Other Therapies: Symptoms may be managed with antacids, acetaminophen, bulk laxatives, stool softeners, anxiolytic agents such as fluoxetine (Prozac) may have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years; dietary calcium (1000-1500 mg/day) and vitamin D (400 IU) are recommended to reduce bone loss.


The primary goal for the nurse is to establish a therapeutic, nonjudgmental, trusting relationship with the patient. The most important nursing intervention is to facilitate refeeding, thus helping the patient meet his or her weight goal and daily nutritional requirements. If tube feedings are needed, use a consistent and matter-of-fact approach. Be alert to possible disconnecting of the tube or signs of suicidal ideation or behavior.

Once tube feedings and total parenteral nutrition are no longer necessary, create a pleasant environment during meals. Smaller meals and supplemental snacks can be an effective strategy. Having a menu available for choice increases a sense of control for the patient. Maintain a regular weighing schedule. To avoid fear of weight gain, weigh patients with their back to the scale. Monitor the exercise program and set limits on physical activities. Work with the patient to develop strategies to stop vomiting and laxative and diuretic abuse as necessary. Usually, strenuous sports activity is limited to reduce energy expenditure, but the disadvantage of curtailing activity is the removal of the patient's coping mechanism, so an activity program needs to be tailored to the individual.

Work with the family individually or in a group to educate about the disease prognosis and treatment process. Parents are educated in ways to encourage their adolescent without limiting her or his growth and independence. Identify family interaction patterns, and encourage each family member to speak for himself or herself. Communicate a message that it is acceptable for family members to be different from each other and that individuation is an important growth step. Assist parents in learning new ways to handle family and marital conflict. Teaching family negotiation skills is important.

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