Anorexia Case Study Anorexia Case Study Lori Stevens is a 16-year-old Anorexic who has struggled with this condition since the age of 11. She admits to drinking several large glasses of water daily. What electrolyte is at risk for problems due to the increased water intake? Anorexia Case Study What electrolyte is at risk for problems due to the increased water intake? Sodium- Too much fluid will dilute the amount of sodium in the bloodstream, leading to abnormally low levels, called hyponatremia. Anorexia Case Study Lori has also been recently engaging in Self Injurious Behavior (SIB). She has been cutting both forearms and upper thighs with broken glass, causing numerous lacerations and scars. Cutting her body represents a deficiency of what needs? Anorexia Case Study Cutting her body represents a deficiency of what needs? Emotional and Spiritual needs- Self-harm can be a way for a person to feel something when experiencing numbness or to distract themselves from depression or anxiety. Some people cut to create a wound that can symbolize their emotional pain, while others use cutting as a way to avoid telling loved ones about their feelings. Anorexia Case Study Lori presents to the emergency department with complaints of increasing weakness, lightheadedness and a near syncopal episode this evening. She admits to inducing vomiting after meals for the past three weeks. She is 5 foot 5 inches and weighs 83 lbs/37.7 kg. These symptoms indicate what possible conditions? Anorexia Case Study These symptoms indicate what possible conditions? Fluid Volume Deficit- Fluid volume deficit (FVD) or hypovolemia is a state or condition where the fluid output exceeds the fluid intake. Cardiac Dysrhythmias-A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be lifethreatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body. Anorexia Case Study Lori’s inducing of vomiting can lead to damage in what other areas? Anorexia Case Study Lori’s inducing of vomiting can lead to damage in what other areas? Damage to the tissue in the throat and mouth, Dehydration, Aspiration, Alkalosis, Loss of sodium, potassium, calcium, and magnesium. Anorexia Case Study Lori is reluctantly brought in by her mother and does not want to be treated. As the primary nurse responsible for the care of Lori. You overhear her say to her Mother “I hate everything about me. I am so tired of living. I wish I were dead”. These statements indicate to the nurse that Lori is at risk for? Anorexia Case Study These statements indicate to the nurse that Lori is at risk for? Suicidal ideation with spiritual crisis and lack of hope. Anorexia Case Study The nurse performs an assessment of Lori and records the following findings: Temp- 96.2 F/35.7 C(oral) Pulse- 50 and irregular Respirations- 16 Blood Pressure- 86/54 MAP- 58 Oxygen Saturation- 99% room air Anorexia Case Study Loris Temperature of 96.2 F/35.7 C(oral) indicates what problem is occurring? Anorexia Case Study Lori’s Temperature of 96.2 F/35.7 C(oral) indicates what problem is occurring? Low metabolic rate due to starvation- When people lose weight, their body temperature drops as their metabolism slows down. Anorexia Case Study Lori’s Low hear rate of 50 beats per minute can indicate what problem? Anorexia Case Study Lori’s Low hear rate of 50 beats per minute can indicate what problem? Electrolyte imbalance- Substances in your blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development Anorexia Case Study Lori’s low blood pressure reading of 86/54 indicates which issue? Anorexia Case Study Lori’s low blood pressure reading of 86/54 indicates which issue? Hypovolemia- With continuing volume loss, the body loses its ability to compensate and blood pressure drops. At this point, the heart is unable to pump enough blood to vital organs to meet their needs and tissue damage is likely to occur. Anorexia Case Study Lori’s Mean Arterial Pressure (MAP) of 58 indicates which issue? Anorexia Case Study Lori’s Mean Arterial Pressure (MAP) of 58 indicates which issue? Organ failure- Normal map is 70-110.- Anything under 60 mmHg is usually considered a low MAP. It indicates that your blood may not be reaching your major organs. Without blood and nutrients, the tissue of these organs begins to die, leading to permanent organ damage. Anorexia Case Study The nurse continues with Lori’s assessment and performs a set of blood pressure readings with her lying, sitting, and standing. Lying BP-86/44, HR 50 Sitting 86/54, HR 50 Standing 72/40, HR 78 These reading are known as a condition called? Anorexia Case Study These reading are known as a condition called? Orthostatic Hypotension- There is a drop of 10 or more mm HG in blood pressure and an increase of 10 to 20 bpm in heart rate. Anorexia Case Study The assessment also