The Nurse Educator is leading a support group for survivors of rape at the local community hospital, which of the following information is evidence-based and should be included in the teaching session?

A. Necklace: This can be a strangulation risk and should be removed from the client’s belongings.

B. Lace-up tennis shoes: The laces can be used for self-harm or strangulation and should be removed.

C. Nylon ankle socks: These are generally safe and do not pose a risk.

D. Cotton underwear: This is also considered safe and does not pose a significant risk.

E. Glass framed picture of the client's partner: The glass can be broken and used for self-harm, making it unsafe for a client with recent suicidal behavior.

Potential Condition

Bulimia nervosa: The client has a BMI of 18.5, which is on the lower end of normal, indicating possible weight issues, but not the severe underweight typical of anorexia nervosa. The client describes cycles of binge eating followed by compensatory behaviors such as purging (using laxatives), which are characteristic of bulimia nervosa. The client expresses a preoccupation with food and body weight, and feelings of embarrassment about their eating habits, which align with bulimia nervosa.

Actions to Take

1. Assess binging and purging patterns: It's crucial to understand the frequency, triggers, and methods of binging and purging to tailor interventions effectively and to monitor the severity and progression of bulimia.

2. Encourage client to identify triggers for overeating: Identifying triggers for binging can help the client develop healthier coping mechanisms and reduce the occurrence of binge eating episodes.

Parameters to Monitor

1. Electrolyte levels: Frequent use of laxatives and purging behaviors can lead to electrolyte imbalances, which are potentially life-threatening and must be monitored regularly.

2. Frequency of compensatory behaviors: Tracking the frequency of purging behaviors (such as laxative use) helps assess the effectiveness of interventions and the client’s progress in reducing harmful behaviors.

Incorrect answers:

Actions to Take:

• Assess for and discourage provocative or seductive behaviour: This is more relevant to histrionic personality disorder, not bulimia nervosa.
• Weigh daily for the first week: While weighing the client can be part of the monitoring process, daily weigh-ins can increase anxiety and may not directly address the core issues of bulimia.
• Assess for consumption of right food items: While dietary intake is important, focusing solely on food items without addressing the psychological aspects may not be effective for treating bulimia.

Parameters to Monitor:

• Attention-seeking behaviours: More relevant to histrionic personality disorder than bulimia nervosa.
• Signs of infection: Not directly relevant unless there is evidence of a related health issue or a compromised immune system, which is not indicated in the provided information.
• Presence of lanugo: Lanugo is more commonly associated with anorexia nervosa due to severe malnutrition, not bulimia.