Question

CASE STUDY ANOREXIA NERVOSA Joyce Mann is a 23-year-old female admitted to the psychiatric unit last night after assessment and treatment at a local hospital emergency room 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 is very loose clothing and is wrapped in a blanket. She tells you, "I don't know why I am here. They are making a big deal out of nothing". She appears to be extremely thin and pale, with very thin and brittle hair and constantly complaining about being cold. As you question her about her weight and nutrition, she becomes defensive and vague, but she does admit to loosing "some weight after an appendectomy two (2) years ago. She tells you that she used to be fat, but after her surgery she did not feel like eating and everybody began to comment on how good she was beginning to look, so she just quit eating for awhile. She tells you that she is eating better now even though everyone keeps "bugging" her about her weight and how much she eats. She eventually admits to a weight loss of about 40 pounds and "I'm still fat." 1. Explain how the diagnosis of anorexia nervosa was made based on the patients presenting symptoms. 2. State the clinical symptoms of anorexia nervosa. 3. List the concomitant disorders associated with anorexia nervosa 4. Identity a list of additional behaviors the patient may engage in that would enhance her weight loss other than self starvation. 5. List the common family dynamics associated with anorexia nervosa. 6. What are the clinical symptoms that should have the highest priority? A care plan is developed for this patient which is very detailed and includes many psychological aspects. 7. List seven (7) psychological aspects you should consider when developing the care plan. Miss Mann is ready for discharge teaching and you are the nurse completing her teaching. Miss Mann states "I'll be so glad to get out of this place. I'm so fat and ugly. I can't wait to lose 10 pounds. I bet I can do that in a couple of days. I don't want to live anymore" 8. Explain the points you would discuss with the primary care provider based on Miss Mann's statements... You report Miss Mann's statements to the primary care provider

Answer 1

Anorexia nervosa is a disorder of eating presented with abnormally low weight ,deep fear of weight gain, and an altered idea of body weight. People with this disorder may take any steps to control their weight and shape and even harm their life for that.

1. Patient’s presenting symptoms:

• Thin appearance
• Blacking out at school
• Intolerance to cold
• Weight loss of around 40 pounds
• Pale appearance
• Thin and brittle hair
• she had loss of appetite
• feeling that she is fat

2. Clinical symptoms of Anorexia nervosa:

This include physical, emotional and behavioral symptoms.

Physical symptoms:

• Intense weight loss
• Thin, fatigued and pale appearance
• Fingers may become blue
• Cold intolerance
• Dizziness and fainting
• Lack of sleep
• Thin and brittle hair
• Absence of menstruation
• Abdominal pain and constipation
• Arrhythmia
• Hypotension
• Dehydration
• Edematous arms and legs

Emotional and behavioral symptoms:

• High restriction of food through dieting or fasting, skipping meals frequently
• Excessive exercising
• Self induced vomiting
• Denying hunger
• Eating low calorie foods only thinking it as safe foods
• Avoiding public eating
• Fear of weight gain and repeated weight checks
• Frequent mirror check for fat look and shape
• Thinks self as very fat
• Covering up in layers of clothing
• Flat mood and social withdrawal
• Reduced sexual interest

3. The concomitant disorders associated with Anorexia:

As the body lacks proper nutrition and weight, all the organ functions get messed up. The associated disorders begins to pop.

The common medical disorders associated with Anorexia are Hypothermia, Hypotension and bradycardia.

Cardiovascular disorders:

Echo changes, mitral valve prolapsed, sudden death etc

Endocrine disorders:

Amenorrhea, infertility, hypoglycemia, thyroid anomalies, growth arrest, hypercortisolemia etc.

Gastrointestinal disorders:

Dysphagia, constipation, delayed gastric emptying, hepatitis etc

Skin disorders:

Dryness of skin and hair, alopecia, pruritus etc

Pulmonary disorders:

Emphysema, aspiration disorder, bronchopneumonia etc..

Hematologic disorders:

Decreased ESR, pancytopenia etc

4. Identify list of behaviors the patient may engage in yhat would enhance her weight loss other than self starvation?

Self starvation is the major strategy the patients use to keep their weight at low levels. The other behaviors are:

• Strict dieting
• Regular fasting
• Excessive exercising
• Self induced vomiting
• Use of laxatives , enemas etc to get rid of the ingested food.
• Avoiding public eating
• Eating a very few set of foods which are low calorie and are considered safe by them.

