Kutarisirwa Kwekuchengetedzwa Kwevana Vane Mimba Muzviitiko zveBulimia
Pendauluan
Bulimia nervosa (bulimia) chirwere chekudya chinoratidzwa nekudya zvakanyanya kakawanda, chinoteverwa nemaitiro ekudzivirira kuwedzera uremu, akadai sekubvisa mafuta mumuviri, kushandisa mushonga wekubvisa dumbu/kubvisa mvura mumuviri, kutsanya zvakanyanya, kana kurovedza muviri zvakanyanya. Panyaya yekuzvitakura, bulimia idambudziko guru nekuti inogona kukanganisa vasikana vechidiki, vakadzi vari pazera rekubereka, uye vanaamai vane pamuviri nevanoyamwisa. Vananyamukuta vari munzvimbo yakanaka yekuona chirwere ichi nekukurumidza, kupa dzidzo, kutsigira shanduko dzehunhu hwakanaka, uye kushanda pamwe chete nechikwata chevanhu vane hunyanzvi hwakasiyana-siyana kuti vave nechokwadi chekuti amai nemwana ari mudumbu vakachengeteka.
Bulimia inyaya inopfuura "tsika yakaipa yekudya." Idambudziko rehutano hwepfungwa rakaoma, rinowanzobatanidzwa nemufananidzo usina kunaka wemuviri, kuda kukwana, kushushikana kwepfungwa, nezvimwe zvirwere zvakaita sekuora mwoyo nekuzvidya mwoyo. Mhedzisiro yaro inogona kusvika kure, kusanganisira kusagadzikana kwe electrolyte, matambudziko emudumbu, kusashanda zvakanaka kwemazino, kusashanda zvakanaka kwemwedzi, uye matambudziko epamuviri akadai sekusununguka kushoma uye kusununguka nguva isati yakwana. Saka, kutarisira bulimia kunoitwa nemadzimai emadzimai kunofanira kunge kwakazara, kuenderera mberi, uye kwakatarisana nekuchengetedzwa uye kupora kwenguva refu.
Etiology uye Njodzi Dzinobva Mumaonero Ekusununguka
Zvinokonzera bulimia zvinokonzerwa nezvinhu zvakawanda, zvinosanganisira zvinhu zvemuviri, zvepfungwa, uye zvetsika. Mukurapa kwekuzvitakura, zvinhu zvinokonzeresa njodzi zvinowanzoonekwa zvinosanganisira:
1. Kumanikidzwa kubva mutsika dzerunako uye kushorwa nehuremu, kunyanya pakati pevechidiki nevasikana vechidiki.
2. Nhoroondo yekudya zvisina kunaka kana kudzikira uremu zvakanyanya, izvo zvinokonzeresa kutenderera kwekudya zvakanyanya.
3. Nhoroondo yekutambudzika kana mhirizhonga, kusanganisira kufambidzana/mhirizhonga mudzimba.
4. Kushushikana muhupenyu hwekubereka, zvakaita sekuzvidya mwoyo kunokonzerwa nepamuviri, kuchinja kwechimiro chemuviri, kana nguva yekusununguka.
5. Zvirwere zvepfungwa, zvakaita sekuora mwoyo, matambudziko ekuzvidya mwoyo, uye kushandisa zvinodhaka zvisina kunaka.
Vananyamukuta vanofanira kuziva kuti varwere vazhinji vanovanza zviratidzo zvavo nekuda kwekunyara. Saka, nzira yekutaurirana netsitsi uye isina mhosva ndiyo inokosha pakutarisira.
Kukanganiswa kweBulimia pahutano hwekubereka nepamuviri
Bulimia inogona kukanganisa hutano hwekubereka kuburikidza nekukanganiswa kwemahormone, kusarongeka kwekuenda kumwedzi, uye kudzikira kwekubereka mune vamwe vanhu. Pakuzvitakura, njodzi inogona kuwedzera kana maitiro ekuchenesa muviri akashanda, kushomeka kwekudya kwakakwana, kana kusaenzana kwema electrolyte kukaitika. Migumisiro inogona kunge iri:
– Kushaya mvura mumuviri uye kusaenzana kwema electrolyte (semuenzaniso hypokalemia) izvo zvinogona kukonzera kusagadzikana kwepfungwa kana kushaya simba kwetsandanyama.
– Matambudziko emudumbu akadai se reflux, esophagitis, kana kuvimbiwa nekuda kwemishonga yekuburitsa mvura mumuviri.
– Matambudziko emukanwa: kuchekwa kwemazino, kuonda, uye kuzvimba kwegland reparotid nekuda kwekurutsa kakawanda.
– Kurambidzwa kukura kwemwana ari mudumbu (IUGR), kupererwa neropa, uye njodzi yekuzvarwa nguva isati yakwana mune mamwe mamiriro ezvinhu.
