Anorexia Nervosa The client, a 15-year-old female, was admitted by her pediatric

Anorexia
Nervosa
The client, a 15-year-old female, was admitted by her
pediatrician for a psychiatric evaluation. Her parents, who are divorced, came
with her to the hospital. The client lives with her mother and has no siblings.
She has no past psychiatric history of other medical problems. The pediatrician
and her parents report that the client has lost 40 pounds in the last year.
Despite this weight loss, she has continued to go to school and to excel
academically. She also jogs 2 hours every day regardless of the weather
conditions. The client has a limited social life.
While the client is an underweight 15-year-old, she
appears much younger due to her small body size and development. She is 5 ft.,
4 in. tall and weighs 90 pounds. She carefully removes her shoes, socks, and
all outer clothing prior to weighing. She is most concerned about accuracy. The
client denies dizziness or seizures. Sometimes she has constipation. She has
not had her period in 5 months, but she is not concerned about this change.
Upon physical examination, her hands and feet are cold and dry with lanugo on
her legs.
The client is defiant during the assessment interview.
When she is asked to describe herself, she says that she is overweight. When
asked about her typical diet, she responds, “It is normal.” She would give no
details about her diet. The client wears a large shirt that hangs down to her
knees. During the interview, she tells you that she must unpack and will not
answer questions unless she can unpack. You notice that she carefully arranges
all of her clothing and personal items.
When you interview her mother and father, they say that
their daughter will not talk about her weight loss with them. Her mother is
well-dressed and thin. She was unaware that her daughter had not had a period
for 5 months. The client sees her father once a month. Both parents say that
their daughter must have a physical problem that is causing the weight loss. In
addition, they think that exercise is important, and they both participate in
daily exercise programs.
After the client’s first day in the hospital, she has
only been out of her room for required activities and has missed some of those.
She has not been eating, but has been drinking water and orange juice at
specific times. You found her exercising in her room, and she refused to stop.
The treatment team is meeting to plan further assessments, laboratory testing,
and treatments. The client’s admission diagnosis is anorexia nervosa.
The client’s diagnostic findings are as follows:
Vital Signs: Blood pressure 100/70, respirations 20, oral
temperature 99.2F, heart rate 82 bpm
Hematology:
RBC 3.5, Hgb 10 g/dL, HCT 32%, WBC 4000
Urinalysis:
Normal
Urine Drug Screen:
negative for illicit drugs
You are assigned as the
psychiatric nurse practitioner to work with this client and her family.
1.
What would be the primary focus of your
initial work with the client/family?
The main goal is to
normalize eating patterns and behaviors to support weight gain. The second goal
is to help change distorted beliefs and thoughts that maintain restrictive
eating.
Weight restoration and
body-weight maintenance. A development of neutrality toward food through
re-developing intuitive understandings of hunger, fullness, and satiety. Stabilizing
weight loss. Beginning nutrition rehabilitation to restore weight. Eliminating
binge eating and/or purging behaviors and other problematic eating patterns.
What further data do
you need regarding the client’s physical status?
2.
What data support the inference that the
client is suffering from an eating disorder?
One of the strongest
risk factors for an eating disorder is perfectionism, especially a type of
perfectionism called self-oriented perfectionism, which involves setting
unrealistically high expectations for yourself. Eating disorders affect at
least 9% of the population worldwide. 9% of the U.S. population, or 28.8
million Americans, will have an eating disorder in their lifetime. Less than 6%
of people with eating disorders are medically diagnosed as “underweight.”
3.
How are anorexia nervosa and bulimia
different?
The
main difference between diagnoses is that anorexia nervosa is a syndrome of
self-starvation involving significant weight loss of 15 percent or more of
ideal body weight, whereas patients with bulimia nervosa are, by definition, at
normal weight or above
4.
What are the relationships between body
image, need for control, and eating disorders?
Body
image plays a critical role in the development and maintenance of an eating
disorder. In fact, it has been researched that having positive body image is a
protective factor in that it reduces the vulnerability for an individual to
develop an eating disorder (Reel, 2013).
5.
What do you think is the most likely
communication style of this family on the basis of the data provided?
Change
the subject when other people talk about food, weight, or body size and shape.
Take a bubble bath to relax yourself. Go to a movie with family or friends
after meal time. Volunteer at an organization you feel passionate about.
6.
Once the client is medically stabilized,
what would you identify as the goals of brief therapy while she is
hospitalized?
7.
How can you best address these goals?
8.
What medication and treatment
recommendations would you order?
9.
What are your biases about adolescents
such as the client?
10.
What should you include in discharge
planning for the client?
11.
What attitude and cognitive critical
thinking skills did you use when answering the questions about the client?
Green,
C. (2000). Critical Thinking in
Nursing–Case Studies across the Curriculum. Upper Saddle River, New Jersey:
Prentice-Hall, Inc.