Ukuphathwa Kokunakekelwa Kwababelethisi Ezimweni Ze-Bulimia
I-Pendahuluan
I-Bulimia nervosa (i-bulimia) iyisifo sokudla esibonakala ngezigameko eziphindaphindwayo zokudla ngokweqile, kulandelwe ukuziphatha okuphindiselayo ukuvimbela ukukhuluphala, njengokuhlanza, ukusebenzisa i-laxative/diuretic, ukuzila ukudla ngokweqile, noma ukuvivinya umzimba ngokweqile. Uma kukhulunywa ngemithi yokubelethisa, i-bulimia iyinkinga enkulu ngoba ingathinta amantombazane asakhula, abesifazane abaseminyakeni yokuzala, kanye nomama abakhulelwe nabancelisayo. Ababelethisi basesimweni esibalulekile sokwenza ukutholakala kusenesikhathi, ukuhlinzeka ngemfundo, ukusekela izinguquko zokuziphatha okunempilo, kanye nokusebenzisana nethimba elihlanganisa imikhakha eminingi ukuqinisekisa ukuphepha komama nosana.
I-Bulimia ingaphezu nje "komkhuba wokudla okubi." Yisimo sempilo yengqondo esiyinkimbinkimbi, esivame ukuhlotshaniswa nomfanekiso womzimba ongemuhle, ukufuna ukuphelela, ukucindezeleka kwengqondo, kanye nezinye izifo ezifana nokucindezeleka nokukhathazeka. Umphumela wayo ungafinyelela kude, kufaka phakathi ukuphazamiseka kwe-electrolyte, izinkinga zesisu, ukukhubazeka kwamazinyo, ukungahambi kahle kokuya esikhathini, kanye nezinkinga zokukhulelwa ezifana nesisindo esiphansi sokuzalwa kanye nokubeletha ngaphambi kwesikhathi. Ngakho-ke, ukunakekelwa kwababelethisi be-bulimia kumele kube okuphelele, okuqhubekayo, futhi kugxile ekuphepheni nasekululameni kwesikhathi eside.
I-Etiology kanye Nezingozi Ezivela Embonweni Wokubeletha
Izimbangela ze-bulimia zinezici eziningi, ezibandakanya izici zebhayoloji, ezengqondo, kanye nezamasiko. Ekwelashweni kokubeletha, izici ezivame ukutholakala ezingozini zifaka:
1. Ingcindezi evela ezindinganisweni zobuhle kanye nokucwaswa kwesisindo, ikakhulukazi phakathi kwentsha kanye nabesifazane abasebasha.
2. Umlando wokunciphisa ukudla ngokweqile noma ukwehlisa isisindo ngokweqile, okubangela umjikelezo wokudla ngokweqile.
3. Umlando wokuhlukumezeka noma ubudlova, okuhlanganisa ukuthandana/ubudlova basekhaya.
4. Ukucindezeleka kokuphila kokuzala, njengokukhathazeka okuhlobene nokukhulelwa, izinguquko esimweni somzimba, noma isikhathi sokubeletha.
5. Izinkinga zengqondo, njengokucindezeleka, izinkinga zokukhathazeka, kanye nokusebenzisa kabi izidakamizwa.
Ababelethisi kudingeka baqaphele ukuthi amakhasimende amaningi afihla izimpawu ngenxa yamahloni. Ngakho-ke, indlela yokuxhumana enozwela futhi engahluleli ibalulekile ekunakekeleni.
Umphumela we-Bulimia empilweni yokuzala kanye nokukhulelwa
I-bulimia ingathinta impilo yokuzala ngokuphazamiseka kwama-hormone, ukungahambi kahle komjikelezo wokuya esikhathini, kanye nokwehla kokuzala kwabanye abantu. Ekukhulelweni, ingozi inganda uma ukuziphatha kokuhlanza kusebenza, ukuntuleka kokudla okunempilo kunganele, noma kwenzeka ukungalingani kwama-electrolyte. Imiphumela emibi engaba khona ihlanganisa:
– Ukuphelelwa amanzi emzimbeni kanye nokungalingani kwama-electrolyte (isib. i-hypokalemia) okungabangela ukungasebenzi kahle kwe-rhythm noma ubuthakathaka bemisipha.
– Izinkinga zesisu ezifana ne-reflux, i-esophagitis, noma ukuqunjelwa okubangelwa imithi yokuhlanza.
– Izinkinga zempilo yomlomo: ukuguguleka kwe-enamel yamazinyo, ukubola kwamazinyo, kanye nokuvuvukala kwe-parotid gland ngenxa yokuhlanza okuphindaphindiwe.
– Ukuvinjelwa kokukhula kwengane engakazalwa (IUGR), ukuntuleka kwegazi, kanye nengozi yokuzalwa ngaphambi kwesikhathi ezimweni ezithile.
– Izinkinga zengqondo zokubeletha, okuhlanganisa ukucindezeleka kwangaphambi kokubeletha kanye nokucindezeleka kwangemva kokubeletha.