- Matambudziko epfungwa panguva yekusununguka, kusanganisira kushungurudzika kwepamberi pekusununguka uye mushure mekusununguka.
Munguva yekusununguka uye yekuyamwisa, bulimia inogona kukanganisa kupora kwaamai, kunaka kwekudya, uye kugadzikana kwepfungwa, saka rutsigiro runogara ruchikosha.
Nheyo dzeKutarisira Kuchengetwa Kwevana Vachizvara
Kutarisirwa kwekuchengetedzwa kwevana vanorwara nebulimia kunotevedzera mitemo inotevera:
1. Kuchengetedzeka kwemwana ari mudumbu ndiko kunonyanya kukosheswa (kuchengetedzeka kwemurwere).
2. Kuonekwa nekukurumidza uye kupindira nekukurumidza kudzivirira matambudziko ehutano.
3. Maitiro ekugadzirisa zvinhu zvemuviri nepfungwa: kwete kungotarisa pahuremu chete, asiwo maitiro, manzwiro, uye rutsigiro rwevanhu.
4. Kuchengetedzwa kweruzivo rwepachivande uye kutaurirana kunorapa kuti pave nekuvimbana.
5. Kushandira pamwe kwevashandi vezvekurapa zvakasiyana-siyana (vanachiremba, vanachiremba vepfungwa/nyanzvi dzezvepfungwa, nyanzvi dzezvekudya, vanachiremba vemazino, uye vezvekurapa zvekukurumidzira kana zvichidikanwa).
Kuongorora muKubata Vana
Ongororo iyi inoitwa kuburikidza ne anamnesis, kuongororwa kwemuviri, kuongororwa kunotsigira kana kuripo, uye kuongororwa kwehutano hwepfungwa.
1) Anamnesis Yakatungamirirwa
Vananyamukuta vanogona kubvunza mibvunzo inonetsa, semuenzaniso:
- Maitiro ekudya zuva nezuva, kudya zvakanyanya, uye zvinokunetsa mupfungwa.
– Kuvapo kwekuzvirutsa, kushandisa mishonga yekunyaradza/yekubuda ropa, kana kurovedza muviri kwakaomarara.
- Nhoroondo yekuchinja kwehuremu, kudya kwakashata, uye maonero emuviri.
– Zviratidzo zvemuviri: dzungu, kushaya simba, kurova kwemoyo, chirungurira, kana matambudziko emudumbu.
- Nhoroondo yekuenda kumwedzi, pamuviri, uye zvirongwa zvekubereka.
– Matambudziko epfungwa: kuzvidya mwoyo, kusuruvara kwenguva refu, kusagadzikana kwehope, pfungwa dzekuzvikuvadza.
2) Kuongororwa Kwemuviri
Tarisa zviratidzo zvekupererwa nemvura mumuviri, mamiriro ekudya, BP, kurova kwemoyo, uye zviratidzo zvematambudziko akadai sekukura kwegland reparotid, maronda padumbu reruoko (chiratidzo chaRussell), kuora kwezino, kana kutsamwa kwehuro. Mumadzimai ane pamuviri, vananyamukuta vanoongororawo kuwedzera huremu, kureba kwechibereko, uye zviratidzo zvekukura kwemwana asati aberekwa.
3) Kuongorora nekutsigira bvunzo
Kana chipatara chichibvumira, shanda pamwe chete nachiremba kuti muongorore huwandu hwema electrolytes (potassium, sodium), hematology (anemia), mashandiro eitsvo, uye kuongororwa kwemwoyo kana paine zviratidzo. Zvishandiso zvekuongorora matambudziko ekudya kana hutano hwepfungwa zvinogona kushandiswa pakusarudza kwechipatara.
Kuronga uye Kuongorora Mimba Yemwana
Kuronga kutarisirwa kunoenderana nematambudziko akaonekwa. Matambudziko anowanzoonekwa muvanhu vane bulimia anosanganisira:
– Njodzi yekusakwana kwezvekudya zvinovaka muviri zvishoma pane zvinodiwa nemuviri.
– Njodzi yekusashanda zvakanaka kwema electrolyte uye kupera mvura mumuviri.
- Kukanganiswa kwemufananidzo wemuviri.
- Kushushikana kana matambudziko emanzwiro.
– Njodzi yematambudziko epamuviri (kana mutengi aine pamuviri).
– Kushaya ruzivo nezvekudya kunovaka muviri uye njodzi dzekubuda ropa zvisina kunaka.
Zvinangwa zvekutarisira zvinosanganisira kugadzirisa mamiriro emuviri, kuwedzera maitiro ekudya ane hutano, kuderedza maitiro ekuchenesa muviri, kuwedzera kugadzirisa matambudziko, uye kubatana nevanopa rubatsiro rwehutano hwepfungwa.
