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HNB 2008 Contemporary Nursing C


Under the medical treatment and decisions act (MTDA, 2016) (Hempton & Bhatia, 2020) and the mental health act (2014) (Maylea & Hirsch, 2017), patients presumably can make decisions regarding their mental and medical treatment. This essay will use a clinical reasoning cycle as a basis for diagnosis and formulating a treatment plan for Jessica jones, a patient diagnosed with bulimia nervosa.

Patient Situation

Jessica Jones is an 18-year-old female diagnosed with bulimia nervosa. She presents at the local hospital with weight loss over the previous six months and strange behaviour, including being secretive about food, being withdrawn and antisocial, eating alone, avoiding people during mealtimes, and frequenting the bathroom. Jessica feels guilty, regretful, ashamed, and depressed about her condition (Forrest et al., 2018). Jessica was reviewed by the mental health team, who performed a SCOFF questionnaire on her to assess her condition. she was reviewed and admitted with electrolyte imbalances and given potassium supplements, a fluid balance chart, referral to a dietitian, fluid chart and supervision, continuous cardiac monitoring, bed rest and supervised toileting.

Collect cues and information

Jessica is reviewed by a general physician who finds out that she has hypernatremia (149mmol/L), hypokalaemia (2.5mmol/L) and cardiac arrhythmias on a background of prolonged binge eating and purging. How vital signs indicate irregular pulse, low blood pressure, and filling dizziness without clear reasons. Jessica’s weight is 40kg, and her height is 170 centimetres. Jessica has a past medical history of bulimia nervosa, a potentially serious medical condition if unaddressed. Bulimia nervosa is a serious eating disorder that causes an individual to consume large amounts of food and then parge them to eliminate the extra calories (Forrest et al., 2018). This can be dangerous as it can cause other complications, including electrolyte imbalances, cardiac arrhythmias, gastroesophageal reflux disease, sore throat and even oesophageal cancer.

Process Information

Jessica’s abnormal electrolyte values, even the acid-base balance system, indicate a disorder. According to Strobel et al. (2019), a normal person’s potassium level ranges from 3.6 to 5.2 mmol/L, while normal sodium levels range from 135 to 150 mmol/litre. As a result, the abnormal ranges indicate that the patient’s health is deteriorating caused of a disorder in one of the electrolyte balance regulators within her body. This electrolyte imbalance likely stems from Jessica’s bulimia nervosa, which makes her purge after eating. According to Berner et al. (2019), almost half of all Patients with bulimia nervosa experience electrolyte imbalances as the cause of their disease. This is because frequent vomiting causes the loss of hydrogen ions in gastric acid, leading to alkalosis, while laxative use causes a patient to lose sodium and potassium. Generally, alkalosis causes hypokalaemia by increasing potassium secretion within the renal tubules (Forrest et al., 2018). increased potassium situation results in a complementary reduced secretion of sodium, accumulating in serum, Leading to two hypernatremia. This electrolyte imbalance can be detrimental to patient health as it can lead to serious consequences, including cardiac arrhythmias.

Identify problems

An adequate examination for Jessica would involve examining for bulimia, anorexia and other low self-esteem indicators. This might involve a comprehensive assessment of overall mental health and evaluation for other eating disorders (Slade et al., 2018). A registered nurse will make an effort to implement comprehensive screening methods for suspected conditions. SCOFF is a useful tool when examining such a patient. It involves asking patients questions that will allow them to give information regarding their condition. The tool may, however, not be used if the patient is emotionally unstable, e.g. when angry. In that case, other assessment tools, such as self-assessments of western air, can be employed to analyse the questions about nutrition and diet behaviour (Berner et al., 2019).

A general physician’s examination reveals that Jessica suffers from hypernatremia, hypokalaemia, and arrhythmia. Furthermore, the assessment reveals that she has hypotension and sometimes experiences unexplained dizziness (Meule et al., 2021). From the history, the general physician finds out that Jessica has been overeating and abusing laxatives. She is then admitted to the local hospital for further monitoring. Jessica’s electrolyte imbalances should be given priority as they are the ones who are likely to cause the most detrimental facts if unaddressed (Tith et al., 2020). A complication of electrolyte imbalances in the body is heart conditions such as arrhythmias. If unaddressed, arrhythmias can be rapidly fatal.

Establish goals

The main goals of treating bulimia nervosa would include first, identifying the adopted abnormal perception about food; reducing and, whenever possible, eliminating the behaviour of binge eating and purging; the physical complications that arise due to eating and purging; restoring the patient health; increasing the patient’s motivation be cooperative when managing her health, and helping the patient adopt A healthy eating diet plan and behaviour (Slade et al., 2018). People struggling with bulimia never saw another eating disorder and believe eating food can make them fat and unhealthy, making them develop rituals of purging after eating. Additionally, they have added distorted body image, making them believe that they are obese or overweight although they have normal weight. Helping the patient adopt a good eating night plan would allow them to choose foods with the most nutritional benefit (Slade et al., 2018). This will be achieved through nutrition counselling, allowing the patient to remain healthy without adopting bad eating behaviour. Lastly, managing compulsive behaviours by addressing the patients’ triggers would be crucial in treating the condition.


