Nursing Key outcomes Nursing Care Plans for Bulimia Nervosa, The patient will:
- State strategies to reduce levels of anxiety.
- Express positive feelings about self.
- Have regular bowel elimination patterns.
- Acknowledge change in body image.
- Verbalize feeling well rested.
- Display appropriate eating patterns, including regular, nutritious meals.
- Participate in decision-making about case.
- Interact with family or friends.
- Fluid balance will remain stable, with intake equal to or greater than output.
Nursing interventions Nursing Care Plans for Bulimia Nervosa
• Supervise the patient during mealtimes and for a specified period after meals, usually 1 hour. Set a time limit for each meal. Provide a pleasant, relaxed environment for eating.
• Using behavior modification techniques, reward the patient for satisfactory weight gain.
• Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
• Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
• Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control.
• Identify the patient's elimination patterns.
• Assess the patient's suicide potential.
• Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.
Nursing interventions for bulimia nervosa base on its nursing diagnosis:
Nursing Diagnosis Imbalanced nutrition: Less than body requirements
Nursing Diagnosis Deficient fluid volume
Nursing Diagnosis Ineffective coping
Patient teaching Nursing Care Plans for Bulimia Nervosa
• Using behavior modification techniques, reward the patient for satisfactory weight gain.
• Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
• Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
• Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control.
• Identify the patient's elimination patterns.
• Assess the patient's suicide potential.
• Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.
Nursing interventions for bulimia nervosa base on its nursing diagnosis:
Nursing Diagnosis Imbalanced nutrition: Less than body requirements
- If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube.
- Nursing care of the individual receiving tube feedings should be administered.
- In collaboration with dietitian, to provide realistic (according to body structure and height) weight gain, determine number of calories required to provide adequate nutrition.
- Explain to patient’s behavior modification program as outlined by physician.
- Explain benefits of compliance with prandial routine and consequences for noncompliance.
- Sit with client during mealtimes for support and to observe amount ingested. Give to the patient a time limit for meals.
- Client should be observed for at least 1 hour following meals.
- Client may need to be accompanied to bathroom.
- Weigh client daily; use same scale, if possible.
- Do not discuss food or eating with client.
Nursing Diagnosis Deficient fluid volume
- Teach client importance of daily fluid intake of 2000 to 3000 ml. This information is required to promote client safety and plan nursing care. Keep strict record of intake and output.
- Weigh client daily; use same scale, if possible.
- Assess and document condition of skin turgor and any changes in skin integrity.
- Hot water and soap are drying to the skin, .Discourage client from bathing every day if skin is very dry.
- Monitor laboratory serum values, and notify physician of significant alterations.
- Client should be observed for at least 1 hour after meals and may need to be accompanied to the bathroom if self-induced vomiting is suspected.
- Assess and document moistness and color of oral mucous membranes.
- To minimizing risk of tissue infection. Encourage frequent oral care to moisten mucous membranes, reducing discomfort from dry mouth, and to decrease bacterial count.
- Help client identify true feelings and fears that contribute to maladaptive eating behaviors.
Nursing Diagnosis Ineffective coping
- Establish a trusting relationship with.
- When nutritional status has improved, begin to explore with client the feelings associated with his or her extreme fear of gaining weight,
- Explore family dynamics. Help client to identify his or her role contributions and their appropriateness within the family system
- Initially, allow client to maintain dependent role. To deprive the individual of this role at this time could cause his or her anxiety to rise to an unmanageable level.
- Give Positive reinforcement to increases self-esteem and encourages the client to use behaviors that are more acceptable.
- Explore with client ways in which he or she may feel in control within the environment, without resorting to maladaptive eating behaviors.
Patient teaching Nursing Care Plans for Bulimia Nervosa
- To monitor the treatment progress Teach the patient how to keep a food journal.
- Teach about risks abuse of laxative, emetic, and diuretic to the patient.
- To help the patient gain control over her behavior and achieve a realistic and positive self-image provide assertiveness training.
- If the patient is taking a prescribed tricyclic antidepressant, instruct her to take the drug with food. Warn her to avoid consuming alcoholic beverages; exposing herself to sunlight, heat lamps, or tanning beds; and discontinuing the medication unless she has notified the physician.
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