Ngesikhathi sokubeletha kanye nesikhathi sokuncelisa, i-bulimia ingaphazamisa ukululama kukamama, ikhwalithi yokudla okunempilo, kanye nokuzinza ngokomzwelo, ngakho-ke ukwesekwa okuqhubekayo kubalulekile.
Izimiso Zokuphathwa Kokunakekelwa Kwababelethisi
Ukuphathwa kokunakekelwa kwababelethisi be-bulimia kunamathela ezimisweni ezilandelayo:
1. Ukuphepha komama nomntwana osesiswini njengento eza kuqala (ukuphepha kwesiguli).
2. Ukutholwa kusenesikhathi kanye nokungenelela okusheshayo ukuvimbela izinkinga zezokwelapha.
3. Indlela yokuxhumana nabantu ngokwengqondo nangokwenhlalo: hhayi nje ukugxila esisindweni, kodwa nasekuziphatheni, emizweni, kanye nokusekelwa kwabantu.
4. Ubumfihlo kanye nokuxhumana okwelaphayo ukuze kwakhiwe ukwethembana.
5. Ukubambisana kwemikhakha eminingi (odokotela, odokotela bezifo zengqondo/izazi zokusebenza kwengqondo, odokotela bezokudla okunempilo, odokotela bamazinyo, kanye nezinsizakalo eziphuthumayo uma kudingeka).
Ukuhlolwa Kwezokwelapha Ababelethisi
Ukuhlolwa kwenziwa nge-anamnesis, ukuhlolwa ngokomzimba, ukuhlolwa okusekelayo uma kutholakala, kanye nokuhlolwa kwempilo yengqondo.
1) I-Anamnesis Eqondisiwe
Ababelethisi bangabuza imibuzo ebucayi, isibonelo:
- Izindlela zokudla zansuku zonke, izigameko zokudla ngokweqile, kanye nezinto ezibangela imizwa.
– Ukuba khona kokuhlanza okubangelwa nguwe, ukusebenzisa imithi yokuhlanza/yokuhlanza, noma ukuvivinya umzimba okuphoqelekile.
- Umlando wokushintsha kwesisindo, ukudla okuphazamisekile, kanye nombono womzimba.
– Izimpawu zomzimba: isiyezi, ubuthakathaka, ukushaya kwenhliziyo, isilungulela, noma izinkinga zamathumbu.
– Umlando wokuya esikhathini, ukukhulelwa, kanye nezinhlelo zokuzala.
– Izimo zengqondo: ukukhathazeka, ukudabuka isikhathi eside, ukuphazamiseka kokulala, imicabango yokuzilimaza.
2) Ukuhlolwa Komzimba
Gxila ezimpawini zokuphelelwa ngamanzi emzimbeni, isimo sokudla okunempilo, umfutho wegazi, ukushaya kwenhliziyo, kanye nezimpawu zezinkinga ezifana nokukhula kwendlala ye-parotid, amanxeba engxenyeni engezansi yesandla (uphawu lukaRussell), ukuguguleka kwamazinyo, noma ukucasuka komphimbo. Kwabesifazane abakhulelwe, ababelethisi baphinde baqaphe ukukhuluphala, ukuphakama kwesizalo, kanye nezimpawu zokukhula kombungu.
3) Ukuhlolwa Kokuhlola Nokusekela
Uma isikhungo sivuma, sebenzisana nodokotela ukuhlola ama-electrolyte (i-potassium, i-sodium), i-hematology (i-anemia), ukusebenza kwezinso, kanye nokuhlolwa kwenhliziyo uma kukhona izimpawu. Amathuluzi okuhlola izinkinga zokudla noma impilo yengqondo angasetshenziswa ngokubona kwesikhungo.
Ukuhlela Nokuxilongwa Kwezibeletho
Ukuhlela ukunakekelwa kusekelwe ezinkingeni ezitholakele. Ukuxilongwa/izinkinga ezivamile ezimweni ze-bulimia zifaka:
– Ingozi yokungalingani kokudla okunempilo okungaphansi kwezidingo zomzimba.
– Ingozi yokuphazamiseka kwe-electrolyte kanye nokuphelelwa amanzi emzimbeni.
– Ukuphazamiseka kwesithombe somzimba.
– Ukukhathazeka noma ukuphazamiseka kwemizwelo.
– Ingozi yezinkinga zokukhulelwa (uma iklayenti likhulelwe).
– Ukuntuleka kolwazi ngokudla okunempilo kanye nezingozi zokuhlanza umzimba.
Imigomo yokunakekelwa ihlanganisa ukuzinzisa izimo zomzimba, ukwandisa ukuziphatha kokudla okunempilo, ukunciphisa ukuziphatha kokuhlanza umzimba, ukwandisa ukubhekana nesimo, kanye nokuxhumana nezinsizakalo zempilo yengqondo.