The treatment plan for bulimia nervosa would involve a combination of psychotherapy, pharmacotherapy, and education (Slade et al., 2018). Effective treatment of bulimia nervosa involves a multidisciplinary approach which will include a primary health caregiver, a mental health professional, family members, an experienced dietitian and a case manager. The case manager will be tasked with coordinating the treatment plan of the various team members (Slade et al., 2018). Jessica should first be hospitalised for the stabilisation of her symptoms. To manage Jessica’s electrolyte imbalances, a healthcare practitioner should prescribe intravenous reads such as normal saline to replace the lost fluids. The mark, intravenous or oral medications and supplements that restore electrolyte imbalance can be prescribed (Strobel et al., 2019). Once the electrolyte imbalances are corrected, Jessica’s arrhythmias are likely to disappear, although an antiarrhythmic agent can be prescribed if her arrhythmias become severe.

The next course of action would be managing Jessica’s bulimia nervosa. Evidence suggests that psychotherapy in treating bulimia nervosa has effectively mitigated and improved the symptoms (Slade et al., 2018). A mental health professional can use various psychotherapeutic methods to treat bulimia, including cognitive behavioural therapy, which would help the patient identify the abnormal eating behaviours and beliefs and replace them with much healthier positive ones (Slade et al., 2018). A therapeutic method that his family can employ builds treatment that would help Jessica’s parents identify her unhealthy eating patterns and help her have control over it. Lastly, a mental health professional can employ interpersonal psychotherapy to address Jessica’s difficulties in high relationships and improve her problem-solving and communication skills, helping her interact better with others without being ashamed (Slade et al., 2018).

A mental health professional can also employ pharmacotherapeutic methods to treat bulimia nervosa (Strobel et al., 2019). The commonest medications used in this issue you are anti-depressants such as fluoxetine. These medications suppress the compulsive thoughts of binge eating and purging, thereby helping manage the condition (Strobel et al., 2019). Nutrition education for Jessica would also be crucial to help her achieve a good eating habits hence reducing her hunger and cravings while providing good nutrition. Additionally, Jessica should be advised to eat regularly and not restrict her food intake while managing her condition. Furthermore, Jessica’s parents should be keen to note any normal behaviours, especially after eating, such as the tendency to toilet immediately after eating (Svaldi et al., 2019). Hence, constantly monitoring her behaviours would be crucial in identifying and managing the symptoms as soon as possible.


Assessing the effectiveness of these various therapeutic methods in treating bulimia nervosa should reveal complete withdrawal of Jessica’s binge eating and purging behaviour at the end of this therapy and complete remission from the symptoms of bulimia (Svaldi et al., 2019). Although the complete disappearance of bulimia nervosa behaviour can take a while, the physical symptoms, such as electrolyte imbalances and arrhythmias, should disappear with strict adherence to the treatment plan. Complete remission from their disease can be assessed using a SCOFF tool (Strobel et al., 2019).


In conclusion, bulimia nervosa is a common condition that is debilitating if addressed. Patients with bulimia nervosa binge eat and then purge afterwards to eliminate the extra calories taken. This can be dangerous as it can cause other complications, including electrolyte imbalances, cardiac arrhythmias, gastroesophageal reflux disease, sore throat and even oesophageal cancer. Diagnosis of bulimia nervosa would involve taking a detailed medical history of the patient and administering an assessment tool such as SCOFF. The catchment of the condition involves both psychotherapy and medical therapy and treating the existing complications from the behaviour.



Berner, L. A., Brown, T. A., Lavender, J. M., Lopez, E., Wierenga, C. E., & Kaye, W. H. (2019). Neuroendocrinology of reward in anorexia nervosa and bulimia nervosa: beyond leptin and ghrelin. Molecular and cellular endocrinology, 497, 110320.

Forrest, L. N., Jones, P. J., Ortiz, S. N., & Smith, A. R. (2018). Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis. International Journal of Eating Disorders, 51(7), 668-679.

Hempton, C., & Bhatia, N. (2020). Deciding for when you cannot decide: The Medical Treatment Planning and Decisions Act 2016 (Vic). Journal of Bioethical Inquiry, 17(1), 109-120.

Maylea, C., & Hirsch, A. (2017). The right to refuse: The Victorian mental health act 2014 and the convention on the rights of persons with disabilities. Alternative Law Journal, 42(2), 149-155.

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Svaldi, J., Schmitz, F., Baur, J., Hartmann, A. S., Legenbauer, T., Thaler, C., … & Tuschen-Caffier, B. (2019). Efficacy of psychotherapies and pharmacotherapies for bulimia nervosa. Psychological medicine, 49(6), 898-910.

Tith, R. M., Paradis, G., Potter, B. J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2020). Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA psychiatry, 77(1), 44-51

van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), 515. 10.1097/YCO.0000000000000739


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