A nurse is caring for a client in an emergency department (ED).

Exhibits

For each assessment finding, click to specify if the finding is consistent with bulimia nervosa or anorexia nervosa. Each finding may support more than one disease process or none at all. There must be at least 1 selection In every column. There does not need to be a selection in every row. (Note: Each category must have at least 1 response option selected)

Rationale:

A. Check for a disconnection in the ventilator tubing: A disconnection typically causes a low-pressure alarm, not an increase in peak airway pressure, and would not be the appropriate first response in this case.

B. Assess the ET for a cuff leak: A cuff leak would decrease airway pressure, potentially causing a low-pressure alarm. It is not associated with increased peak airway pressure alarms.

C. Verify the placement of the ET: ET tube misplacement can lead to ventilation issues, but it does not directly cause increased peak pressures unless malposition leads to obstruction, which would be less common.

D. Check for a kink in the ventilator tubing: A kink or obstruction in the tubing increases airway resistance and can cause high peak airway pressure alarms. Resolving the kink can restore normal pressure.

E. Suction the ET to remove secretions: Mucus plugging or secretion buildup increases resistance in the airway, raising peak pressures. Suctioning helps alleviate the obstruction and reduce alarm triggers.

Rationale:

• Parotid glands: Parotid gland enlargement is a typical finding in clients with bulimia nervosa due to repeated episodes of self-induced vomiting. The recurrent stimulation of salivary glands leads to painless swelling, often bilateral, and may also contribute to facial puffiness or a rounded appearance.
• Potassium level: A potassium level of 3.0 mEq/L is low and may result from either bulimia nervosa or anorexia nervosa. In bulimia, this is typically due to purging through vomiting or laxative use; in anorexia, it stems from prolonged restriction, dehydration, and possible diuretic misuse. Both conditions increase the risk of cardiac complications.
• Weight: The client’s weight of 61.8 kg with a BMI of 20.7 falls within the normal range and is more consistent with bulimia nervosa. Individuals with anorexia nervosa usually present with a significantly lower body weight and BMI, typically below 18.5, due to extreme caloric restriction and prolonged starvation.
• Sodium level: A sodium level of 134 mEq/L is slightly low and can occur in both bulimia nervosa and anorexia nervosa. In bulimia, frequent vomiting may cause sodium loss, while in anorexia, hyponatremia can develop from malnutrition, dehydration, or excessive water intake in attempts to suppress appetite or manipulate weight.
• Hand findings: Calluses on the index and middle fingers, known as Russell’s sign, are associated with bulimia nervosa. These result from repeated trauma during induced vomiting episodes, as the hand comes into contact with the teeth. This finding is a classic physical sign of chronic purging behavior.