What feet · Muscle weakness · Dry skin

What is BulimiaNervosa?  Bulimia nervosa is a potentiallydeadly eating disorder affecting nearly 3% of all Americans at some point intheir lives (National Association of Anorexia Nervosa and Associated Disorders, 2018).  Mainly affecting women, the definingcharacteristics of bulimia nervosa are reoccurring cycles of binge eating and purging. The patient feels out of control whilebingeing, and may consume thousands of calories in a single meal.

 Purging serves the purpose of compensating forbinge eating, for which the patient holds a great amount of guilt andself-loathing.  To regain a sense ofcontrol, the patient will attempt to “undo” what they have eaten; this may beaccomplished by inducing vomiting, misuse of medications (laxatives, diuretics,etc.), fasting, or obsessive exercise. Causes of BulimiaNervosa  In the past, there was amisconception that dysfunctional family relationships were the cause of eatingdisorders.

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  While these relationships mayexacerbate factors contributing to bulimia, they are no longer considered to bethe cause.  One consistent theme with alleating disorders is that the patient has an unhealthy obsession withcontrolling their food consumption, weight, and personal appearance.  However, there is not one specific cause ofbulimia nervosa; there are many factors that can make a person susceptible to developingbulimia nervosa.  Bulimia may behereditary or a result of a neurologic abnormality.  Some patients may use bulimia as a method ofcoping with sexual or physical abuse, anxiety, depression, low self-esteem, orother emotional pain or trauma (The Center For Eating Disorders, 2018).

  Regardless of the underlying cause, bulimianervosa patients are desperate to find relief from the unbearable lack ofcontrol they feel over their own life.Bulimia Nervosa:Signs and SymptomsUnfortunately, people with bulimia areextremely proficient at covering their disorder.  In fact, most people with bulimia are ofnormal weight or overweight.  The earliera patient is diagnosed and treated, the greater their chance of recovery.  Knowing how to recognize the signs andsymptoms of bulimia nervosa is vital, because of all psychiatric diseases,bulimia nervosa is amongst the most fatal.

 PhysicalSymptoms ·      Fluctuating weight ·      Gastrointestinal issues ·      Fainting, or Syncope ·      Irregular/absent periods ·      Impaired immunity ·      Poor wound healing ·      Cold hands and feet ·      Muscle weakness ·      Dry skin and nails ·      Difficulty sleeping ·      Dental problems ·      Anemia ·      Hypothyroid ·      Hypokalemia ·      Bradycardia ·      Cuts or callouses on the knuckles BehavioralSignsRecognizing the behavioral oremotional signs of bulimia is significantly more challenging; the patient makesa conscious effort to hide behaviors that may raise suspicion.  One of the signs of bulimia is an increased and/orunusual focus on body image, weight loss, exercise, and food.  Eating behaviors may change; the patient mayprefer to eat alone, skip meals, or adapt food rituals.  The patient frequently disappears after mealsand is isolating oneself from friends and family in order to conceal purgingrituals.  Large amounts of food or foodwrappers and containers may be hidden to avoid discovery (National Eating Disorders Association, 2018).  Individually, any of these signs may notcause a friend or relative to become suspicious;however, knowing the signs and symptoms of bulimia canhelp a person put together the clues of bulimia nervosa in order to get professionalhelp.

Bulimia Nervosa:Medical Complications            As a result of inadequate nutrition and purging,misuse of laxatives, and/or excessive exercise, serious medical complicationsmay occur.              Cardiac implications may includecardiomyopathy, tachycardia, dysrhythmias, cardiac arrest, murmur, or mitralvalve prolapse.            Fluids and electrolyte imbalances arelikely.  Metabolic alkalosis resulting inelevated bicarbonate, hypochloremia, hypokalemia, and dehydration arecommon.  Dehydration leads to stimulationof the renin-angiotensin-aldosterone system, leading to further potassium loss.            Gastrointestinal consequences consistof elevated serum amylase levels leading to the parotid gland becomingenlarged, esophageal tears, and gastric dilation and severe pain in theabdomen.

            Other complications that may be seenare erosion and attrition of the teeth, loss of the dental arch, and difficultychewing (Varcarolis, 2017).Bulimia Nervosa: TheNursing Process            Assessment priority is to stabilize thepatient after a complete examination and obtaining an electrocardiogram and thefollowing laboratory test results: electrolytes, glucose, thyroid function, andCBC.  The patient should be evaluated forcomorbidity, as depression, anxiety or other psychiatric disorders are commonin bulimic patients; a psychiatric consult should be arranged.  

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