Page 87 Complete Your CE Test Online - Click Here prescription and over-the-counter medications, vitamins, minerals, and herbal supplements. No medications or other supplements should be added to the diet without the knowledge and approval of the clients’ healthcare providers. Such medications and supplements can interact with each other and have adverse effects on treatment outcomes. Clients and families (and even some healthcare professionals) may not be aware that over-the-counter and herbal preparations and vitamins and minerals can cause harmful side effects. ● ● Caution colleagues that clients may try to isolate themselves from family members, friends, work colleagues, and healthcare professionals who genuinely want to help them. Clients may view other people, even family members, as enemies who want them to gain weight and be fat. Help all persons involved in the clients’ plans of care to be on guard for isolation tendencies. Clients need emotional support to reach and maintain a state of health and wellness. Everyone involved in the clients’ treatment initiatives should be aware that clients may have the urge to weigh themselves or check their appearance in a mirror quite frequently. These kinds of behaviors only increase anxiety and may lead to a relapse of unhealthy behaviors. ● ● Treatment of anorexia nervosa is generally a life-long process. Some experts refer to it as a chronic illness. This is not easy for clients and their loved ones to accept. Some clients who regain a normal weight and discontinue unhealthy behaviors that are linked to anorexia nervosa see themselves as completely cured. Caution clients, families, and professional colleagues that ongoing monitoring and therapy may be necessary, particularly during periods of anxiety or stress-provoking events, such as the death of a loved one, job loss, or divorce. Nurses do not only have an obligation to promote quality care that facilitates desired client outcomes, but also a duty to correct false perceptions about eating disorders that are prevalent in the society today. Clients may receive what can be described as “mixed messages” about eating disorders and being thin. Some of them may even hear people (even friends and family) joke about weight loss, making comments such as “I wish I could have anorexia for a little while so that I could be thin, too[1,9,15] .” Such comments only exacerbate feelings of anxiety and possibly resentment of those who are promoting weight gain. Television, magazines, movies, and social media all promote, to some extent, the “ideal” view of a woman’s body as ultra thin. Celebrities are interviewed about weight loss and so-called “super models” talk about how they stay thin. Some of them even joke about purging via self-induced vomiting and abusing laxatives and diuretics. Clients may feel that they are bombarded by a society that equates being very thin with being attractive and successful[1,9,15] . Nurses can help to promote wellness by[1,9,12,15] : ● ● Promoting positive role models. Contact media sites that endorse unrealistic presentations of women’s (and men’s) bodies. Remind clients and families that models or actors and actresses do not necessarily represent a healthy lifestyle just because they are thin. Also remind them that photographs and other images are often altered to make them appear much thinner than they actually are. ● ● Working to expose websites that promote unhealthy eating (or failure to eat) lifestyles. The Internet is a source of a wide variety of “pro-anorexia” web sites. These sites are easily accessed by clients and families. The information on these sites may reinforce beliefs that anorexia nervosa is a lifestyle choice, not a disease. ● ● Reminding healthcare professionals, as well as the general public, what a healthy weight actually is. There are so many extremes represented in the media that many people can no longer recognize what is healthy and what is not. ● ● Helping clients and families realize that they may not always be the best judge of whether or not the client is at a healthy weight. This may be especially true if there is a family history of eating disorders. ● ● Helping clients and families to recognize situations that are likely to prolong recovery or to trigger relapses after a healthy weight is achieved. Healthcare professionals must also be taught to recognize such situations and help clients and families to know when to seek help if such situations occur. Clients must be taught how to access help if and when they encounter life events that can lead to unhealthy behaviors. In summary, anorexia nervosa is a serious, potentially life-threatening illness that may need life-long monitoring and treatment. In addition to their local network of healthcare professionals, clients and families may find it helpful to join an eating disorder support group or to access organizations devoted to eating disorder recovery such as the National Association of Anorexia Nervosa and Associated Disorders (http:// 630-577-1330. BULIMIA NERVOSA Evelyn is a 30 year old management consultant for a prestigious consulting firm. She is married and is the mother of a two year old little girl. Evelyn is intelligent, slim, and attractive and is the envy of many people who know her. Her family, friends, and colleagues describe her as “having it all,” a successful career, a wonderful marriage, and a beautiful little girl. What they don’t know is that Evelyn, in an attempt to fulfill her image of having the perfect life, including the perfect physical appearance, has been binging and purging since she was 20 years old. Evelyn suffers from bulimia nervosa (often referred to as bulimia). This disorder is characterized by repeated episodes of binge eating, which is defined as eating, in a specific period of time, an amount of food that is “definitely larger than most individuals would eat in a similar period of time under similar circumstances[1] .” Binge eating is followed by purging in order to prevent weight gain. Examples of purging behaviors include self-induced vomiting, excessive use of laxatives and/or diuretics, and excessive exercise[2,9] . Persons suffering from bulimia nervosa feel a significant loss of control over their binging and purging behaviors[2] . According to publications by the Mayo Clinic, bulimia can be classified in two ways[16] : ● ● Purging bulimia: Clients regularly self-induce vomiting or abuse laxatives, diuretics, and/or enemas after eating. ● ● Non-purging bulimia: Clients use other methods to prevent weight gain after eating, such as fasting or extreme, excessive exercise. However, it should be noted that purging and non-purging behaviors often overlap. Purging generally indicates attempts to rid the body of calories and avoid weight gain regardless of the methods that are used[16] . Nursing consideration: Bulimia nervosa and anorexia nervosa can occur at the same time[1,9] . When assessing clients for eating disorders, it is important that they be evaluated for both of these disorders. Not all healthcare professionals know that bulimia nervosa and anorexia nervosa can co-exist. It is important to help to educate colleagues, as well as clients and families, about the possibility of this simultaneous occurrence.