Ukuqaliswa (Ukungenelela) Kokunakekelwa Kwababelethisi
1) Ukuxhumana Kwezokwelapha kanye Nokwelulekwa Okuyisisekelo
Ababelethisi kudingeka basebenzise indlela engahluleli, baqinisekise imizwa, futhi basebenzise amasu okweluleka amafushane. Gxila ekwakheni isisusa soshintsho, ukuhlonza izimbangela zokuhlanza ngokweqile, kanye nokuthuthukisa amasu okubhekana nezimo ahambisanayo (isib. amasu okuphumula, ukubhala phansi, noma ukwesekwa komphakathi).
2) Imfundo Yezempilo Nokudla Okunomsoco
Ababelethisi banikeza imfundo mayelana nalokhu:
– Umphumela wokuhlanza inhliziyo, izinso kanye nokukhulelwa.
– Izindlela zokudla ezivamile (isib. ukudla okuyinhloko oku-3 kanye nokudla okulula okunempilo okungu-2–3) ukuvimbela indlala enkulu ebangela ukugwinya.
– Ukubaluleka kokuthola amanzi emzimbeni nokukhetha ukudla okucebile ngamaprotheni, i-iron, i-folate, kanye ne-calcium, ikakhulukazi kwabesifazane abakhulelwe.
- Izinganekwane zokudla kanye nemigomo yokwehlisa isisindo engenakwenzeka.
Ezimweni eziningi, uhlelo lokudla lungcono kakhulu oluthuthukiswe nochwepheshe wezokudla ukuze luvumelane nezidingo zomuntu ngamunye.
3) Ukuqapha Ukukhulelwa kanye Nezimpawu Zengozi
Kumaklayenti akhulelwe, ababelethisi baqapha ngokucophelela ukukhuluphala, umfutho wegazi, isimo sokuntuleka kwegazi emzimbeni, ukunyakaza kombungu, kanye nezimpawu zokubeletha ngaphambi kwesikhathi. Uma kusolwa ukuthi kukhona ukuvinjelwa kokukhula kombungu, thumela isiguli ukuze sihlolwe kabanzi.
4) Ukubambisana kanye Nokudluliselwa
I-Bulimia idinga ukwelashwa kwengqondo (isb., i-CBT-E) futhi ngezinye izikhathi ukwelashwa ngemithi njengoba kuyalelwe udokotela. Ababelethisi badlulisela iziguli kodokotela bezengqondo/odokotela bezifo zengqondo, odokotela bezokudla okunempilo, kanye nodokotela bezifo zabesifazane/odokotela bezifo zabesifazane uma kuvela izinkinga. Ukudluliselwa ngokushesha kuyadingeka uma kuvela ukuhlanza okungalawuleki, izimpawu zokuphelelwa amanzi emzimbeni okukhulu, ukuquleka, ubuhlungu besifuba/ukushaya kwenhliziyo, noma imicabango yokuzibulala.
5) Ukusekelwa Komndeni Nezemvelo
Ngemvume yeklayenti, umbelethisi angabandakanya umlingani/umndeni ukudala indawo yokusekela, ukunciphisa ukuphawula okungekuhle ngomzimba wabo, nokusiza ngokuphathwa kokudla. Ukugcinwa kwemfihlo kuyagcinwa, futhi izinqumo zenziwa yiklayenti ekugcineni.
Ukuhlolwa
Impumelelo yokunakekelwa kwababelethisi ihlolwa ngezinkomba ezilandelayo:
– Ukwehla kwezikhathi zokuhlanza ukudla ngokweqile kanye nokwanda kokudla njalo.
– Isimo sokuntuleka kwamanzi emzimbeni kanye nezimpawu zokuphila zizinzile, izikhalazo zomzimba ziyancipha.
– Imingcele yokukhulelwa ngokweminyaka yokukhulelwa (uma ukhulelwe).
- Amakhono okubhekana nezimo athuthukisiwe, ubuthongo obuthuthukisiwe, kanye nokukhathazeka okuncishisiwe.
- Ukulawulwa kokuthobela imithetho kanye nokuxhumana nezinsizakalo zengqondo/zengqondo.
Ukuhlolwa kwenziwa njalo ngoba i-bulimia ivame ukuphinda ibuye, ikakhulukazi lapho ukucindezeleka kukhuphuka.
Isiphetho
Ukuphathwa kokunakekelwa kwababelethisi be-bulimia kudinga indlela ebanzi ehlanganisa ukutholwa kusenesikhathi, ukuqapha ngokomzimba nangokwesisu, imfundo yokudla okunempilo, ukwelulekwa okuyisisekelo, kanye nokubambisana nochwepheshe bezempilo yengqondo kanye nochwepheshe bezokudla. Ababelethisi basebenza njengabaphambili, bakha ukwethembana, banciphise ukucwaswa, futhi baqinisekise ukuphepha komama nosana. Ngokunakekelwa okuqhubekayo nokusekelayo, amaklayenti anethuba elikhulu lokululama, alondoloze impilo yokuzala, futhi athole ukukhulelwa okuphephile nokunenjongo kanye nesikhathi sokubeletha.
