Anorexia Nervosa Sase Study

CASE STuDY #130 ANOREXIA NERVOSA SCENARIO: You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the psychiatric unit last night after assessment and treatment at a local hospital emergency department (ED) for “blacking out at school.” She has been given a preliminary diagnosis of anorexia nervosa. As you begin to assess her, you notice that she has very loose clothing, she is wrapped in a blanket, and her extremities are very thin. She tells you, “I don’t know why I’m here. They’re making a big deal about nothing.” She appears to be extremely thin and pale, with dry and brittle hair, which is very thin and patchy, and she constantly complains about being cold. As you ask questions pertaining to weight and nutrition, she becomes defensive and vague, but she does admit to losing “some” weight after an appendectomy 2 years ago. She tells you that she used to be fat, but after her surgery she didn’t feel like eating and everybody started commenting on how good she was beginning to look, so she just quit eating for a while. She informs you that she is eating lots now, even though everyone keeps “bugging me about my weight and how much I eat.” She eventually admits to a weight loss of “about 40 pounds and I’m still fat.” 1. How is the diagnosis of anorexia nervosa determined? The diagnosis was made according to the clinical signs like very thin extremities, very low body weight, loss of appetite, false body imaging, and intense desire to look socially acceptable. 2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next to those that J.M. has. a. Intense weight loss** b. Thin hair** c. Intolerance to cold** d. Rough skin e. Bruising f. Anemia g. Lanugo h. Fatigue 3. What other disorders might occur along with anorexia nervosa? Other disorders are cardiac issues, kidney disease, infections, anemia, binge eating, posttraumatic stress disorder, major depression, and vitamin deficiency. 4. How does bulimia nervosa differ from anorexia nervosa? In bulimia nervosa patients’ binge and purge often while in anorexia patients have critically low intake. Bulimia patients additionally face dental issues, swollen salivary glands, irritation of the esophagus, and stomach ulcers. 5. Name behaviors the J.M. or any other patient with anorexia may engage in other than self-starvation. Patients and J.M with anorexia may engage in rigidity, obsessive, hopeless, socially isolate, low self-esteem, excessive exercise, wearing loose clothes and self-starvation. 6. What common family dynamics are associated with anorexia nervosa?  Mother's distorted views of body shape.  High parents’ standards  Overbearing mother  Emotionally absent father  Expectations of perfectionistic CHART VIEW Admissions Lab Work Sodium 135 mEq/L Potassium 3.4 mEq/L Chloride 99 mEq/L BUN 18 mg/dL Creatinine 1.0 mg/dL Hemoglobin 11 g/dL Hematocrit 35% 7. Which lab results might be of concern at this time? Explain your answers. The hemoglobin level is of most concern as the Hb level should be between 12 to 14 g/dl. Hemoglobin is the chemical that gives red blood cells their color and permits oxygen to be transported throughout the body. The causes of low hemoglobin are from low iron intake, menstrual bleeding, anemia, fatigue, and trouble breathing. The potassium level is also low because the results are 3.4 mEq/L, whereas the normal range is 3.5 – 5.0 mEq/L. The causes are vomiting, diarrhea, adrenal gland disorders, muscle feel weak, cramps, twitch, and abnormal heart rhythms. 8. What clinical symptoms of anorexia nervosa should have the highest priority? Explain your answers. The abnormal mental state, critically low body weight, and anemia are the most significant clinical signs these should be treated promptly otherwise, anorexia can lead to even death. J.M.’s ECG results show normal sinus rhythm with no ST segment or other changes. You meet with J.M. to formulate a plan of care. 9. In general, the care plans for patients with anorexia are detailed and include many psychological aspects. What are they? You should be able to name at least 10. a. Change irrational behavior about eating. b. Accept healthy body weight. c. Education about the consequences of semi-starvation. d. Healthy relationships e. Family therapy f. Healthy eating g. Cope with difficult situations h. Exercise some autonomy i. Run healthy life j. Control other aspects of life. 10. What would indicate successful treatment with J.M.? The weight gains of 2-3 pounds per week and the patient's acceptance of realistic beliefs about eating, body image, and social relationship indicate the successful treatment. After 3 weeks, you are providing discharge teaching for J.M. You ask her whether she is ready to go home. J.M. states, “I’ll be so glad to get out of this place. I’m so fat and ugly. I need to lose 20 pounds. I bet I can do it in just a couple of days. Otherwise, I don’t want to live anymore.” 11. What will you discuss with the physician before any further discharge teaching or plans? The patient needs further hospitalization and psychotherapy as she is still stuck with the same false body imaging. 12. You report J.M.’s statements to the physician. What do you expect to be ordered by the physician? The physician may order to delay the patient's discharge and proper psychotherapy. 13. What medications would be indicated for J.M. to assist with resolution of both her anorexia nervosa and major depression? Medications that could help J.M are the SSRI’s Fluoxetine and olanzapine, Also, benzodiazepine, can also be bought over the counter. After 2 weeks, J.M. has gained 5 pounds and seems to be more willing to eat. She still expresses fears of “getting fat,” but states that she is ready to go home and back to school. The PCP arranges for J.M. to participate in an outpatient partial hospitalization program that specializes in eating disorders. J.M. expresses interest in meeting others with the same problem.