010-Psychiatric-Mental Health Nursing, 5th Edition-Sheila L. Videbeck-160547861X-Lippincott Willi

380UNIT 4 • NURSING PRACTICE FOR PSYCHIATRIC DISORDERSPsychopharmacologySince the 1980s, several controlled studies have beenconducted to evaluate the effectiveness of antidepressantsto treat bulimia. Drugs, such as desipramine (Norpramin),imipramine (Tofranil), amitriptyline (Elavil),nortriptyline (Pamelor), phenelzine (Nardil), and fluoxetine(Prozac) were prescribed in the same dosages usedto treat depression (see Chapter 2). In all the studies, theantidepressants were more effective than were the placebosin reducing binge eating. They also improved moodand reduced preoccupation with shape and weight. Mostof the positive results, however, were short term, withabout one third of clients relapsing within a 2-year period(Agras, 2006).APPLICATION OF THE NURSING PROCESSAlthough anorexia and bulimia have several differences,many similarities are found in assessing, planning, implementing,and evaluating nursing care for clients with thesedisorders. Thus, this section addresses both eating disordersand highlights differences where they exist.Nursing Care Plan ❘ BulimiaNursing DiagnosisIneffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices ofpracticed responses, and/or inability to use available resources.ASSESSMENT DATAEXPECTED OUTCOMES• Inability to meet basic needs• Inability to ask for help• Inability to solve problem• Inability to change behaviors• Self-destructive behavior• Suicidal thoughts or behavior• Inability to delay gratification• Poor impulse control• Stealing or shoplifting behavior• Desire for perfection• Feelings of worthlessness• Feelings of inadequacy or guilt• Unsatisfactory interpersonal relationships• Self-deprecatory verbalization• Denial of feelings, illness, or problems• Anxiety• Sleep disturbances• Low self-esteem• Excessive need to control• Feelings of being out of control• Preoccupation with weight, food, or diets• Distortions of body image• Overuse of laxatives, diet pills, or diuretics• Secrecy regarding eating habits or amounts eaten• Fear of being fat• Recurrent vomiting• Binge eating• Compulsive eating• Substance useImmediateThe client will• Be free from self-inflicted harm.• Identify methods not related to food of dealing withstress or crises, e.g., initiate interaction with othersor keep a journal/diary.• Verbalize feelings of guilt, anxiety, anger, or anexcessive need for control.StabilizationThe client will• Demonstrate more satisfying interpersonalrelationships.• Demonstrate alternative methods of dealing withstress or crises.• Eliminate shoplifting or stealing behaviors.• Express feelings in ways not related to food.• Verbalize understanding of disease process and safeuse of medications, if any.CommunityThe client will• Verbalize more realistic body image.• Follow through with discharge planning, includingsupport groups or therapy as indicated.• Verbalize increased self-esteem and self-confidence.(continued)