• Build trust by acknowledging emotional and physical struggles

• Assess for suicide risk and self-harm

• Monitor vitals and electrolytes

• Weigh consistently; expect gradual weight gain

• Supervise meals and after-meal periods

• Address distorted body image without arguing

• Educate on health risks and recovery benefits

• Identify strengths to improve coping

Interventions for Bulimia Nervosa

• Assess mood and suicide/self-harm risk

• Monitor vitals and electrolytes

• Track weight per protocol

• Challenge thoughts driving the binge–purge cycle

• Educate that fasting worsens the cycle

• Supervise during and after meals

• Acknowledge body image distortions without conflict

• Encourage journaling to identify triggers

Interventions for Binge-Eating Disorder

• Assess mood, stressors, and suicide/self-harm risk

• Set treatment goals with the care team

• Provide nutritional counseling (consider risks like Type 2 Diabetes)

• Use psychosocial treatments (e.g., cognitive-behavioral therapy)

-Impaired Nutritional Status

-Risk for Injury

-Disturbed Body Image

-Negative Self-Image

-Low Self-Esteem

-Difficulty Coping

-Anxiety

-Risk for Self-Mutilation

-Risk for Suicide

-Impaired Health-Seeking Behavior

-Non-Adherence

-Impaired Family Coping

-abnormal thyroid function

-sudden cardiac arrest caused by electrolyte disturbances

-keratinemia (very pale skin)

-elevated cholesterol

-fatty degeneration of the liver (indicated by elevated serum enzyme levels)

-prolonged QT interval

Bulimia

-erosion of teeth

-Russel's sign (callused knuckles from induced vomiting)

-cardiac murmur (commonly mitral valve prolapse)

-hypokalemia

-loss of dental arch

-esophageal tears

-severe abdominal pain

-cardiomyopathy (rare)

box 14.2 pg 194

Subjective (what the patient reports)

Intense fear of gaining weight

Distorted body image (“I’m fat” despite being underweight)  

Obsessive thoughts about food, calories, and weight

Denial of the seriousness of low weight

Rigid thinking, perfectionism, need for control  

Objective (what the nurse observes):

Severely underweight/extreme weight loss

Amenorrhea (or menstrual irregularities)  

Wearing baggy or layered clothing to hide the body  

Lanugo (fine body hair), dry skin, brittle nails

Bradycardia, hypotension, hypothermia

Muscle wasting, weakness

Refusal to eat / very restrictive intake

Behavioral cues:

Ritualistic eating behaviors (cutting food tiny, pushing food around)

Excessive exercise

Social withdrawal (especially around meals)

Bulimia:

Subjective

• Recurrent binge eating (loss of control)  

• Feelings of guilt, shame after eating

• Preoccupation with weight/body shape

• Reports of purging behaviors (vomiting, laxatives, fasting, excessive exercise)  

Objective

• Weight usually normal or slightly above normal  

• Parotid gland swelling (puffy cheeks)  

• Dental erosion/cavities

• Russell’s sign (calluses on knuckles)  

• Dry skin, hair thinning

• Possible edema

Lab findings (important for exams)

• Hypokalemia (from vomiting/laxatives)  

• Metabolic alkalosis (vomiting)  

• Dehydration labs (↑ BUN, electrolyte imbalance)  

Behavioral cues

• Frequent trips to the bathroom after meals

• Secretive eating/binge episodes

• Hoarding food or eating large amounts rapidly