Anorexia nervosa is a disorder of eating presented with abnormally low weight ,deep fear of weight gain, and an altered idea of body weight. People with this disorder may take any steps to control their weight and shape and even harm their life for that.

1. Patient’s presenting symptoms:

• Thin appearance
• Blacking out at school
• Intolerance to cold
• Weight loss of around 40 pounds
• Pale appearance
• Thin and brittle hair
• she had loss of appetite
• feeling that she is fat

2. Clinical symptoms of Anorexia nervosa:

This include physical, emotional and behavioral symptoms.

Physical symptoms:

• Intense weight loss
• Thin, fatigued and pale appearance
• Fingers may become blue
• Cold intolerance
• Dizziness and fainting
• Lack of sleep
• Thin and brittle hair
• Absence of menstruation
• Abdominal pain and constipation
• Arrhythmia
• Hypotension
• Dehydration
• Edematous arms and legs

Emotional and behavioral symptoms:

• High restriction of food through dieting or fasting, skipping meals frequently
• Excessive exercising
• Self induced vomiting
• Denying hunger
• Eating low calorie foods only thinking it as safe foods
• Avoiding public eating
• Fear of weight gain and repeated weight checks
• Frequent mirror check for fat look and shape
• Thinks self as very fat
• Covering up in layers of clothing
• Flat mood and social withdrawal
• Reduced sexual interest

3. The concomitant disorders associated with Anorexia:

As the body lacks proper nutrition and weight, all the organ functions get messed up. The associated disorders begins to pop.

The common medical disorders associated with Anorexia are Hypothermia, Hypotension and bradycardia.

Cardiovascular disorders:

Echo changes, mitral valve prolapsed, sudden death etc

Endocrine disorders:

Amenorrhea, infertility, hypoglycemia, thyroid anomalies, growth arrest, hypercortisolemia etc.

Gastrointestinal disorders:

Dysphagia, constipation, delayed gastric emptying, hepatitis etc

Skin disorders:

Dryness of skin and hair, alopecia, pruritus etc

Pulmonary disorders:

Emphysema, aspiration disorder, bronchopneumonia etc..

Hematologic disorders:

Decreased ESR, pancytopenia etc

4. Identify list of behaviors the patient may engage in yhat would enhance her weight loss other than self starvation?

Self starvation is the major strategy the patients use to keep their weight at low levels. The other behaviors are:

• Strict dieting
• Regular fasting
• Excessive exercising
• Self induced vomiting
• Use of laxatives , enemas etc to get rid of the ingested food.
• Avoiding public eating
• Eating a very few set of foods which are low calorie and are considered safe by them.

4. Common family dynamics associated with anorexia nervosa?

The family plays a crucial role in the development of eating disorders.

The anorexic patient’s family is seen highly rigid and controlling type.

Anorexia is seen in young girls who think they are exploited and controlled by their families.

The family controls their life and are not allowed to take independent decisions.

Their families are very protecting and hook into the thoughts of family members.

The family won’t allow the true expression of the feelings of its members. They are more concerned ‘what people will think?’ or what society will think. This puts extreme pressure on the members to be well behaved than truly behaved.

The girls growing in such families are having feeling of ineffectiveness and fail to establish an identity. They feel huge pressure to live up to the expectations of the family in order to gain the love and acceptance from family.

All these make the girl feel anger towards the family, but she expresses it on her body, denying food.

5. What are the clinical symptoms of highest priority?

The symptoms to be considered of highest priority are:

• Malnutrition
• Electrolyte imbalance
• Amenorrhea
• Arrhythmia
• Emphysema and Bronchopneumonia

These and any health issues which has led to a critical situation in the body’s functioning has to be addressed first. This tells that the person’s condition has gone beyond the limits and need care to take her back to normal.

6. Psychological aspects to be considered

The client may need counseling and medical attention to nutritional and health needs.

1. Addressing the body image issues.
2. Addressing the self esteem issues
3. Addressing the issues of family control
4. Addressing the issues of perfectionism
5. Deciding and involving the patient to a correct therapy like Cognitive behavioral therapy (CBT)
6. Assessing Family therapy needs and initiating one
7. Plan for rehabilitation.