Clients may also become frustrated easily, behave impulsively, and have difficulty functioning in social settings at school or at work (Gersch et al., 2016; Videbeck, 2017). Menstrual irregularities, including amenorrhea, can occur. Repeated episodes of vomiting can 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 (Eating Disorder Hope, 2018b; Videbeck, 2017). Examination of the client’s hands reveals calluses on the knuckles or abrasions and scars on the backs of the hands (called Russell’s sign) because of tooth injury as the client self-induces vomiting 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 include fluid and electrolyte imbalances (Gersch et al., 2016). Fluid and Electrolyte Imbalances Several electrolyte imbalances are found in persons suffering from bulimia nervosa (Eating Disorder Hope, 2018b; Gersch et al., 2016). 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 (Willis, 2015). Fluid loss from vomiting or diarrhea is characteristic of the purging behaviors associated with bulimia nervosa as is the abuse of diuretics, which also causes significant loss of fluids (Gersch et al., 2016; Willis, 2015). Here are other signs of hypokalemia (Willis, 2015): ● 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 these cardiac problems (Willis, 2015): ● Weak, irregular pulse ● Arrhythmias (prolonged QT interval) ● 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 Hyponatremia (decreased sodium) 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 imbalances occur (Willis, 2015). The signs and symptoms of hyponatremia vary from client to client, depending on how quickly the client’s sodium level drops (Willis, 2015). These are general signs and symptoms of this imbalance (Mayo Clinic, 2018e; Willis, 2015): ● 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
by sticking their fingers down the throat (Eating Disorder Hope, 2018b; Videbeck, 2017). 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 person, 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, low self-esteem, or childhood trauma such as sexual abuse (Eating Disorder Hope, 2018b; Gersch et al., 2016; Videbeck, 2017). Hypochloremia Hypochloremia, or a deficiency of chloride, is defined as a serum chloride level below 98 mEq/L. Chlorine is lost when fluid is lost from the GI tract or from the kidneys (Willis, 2015). Clients with hypochloremia often exhibit signs and symptoms of various other electrolyte imbalances (hypokalemia and hyponatremia) or metabolic alkalosis. The nerves are more irritable and excitable, potentially resulting in tetany, hyperactive deep tendon reflexes, and hypertonicity of the muscles (Willis, 2015). Here are additional signs and symptoms (Willis, 2015): ● Muscle cramps
● Muscle twitching ● Muscle weakness
● Irritability ● Agitation
If levels continue to dangerously decrease, the client could develop seizures, arrhythmias, respiratory arrest, and coma (Willis, 2015). Metabolic Alkalosis Elevated bicarbonate levels can lead to metabolic alkalosis. This imbalance is caused by a decrease in hydrogen ion production characterized by a blood pH above 7.45 and a bicarbonate level above 26 mEq/L (Thomas, 2018; Willis, 2015). A variety of problems can lead to metabolic alkalosis. The most common cause is an excessive loss of acid from the GI tract. For example, prolonged periods of vomiting can cause a loss of hydrochloric acid from the stomach. Diuretic use is another cause. Thiazide and loop diuretics cause fluid loss as well as the loss of hydrogen, potassium, and chloride ions from the kidneys. Low potassium levels cause the kidneys to excrete hydrogen ions as they try to conserve potassium. Potassium moves out of the cells, hydrogen moves into the cells, and the result is alkalosis (Thomas, 2018; Willis, 2015). In the early stages of metabolic alkalosis, slow, shallow respirations prevail. As the problem continues, hypoxemia (low levels of oxygen in the blood) develops, which stimulates and increases respirations. Following are additional signs and symptoms of metabolic alkalosis (Thomas, 2018; Willis, 2015): ● Anorexia ● Apathy ● Confusion ● Cyanosis ● Hypotension ● Loss of reflexes ● Twitching of muscles ● Weakness ● Nausea and vomiting
Page 129
Book Code: PYMA2024
EliteLearning.com/Psychology
Powered by FlippingBook