Bulimia Nervosa Disease Process, Symptoms, Treatment, and Recovery

Bulimia Nervosa Case Analysis
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Bulimia Nervosa Case Analysis
1 Pathology
1 Disease Process
Bulimia nervosa, or simply called bulimia is a serious eating disorder that can become life threatening if not handled early enough. The illness is characterized by binging, which involves eating large amounts of food, and then purging, which entails attempts to get rid of the extra calories resulting from the uncontrolled eating (John Hopkins Medicine, 2021). Individuals suffering from the disease utilize different approaches to eliminate the calories and prevent weight gain. For example, some may induce vomiting, others may utilize weight-loss supplements, and others may use diuretics or enemas. In the case provided, the patient exhibits binge eating by consuming several chocolate bars and then inducing vomiting. She has been exhibiting this behavior for a significant period and now she is engaged. She desires to be treated from the condition and hence the need for analysis and recommendation for appropriate intervention. The nursing process will include a physical observation for any signs and symptoms, a psychological assessment to confirm the signs, and finally an educational diagnosis to link the signs to the underlying causes that will culminate into the recommendation for proper intervention.
2 Etiology of the Disease Process
The disease affects approximately 1.6% of the adolescents, with the affected people being extremely sensitive about their body shape and weight. These people apply different approaches in an attempt to lose their weight. The illness begins in late childhood or early adulthood. The exact cause of the disease has not been identified. However, according to research, there could be a mixture of personality traits, emotions, and thinking patterns combined with environmental and biological factors (Bhandari, 2020). Researchers posit that the behavior may begin with dissatisfaction of one’s body in terms of its size and shape. This dissatisfaction results in low self-esteem and fear. Other potential risk factors to the condition include depression and anxiety, substance use, traumatic events, stress, and frequent dieting.
3 Signs and Symptoms
Different people present different signs and symptoms of the disease. However, there are some common signs that tend to be exhibited by many people. Some of these include dental problems, sore throat, swollen glands on the neck and face, heartburn, indigestion, bloating, irregular periods, and exhaustion (The Kusnacht Practice, 2021). In addition, one can also exhibit calluses at the knuckles or back of the hand, some people gain and lose weight more often, cases of dizziness, feeling cold most of the time, dry skin and brittle nails. Behavioral problems associated with the condition include uncontrollable eating accompanied by purging, hoarding, food rituals, skipping meals, feeling out of control.
2 Medication
4 First Line Treatment
People suffering from the condition may require several types of treatment. However, combining psychotherapy with the use of antidepressants as the first line treatment may be the most effective approach in the management of the disorder. Talk therapy or psychological counselling and involves a professional, mainly in mental health, talking to the bulimia patient about their lifestyle. According to the available evidence, the different types of psychotherapy that can help improve the patient’s condition include cognitive behavioral therapy, family-based treatment, and interpersonal psychotherapy (Kass, Kolko, & Wilfley, 2013). Cognitive behavioral therapy helps normalize the patient’s eating patterns by debunking negative beliefs and behaviors and instilling healthy ones. Family-based treatment helps parents intervene to prevent their children from engaging in unhealthy eating habits. The parents also ensure that their children regain control of their eating. Finally, interpersonal psychotherapy addresses the challenges affecting one’s close relationships and helps the patient improve their communication and problem-solving skills.
5 Second Line Treatment
Treatment does not only focus on the patient but their family, primary care provider, a mental health professional, and a dietitian with suitable experience in handling eating disorders. In this approach, the patient’s success is based on the relationship that he or she shares with her family and medical service providers
6 Medication
There are several classes of medication proven to be effective at managing bulimia nervosa. The most effective class is that of antidepressants. Another class is seizure control medications. Alternative medications such as attention deficit/hyperactivity disorder (ADHD) and anti-craving agents have also been established to be helpful in managing the condition.
7 Class of Medication
Psychotherapy works best when combined with antidepressants. The antidepressants have several other classes that include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (O’Melia, 2016). These drugs help reduce the symptoms of the disorder and allow the patient to cope with the therapy. Fluoxetine (Prozac) is the only antidepressant approved by the Food and Drug Administration. The drug works by inhibiting serotonin uptake and hence belongs to the selective serotonin reuptake inhibitor (SSRI) class. The drugs are effective for a person even if they are not depressed. Other drugs include Topamax, Topiramate, and Fluoxetine. Other second-line treatment approaches in the management of the condition include nutrition education and hospitalization. Under the former, the patient works with dietitians, who help design an eating plan suitable for the desired health benefits. The dietitian must ensure that the diet prevents hunger and cravings (Mayo Clinic Staff, 2018). The patient can also be encouraged to eat regularly and not restrict their food intake. The hospitalization option occurs when the symptoms are severe and present serious health implications. The patient can also be subjected to some eating disorder programs instead of inpatient hospitalization.
8 Common Side Effects
Patients in the recovery process are still prone to various challenges. Consequently, each caregiver should have appropriate counselling skills to help them overcome the stresses that they face. Among the important measures that the patients should be exposed to in their use of bulimia medication is the effect of those medicines. Among the possible side effects for use of the drugs is the increased risk of suicidal thoughts and behavior among the users of antidepressants. Bupropion is a prominent antidepressant with an FDA “black box” warning for use by patients suffering from bulimia nervosa (Uniacke & Broft, 2016). Patients are cautioned against using this drug for the treatment of eating disorders and comorbid depression as it is associated with an increase in the seizure risk. For example, in a trial involving bupropion and a placebo as interventions for treatment of bulimia, 4 of the 55 women who participated in the study experienced grand mal seizures. Therefore, users have to be cautious on how they use the drugs.
3 Diagnosis
9 Primary Physical, Psychosocial and Education
1 Primary Physical Diagnosis
Bulimia can be diagnosed using various approaches. Three of the common nursing techniques used can be classified into three groups: primary physical, psychosocial, and educational diagnosis. Nurses should be concerned about these signs as they can serve as leads to more prominent problems. The signs include:
* Facial swelling or swollen parotid glands
* Heartburn, indigestion, bloating
* Irregular menstrual patterns
* Weakness, exhaustion
* Bloodshot eyes.
2 Psychosocial Diagnosis
The psychosocial approach entails observation of the individual’s psychosocial behavior. The potential signs that the patient may exhibit in this aspective include:
* Tendency to withdraw from normal social activities
* Excessive preoccupation with his weight and body
* Guilt
* Anxiety
* Depression
* Irritable or moody
3 Educational Diagnosis
The educational approach entail utilizing the information obtained and applying the necessary framework to diagnose the patient. Nurses note these signs and assign meaning to the collected information, which is subjected to the NANDA labelling that is an approved tool for nursing diagnosis.
The NANDA-International (NANDA-I), previously known as the North American Nursing Diagnosis Association (NANDA) refers to the main organization that facilitates the defining, distribution and integration of standardized nursing diagnoses around the world. The organization first held its conference in 1973 to identify, develop, and classify nursing diagnoses. While the organization was previously limited within the United States, it changed its name to NANDA-I owing to the significant growth in membership across the world (Herdman & Kamitsuru, 2014). The organization has four types of nursing diagnosis: actual, risk, health promotion, and syndrome. Problem-focused diagnosis refers to the patient’s problem that is...