Kuitwa (Kupindira) kweKutarisirwa kweVananyamukuta
1) Kutaurirana Kwekurapa uye Kupa Mazano Ekutanga
Vananyamukuta vanofanira kushandisa nzira isina mhosva, kusimbisa manzwiro avo, uye kushandisa nzira pfupi dzekupa mazano. Tarisa pakuvaka chikonzero chekuchinja, kuona zvinhu zvinokonzera kubvisa doro zvakanyanya, uye kugadzira nzira dzekugadzirisa matambudziko (semuenzaniso, nzira dzekuzorora, kunyora pasi, kana rutsigiro rwevanhu).
2) Dzidzo yehutano nekudya zvinovaka muviri
Vananyamukuta vanopa dzidziso nezve:
– Kukanganiswa kwekuchenesa pamoyo, itsvo, uye pamuviri.
- Maitiro ekudya nguva dzose (semuenzaniso kudya kukuru katatu uye zvekudya zvine hutano zviviri kusvika zvitatu) kudzivirira nzara yakanyanya inokonzera kudhakwa zvakanyanya.
- Kukosha kwemvura mumuviri uye kusarudza chikafu chine mapuroteni akawanda, iron, folate, uye calcium, kunyanya kuvakadzi vane pamuviri.
- Ngano dzekudya zvisina kunaka uye zvinangwa zvekurema zvisingaite.
Kazhinji, chirongwa chekudya chinonyatsogadzirwa nenyanzvi yezvekudya zvinoenderana nezvinodiwa nemunhu mumwe nemumwe.
3) Kuongororwa Kwepamuviri uye Zviratidzo zveNjodzi
Kune varwere vane pamuviri, vananyamukuta vanotarisisa kuwedzera huremu, BP, mamiriro ekushaya ropa, kufamba kwemwana ari mudumbu, uye zviratidzo zvekusununguka nguva isati yakwana. Kana paine fungidziro yekuti mwana ari mudumbu haakure zvakanaka, tumirai murwere kuti aongororwe zvakanyanya.
4) Kushandira pamwe uye Kutumira Vamwe
Bulimia inoda kurapwa kwepfungwa (semuenzaniso, CBT-E) uye dzimwe nguva kurapwa nemishonga sekurairwa nachiremba. Vananyamukuta vanotumira varwere kunyanzvi dzepfungwa/nyanzvi dzepfungwa, nyanzvi dzezvekudya, uye nyanzvi dzezvekurapa/nyanzvi dzezvekubereka/nyanzvi dzemadzimai kana paine matambudziko. Kutumirwa nekukurumidza kunodiwa kana munhu achirutsa zvisingadzoreki, zviratidzo zvekupererwa nemvura zvakanyanya, kupera simba, kurwadziwa muchipfuva/kurova kwemoyo, kana kufunga kuzviuraya.
5) Rutsigiro rwemhuri nerwezvakatipoteredza
Kana mutengi abvumira, nyamukuta anogona kubatanidza mudiwa/mhuri kuti vagadzire nzvimbo yekutsigirana, kuderedza mashoko asina kunaka nezvemuviri wavo, uye kubatsira nekutarisira kudya. Kuchengetedzwa kwekuchengetedzwa kwenyaya dzepachivande kunochengetwa, uye sarudzo dzinozoitwa nemutengi pakupedzisira.
Kuongorora
Kubudirira kwekuchengetedzwa kwevana vadiki kunoongororwa kuburikidza nezviratidzo zvinotevera:
- Kudzikira kwekunwa doro zvakanyanya uye kuwedzera kudya nguva nenguva.
– Kuwanda kwemvura mumuviri uye zviratidzo zvehupenyu zvinogara zvakanaka, kunyunyuta kwemuviri kushoma.
– Zviyero zvepamuviri zvichienderana nemakore ekuzvitakura (kana uine pamuviri).
- Kuwedzera hunyanzvi hwekugadzirisa matambudziko, kuvandudzika kwekurara, uye kudzikira kwekuzvidya mwoyo.
- Kudzora kutevedza mitemo uye kubatana nemabasa epfungwa/epfungwa.
Kuongororwa kunoitwa nguva nenguva nekuti bulimia inowanzo dzoka, kunyanya kana kushushikana kwawedzera.
Mhedziso
Kutarisirwa kwekuchengetedzwa kwevana vane bulimia kunoda nzira yakazara inosanganisa kuongororwa kwevana nekukurumidza, kuongororwa kwemuviri nepamuviri, dzidzo yezvekudya, mazano ekutanga, uye kushanda pamwe chete nenyanzvi dzehutano hwepfungwa nenyanzvi dzezvekudya. Vananyamukuta vanoshanda semutambi wepamberi, vachivaka kuvimbana, vachideredza rusarura, uye vachiona kuchengetedzeka kwevanaamai nemwana ari mudumbu. Nekutarisirwa nguva dzose uye kutsigira, varwere vane mukana wakakura wekupora, kuchengetedza hutano hwekubereka, uye kuva nepamuviri pakachengeteka uye zvine chinangwa uye mushure mekusununguka.
