Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: [Link] Mail: unp_nursingvc@[Link]
CP# 09177148749, 09175785986
NCM 109 PEDIA
ACTIVITY 4
Bulimia Nervosa
By: Catherine A. Prado BSN II – B
Bulimia Nervosa
A psychological and severe life-threatening eating disorder described by the ingestion of an abnormally
large amount of food in short time period, followed by an attempt to avoid gaining weight by purging
what was consumed.
Causes of Bulimia
The exact cause of bulimia nervosa is currently unknown; though it is thought that multiple factors
contribute to the development of this eating disorder, including genetic, environmental, psychological,
and cultural influences. Some of the main causes include:
Stressful transitions or life changes
History of abuse or trauma
Negative body image
Poor self-esteem
Professions or activities that focus on appearance/performance
Risk factors
Girls and women are more likely to have bulimia than boys and men are. Bulimia often begins in the late
teens or early adulthood.
Factors that increase your risk of bulimia may include:
Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder
may be more likely to develop an eating disorder, suggesting a possible genetic link. Being
overweight as a child or teen may increase the risk.
Psychological and emotional issues. Psychological and emotional problems, such as depression,
anxiety disorders or substance use disorders are closely linked with eating disorders. People with
bulimia may feel negatively about themselves. In some cases, traumatic events and environmental
stress may be contributing factors.
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Dieting. People who diet are at higher risk of developing eating disorders. Many people with
bulimia severely restrict calories between binge episodes, which may trigger an urge to again
binge eat and then purge. Other triggers for bingeing can include stress, poor body self-image,
food and boredom.
Signs and Symptoms
Physical signs and symptoms of this eating disorder are:
Constant weight fluctuations
Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death
Broken blood vessels within the eyes
Enlarged glands in the neck and under the jaw line
Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting
Chronic dehydration
Inflammation of the esophagus
Chronic gastric reflux after eating or peptic ulcers
Infertility
Signs and symptoms of binge eating and purging are:
Disappearance of large amounts of food
Eating in secrecy
Lack of control when eating
Switching between periods of overeating and fasting
Frequent use of the bathroom after meals
Having the smell of vomit
Complications
Bulimia may cause numerous serious and even life-threatening complications. Possible complications
include:
Negative self-esteem and problems with relationships and social functioning
Dehydration, which can lead to major medical problems, such as kidney failure
Heart problems, such as an irregular heartbeat or heart failure
Severe tooth decay and gum disease
Absent or irregular periods in females
Digestive problems
Anxiety, depression, personality disorders or bipolar disorder
Misuse of alcohol or drugs
Self-injury, suicidal thoughts or suicide
Prevention
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Education about and awareness of the disorder and associated risk factors
Early intervention if risk factors are identified
Knowledge and maintenance of healthy eating habits
Cultivation of a positive self-image of the body
Maintenance of good mental health
Counseling as needed to identify and resolve areas of conflict and stress
Balancing school, work, social life, rest, and exercise
Medical and Nursing Management
Nutritional counseling.
CBT
Interpersonal therapy.
SSRIs. The only FDA-approved medication for treating eating disorders is fluoxetine (Prozac).
Patient with bulimia are aware of their problems and they want to be helped because they feel
helpless and unable to control themselves during episodes of binging. But because of their intense
desire to please and need to conform they may resort to manipulative behavior and tell half-truths
during interview to gain trust and acceptance of nurses. Create an atmosphere of trust. Accept
person as worthwhile individual. If they know that no rejection or punishment is forth coming
they disclose their problem, they will be more open and honest.
Develop strength to cope with problems. Encourage patient to discuss positive qualities about
themselves to increase self-esteem.
Help patient identify feelings and situations associated with or that triggers binge eating.
Assist to explore alternative and positive ways of coping.
Encourage making a journal of incident and feelings before-during and after a binge episode.
Make a contract with the patient to approach the nurse when they feel the urge to binge so that
feelings and alternative ways of coping can be explored.
Encourage adhering to meal and snack schedule of hospital. This decreases the incidence of
binging, which is often precipitated by starvation and fasting.
Encourage participating in group activities with other persons having the same eating disorder to
gain additional support.
For young adolescent living at home, encourage family therapy to correct dysfunctional family
patterns.
Cognitive behavioral therapy is the ideal therapy to help the bulimic understand the problem and
explore appropriate behaviors.