. Consistency is important in establishing trust. As part of the behavior modification program, the patient knows risks involved in not following established rules (decrease in privileges). Failure to follow rules is viewed as a patient’s choice and accepted by staff in a matter-of-fact manner so as not to provide reinforcement for undesirable behavior.
Option C: Respond (confront) with reality when a patient makes unrealistic statements. The patient may be denying the psychological aspects of their own situation and are often expressing a sense of inadequacy and depression. Encourage the patient to express anger and acknowledge when it is verbalized. Important to know that anger is part of self and as such is acceptable. Expressing anger may need to be taught to the patient because anger is generally considered unacceptable in the family, and therefore the patient does not express it.
Option D: Determine the level of knowledge and readiness to learn. Learning is easier when it begins where the learner is. Provide written information for the patient and SO(s); these are helpful as a reminder of and reinforcement for learning. Discuss the consequences of behavior. Sudden death can occur because of electrolyte imbalances; suppression of the immune system and liver damage may result from protein deficiency, or gastric rupture may follow binge-eating and vomiting.