Perhaps one of the most important interventions when treating a patient with anorexia or bulimia is to develop a trusting relationship with the patient. Often times, these patients follow “pro-ana”, websites promoting anorexia, which further promotes their extreme dieting habits. It is important to develop a trusting relationship with the patient in order to learn how to best help them and for the patient to know that you are acting in their best interest.
In order to increase weight to a healthy level, a plan of caloric intake should be developed to aid the patient with anorexia in gaining 2-3 lbs per week. For the patient with bulimia, the plan should focus on maintaining a normal weight.
Patients with eating disorders should be monitored during meals and for one hour after in order to ensure that sufficient food is being eaten and not purged afterward. The patient should be allowed to choose the meals or bring food from home if it will help them eat. This will also provide patients with a level of control. Monitor for hoarding food for binging episodes that are typically high calorie, high carbohydrate foods.
Patients with bulimia or anorexia should be monitored during elimination in order to prevent self-induced emesis from occurring.
Supplemental drinks should be offered to help meet adequate caloric intake. This intervention may be more acceptable to patients in the early stages of treatment. In addition, in the beginning, feedings should start slow in order to prevent cardiac overload.
In order to properly assess and manage weight gain throughout treatment, daily weights should be measured. For patients with anorexia, daily weights should be measured for the first week and then should be measured three times a week.
The nurse should use matter-of-fact statements with patients with anorexia or bulimia. This prevents input on bargaining and opinions during treatment.
Often times, patients with anorexia or bulimia engage in extreme dieting patterns in order to gain control in their life. For treatment to be effective, it is important to offer these patients realistic and healthy control over things within their environment. This intervention will also aid in the development of a trusting relationship.
It is important to remember that refeeding must occur slowly in order to prevent these patients from developing cardiac overload or failure. Tube feedings may be suggested in early treatment in order to accurately measure caloric and fluid intake.
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