Question

You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was Respond to at least one other student admitted to the psychiatric unit last night after assessment and treatment at a local hospital emergency department 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."

**remember these are not “all-inclusive” responses. Rather, guiding points and areas to use when discussing the scenario with students. Remember to follow the rubric and provide students with detailed grading.

Answer the following questions:

1. Identify eight clinical signs or symptoms of anorexia nervosa. Place a star or asterisk next to those that J.M. has.
2. What other disorders might occur along with anorexia nervosa? Name at least four.
3. Name five behaviors that J.M. or any other patient with anorexia may engage in other than self-starvation.
4. Which laboratory results might be of concern at this time? Explain your answers.
5. What clinical symptoms of anorexia nervosa, if present, should have the highest priority? Explain your answers.

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Answer 1

Anorexia nervosa, commonly called as anorexia is a serious eating disorder in which a person adopts unhealthy and extreme methods to lose weight or avoid gaining weight.

The clinical signs and symptoms of anorexia nervosa includes

• Severe weight loss. The person may talk about being over weight , although objective measures such as BMI show that this is not true.*
• Severe loss of muscle mass.*
• Hypotension and hypoglycemia
• Hypothermia, or low body temperature, and cold hands and feets.*
• Dry skin and hair, alopecia or hair loss, brittle nails.*
• An over whelming fear of gaining weight*
• Poor circulation in hands and feet, pale extrimities*
• Bloating, constipation and abdominal pain.

There are other disorders that occur along with anorexia nervosa. It includes,

• Superior mesenteric artery syndrome (SMA)

Results from compression of the duodenum between the aorta and spine posteriorly and the SMA anteriorly as a result of loss of the adipose tissue fat pad that normally surrounds the SMA as a direct result of weight loss.

• Osteoporosis

People with anorexia nervosa will have low bone density and reduced bone strength and have the risk of breaking bones.

• Pericardial effusion

A pericardial effusion is excess fluid between the heart and the sac surrounding the heart known as pericardium.

Due to low body mass index, rapid weight loss, and low T3 level and IGF-1 levels, pericardial effusion occurs.

• Spontaneous tension pneumo peritoneum nad tension pneumothorax

Occurs as a result from acute gastric rupture in eating disorder patients who both restrict and purge via self induced vomiting.

Anorexia nervosa patients may may engage in certain behavious other than self starvation. It includes

- Enhanced weight loss by over exercise, diuretics, laxatives and self induced vomiting.

- Disturbance in the way weight or shape is experienced, resulting in over evaluation of size, disproportion in concern about weight or shape.

- Avoidance of socialfunction,family and friends. May become isolated and depressed.

- Engaging in ritualistic eating pattern such as cutting food into tiny pieces, eating alone and or hiding food.

- People with anorexia may wear baggy or over sized clothing to hide their thin bodies.

Laboratory results of people with anorexia nervosa shows

• Hematological examination

Leukopenia and mild anemia are common. Thrombocytopenia occurs rarely.

• Biochemical examination shows

Elevated blood urea nitrogen, hyper cholesterolemia, elevated liver function test, induced vomiting leads to metabolic alkalosis, serum thyroxine level and tri iodo thyronine levels are decreased.

In females, low serum estrogen levels and in males, low serum testosterone levels.

• Elecrocardiography

Sinus brady cardia and rarely arrythmia

• Electro encephalography

Diffuse abnormalities reflecting a metabolic encephalography resulting from fluid and elecrolyte imbalances.

• Brain imaging

Shows increase in ventricular brain ratio secondary to starvation.

If the anorexia nervosa patient is having hypoglycemia, highest priority management should be taken to resolve this problem. Otherwise it may get fatal.

-> With anorexia, the liver becomes depleted of the chemical building blocks needed to create glucose, as well as depleted of glycogen, which is key to maintain normal blood sugar.

-> For people with eating disorders, meals are inadequate and imbalanced and body is not able to sustain blood sugar.

-> Blood glucose levels will be particularly very low in early morning and some people may have symptoms such as sweating, lack of concentration, irritability etc and some people do not show symptoms at all. Regardless of these symptoms, hypoglycemia can be deadly.

-> The brain and heart will be damaged if sufficient glucose will be not in body.

-> Brain needs glucose. When glucose is not available, the brain will run on ketone bodies that the body produces from fatty acids. But in anorexia, fatty acids are not available and leads to brain damage.