NURSING HISTORY AND ASSESSMENT
When Katie fainted in history class, she was taken to the university health center by her roommate, Ashley. Ashley told the nurse that Katie has been taking a lot of over-the-counter laxatives and diuretics. She also said that Katie often selfinduced vomiting when she felt that she had eaten too much. After an initial physical assessment, the nurse in the university health center referred Katie to the mental health clinic.
At the mental health clinic, Katie weighed 110 pounds and measured 5 feet 6 inches. She admitted to the psychiatric nurse that she tried to keep her weight down by dieting, but sometimes she got so hungry that she would overeat, and then she felt the need to self-induce vomiting to get rid of the calories. “I really don’t like doing it, but lots of the girls do. In fact, that is where I got the idea. I always thought I was too fat in high school, but the competition wasn’t so great there. Here all the girls are so pretty—and so thin! It’s the only way I can keep my weight down!”
Katie also admitted that she hoards food in her dorm room and that she eats when she is feeling particularly anxious and depressed (often during the night). She admitted to having eaten several bags of potato chips and whole packages of cookies in a single sitting. She sometimes drives to the local hamburger stand in the middle of the night, orders several hamburgers, fries, and milkshakes, and consumes them as she sits in her car alone. She stated that she feels so much better while she is eating these foods but then feels panicky after they have been consumed. That is when she self-induces vomiting. “Then I feel more depressed, and the only thing that helps is eating! I feel so out of control!”
NURSING DIAGNOSES AND OUTCOME
IDENTIFICATION
From the assessment data, the nurse develops the following nursing diagnosis for Katie:
Ineffective coping related to feelings of helplessness, low self-esteem, and lack of control in life situation.
■ Short-Term Goal: Client will identify and discuss fears and anxieties with the nurse.
■ Long-Term Goal: Client will identify adaptive coping strategies that can be realistically incorporated into her lifestyle, thereby eliminating binging and purging in response to anxiety
PLANNING AND IMPLEMENTATION
INEFFECTIVE COPING
The following nursing interventions have been identified for
Katie.
■ Establish a trusting relationship with Katie. Be honest and accepting. Show unconditional positive regard.
■ Help Katie identify the situations that produce anxiety and discuss how she coped with these situations before she began binging and purging.
■ Help Katie identify the emotions that precipitate binging (e.g., fear, boredom, anger, loneliness).
■ Once these high-risk situations have been identified, help her identify alternate behaviors, such as exercise, a hobby, or a warm bath.
■ Encourage Katie to express feelings that have been suppressed because they were considered unacceptable. Help her identify healthier ways to express those feelings.
■ Use role-play with Katie to deal with feelings and experiment with new behaviors.
■ Explore the dynamics of Katie’s family and encourage family involvement for support with Katie’s consent.
■ Teach the concepts of good nutrition, and the importance of healthy eating patterns in overall wellness.
■ Consult with the physician about a prescription for fluoxetine for Katie.
■ Help Katie find a support group for individuals with eating disorders. Encourage regular attendance in this group.
EVALUATION
The outcome criteria for Katie have been met. She discussed with the nurse the feelings that triggered binging episodes and the situations that precipitated those feelings. She has joined a support group of individuals with eating disorders and now has a “buddy” that she may call (even in the middle of the night) when she is feeling like binging. She has started riding her bicycle regularly and goes to the fitness center when she is feeling especially anxious. She still sees the mental health nurse weekly and continues to discuss her fears and anxieties. The urges to binge at stressful times have not disappeared completely. However, they have decreased in frequency, and Katie is now able to choose more adaptive strategies for dealing with stress.
