Page 90 Complete Your CE Test Online - Click Here ● ● Affected persons may eat to the point of discomfort and epigastric pain. They may eat rapidly during periods of binging. ● ● Affected persons may exercise excessively. ● ● Affected persons seem to spend an unusual amount of time in the bathroom, especially after meals. ● ● Affected persons are preoccupied with body shape and weight. ● ● Affected persons are obsessed with and fearful of the idea of gaining weight. ● ● Affected persons often eat abnormally large amounts of food at a time, especially high-fat, high-calorie foods. The foods are often soft in consistency since these kinds of food do not irritate a throat that may already be injured due to self-induced vomiting. ● ● Affected persons may dislike and avoid eating in public or in front of other people. ● ● Affected persons may abuse alcohol and/or other drugs. Physical assessment reveals normal weight or slightly above normal weight. This characteristic helps to distinguish bulimia nervosa from anorexia nervosa. Symptoms of anxiety or depression may be evident. Clients may also frustrate easily, behave impulsively, and have difficulty functioning in social settings, at school, or at work[9,12] . Menstrual irregularities, including amenorrhea, may occur[9] . Repeated episodes of vomiting may lead to painless enlargement of the salivary glands, hoarseness, sore throat, lacerations of the throat, and esophageal tears. Dental examination shows a loss of dental enamel, and teeth are chipped, ragged, or moth-eaten in appearance[9,12] . Examination of the client’s hands reveals calluses on the knuckles or abrasions and scars on the backs of the hands due to tooth injury as the client self-induced vomiting by sticking her/his fingers down the throat[9,12] . Nursing consideration: Many persons with bulimia nervosa induce vomiting by ingesting ipecac[9] . Therefore, injuries to the hands and knuckles would not be evident. Persons with bulimia nervosa are commonly perceived by others to have the “perfect” life. They may be thought to be the perfect student, perfect spouse, perfect career woman, and/or the perfect parent. Adolescents may excel at competitive activities such as sports or academic test scores. However, psychosocial assessment may reveal symptoms of depression or anxiety disorders, feelings of guilt, and/or childhood trauma such as sexual abuse[9] . PATHOPHYSIOLOGY Compared to anorexia nervosa, the pathophysiology of bulimia nervosa does not show the effects of near starvation. This does not mean, however, that the client is free from dangerous pathophysiological effects. These effects can include fluid and electrolyte imbalances[14] . Electrolyte imbalances Several electrolyte imbalances may be found in persons suffering from bulimia nervosa. Hypokalemia Hypokalemia may exist. Hypokalemia is defined as potassium levels lower than 3.5 mEq/L. The imbalance occurs when there is a significant loss of gastrointestinal fluids from prolonged vomiting or diarrhea[14] . Fluid loss from vomiting or diarrhea are characteristic of the purging behaviors associated with bulimia nervosa as is the abuse of diuretics, which also causes significant loss of fluids[9,14] . Other signs of hypokalemia include[9,14] : ● ● Weakness of the skeletal muscles, especially in the legs. ● ● Paresthesia (tingling or “pins and needles” sensations). ● ● Leg cramps. ● ● Decreased or absent deep tendon reflexes. ● ● Weakness of respiratory muscles that can lead to respiratory distress. ● ● Tachycardia. ● ● Rapid respiratory rate. ● ● Anorexia, nausea, and vomiting. Hypokalemia can also lead to cardiac problems. Signs of hypokalemia- related cardiac problems include[14] : ● ● Weak, irregular pulse. ● ● Arrhythmias. ● ● Orthostatic hypotension. ● ● Bradycardia or tachycardia. ● ● ECG changes, such as a flattened or inverted T wave, a depressed ST segment, and a characteristic U wave. Hyponatremia Decreased sodium, or hyponatremia, may develop. Hyponatremia is defined as a sodium level less than 135 mEq/L. When diuretics are abused, the body loses both fluid and sodium and imbalance occurs[14] . The signs and symptoms of hyponatremia can vary from client to client, depending on how quickly the client’s sodium level drops[14] . Some general signs and symptoms of this imbalance include[14] : ● ● Poor skin turgor. ● ● Dry, cracked skin. ● ● Weak, rapid pulse. ● ● Hypotension. ● ● Orthostatic hypotension. ● ● Central venous pressure (CVP), pulmonary artery pressure (PAP), and pulmonary wedge pressure (PAWP) may be decreased.