indicates that Lori’s respirations are of normal rate and rhythm, lungs are clear in all fields and no labored breathing is noted. Her heart sounds are regular. Her skin is pale, pink and cool to touch, she has +2 pitting edema of bilateral ankles. Pulses are weak to palpation at radial/pedal/post tibial landmarks and capillary refill is less than 3 seconds. What is the nurses biggest concern regarding this part of the assessment and what can it indicate? Anorexia Case Study What is the nurses biggest concern regarding this part of the assessment and what can it indicate? The largest concern is the +2-pitting edema in bilateral ankles, this indicates a lack of protein causing a leak of fluid into the interstitial spaces. Anorexia Case Study The Gastrointestinal portion of Lori’s assessment presents as follows: Bowel sounds hypoactive. Abdomen soft, tender to palpation and scaphoid in appearance, several 1 cm open ulcers are present on the oral mucosa. What are the possible causes of the ulcerations? Anorexia Case Study What are the possible causes of the ulcerations? The loss of stomach acid while vomiting contributes to dental cavities by eroding tooth enamel, lead to frequent heartburn, and abdominal pain or nausea. Frequent vomiting may cause a tear in the lining of the esophagus close to the stomach (a Mallory-Weiss tear) that may produce blood in vomit (hematemesis). The use of instruments or fingers to trigger gagging can lead to tears in the back of the throat, sore throat and frequent infections, and calluses may form on the back of the hand and knuckles (Russell’s sign) used to trigger gagging from frequent scraping against upper teeth. Anorexia Case Study Lori tells the nurse that she has not experienced any pain or difficulty with urination but that her urine is dark amber in color and clear. She also reports that she has not had her menses for the last 6 months. What is the cause of the amenorrhea? Anorexia Case Study What is the cause of the amenorrhea? Malnutrition- Malnutrition may affect how the hypothalamus and pituitary gland function, which can lead to amenorrhea. Having a low body weight can also prevent the hypothalamus and pituitary gland from functioning correctly. This can lead to a type of amenorrhea known as functional hypothalamic amenorrhea. Anorexia Case Study The nurse notes that Lori has numerous vertical scars present on both forearms and upper thighs from SIB. She notes that she also has several recent vertical lacerations on her forearm that are partial thickness. The hair on Lori’s head is thinning and her skin is dry and flaky. The nurse notes fine lanugo on her face and arms. What is the most likely cause of the appearance of the lanugo on Lori’s face and arms? Anorexia Case Study What is the most likely cause of the appearance of the lanugo on Lori’s face and arms? Anorexia induced malnutrition- Some anorexia sufferers develop a condition doctors call lanugo - soft, downy hair on their arms and legs. It's the body's strategy to protecting itself against heat loss associated with extreme thinness Anorexia Case Study The nurse will now review Lori’s recent lab values and diagnostic results. Lori’s recent EKG shows Identify the rhythm and the possible cause? Anorexia Case Study Identify the rhythm and the possible cause? Sinus Brady Cardia with Premature Ventricular Contraction (PVC). Usually due to electrolyte imbalance Anorexia Case Study Knowing that Lori’s rhythm is abnormal prompts the nurse to review her last 2 sets of laboratory results: Metabolic panel Na+ 132, 135 K+ 1.9, 3.4 Glucose- 60, 70 Creatinine 1.5, 0.9 What do these values indicate? Anorexia Case Study Metabolic panel Na+ 132, 135 K+ 1.9, 3.4 Glucose- 60, 70 Creatinine 1.5, 0.9 What do these values indicate? Hyponatremia, hypokalemia, acute renal failure and they contributed to her ventricular dysrhythmia Anorexia Case Study WBC- 4.0, 5.2 HGB- 9.8, 10.5 Platelets- 85,125 Neutrophils- 60, 68 What do these values indicate? Anorexia Case Study WBC- 4.0, 5.2 HGB- 9.8, 10.5 Platelets- 85,125 Neutrophils- 60, 68 What do these values indicate? Anemia-Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia can make you feel tired and weak. There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe. Anorexia Case Study Albumin- 2.4, 2.9 Liver panel total- 0.5, 0.6 alkaline phosphatase- 285, 155 ALT- 128, 78 AST- 124, 17 What do these lab values indicate? Anorexia Case Study What do these lab values indicate? Liver failure and hypoproteinemia-Hypoproteinemia is a condition in which a person has very low levels of protein in the blood. Proteins are essential to every part of the human body. Liver failure happens when your liver can't work well enough to perform its many vital functions, such as producing bile to help you digest food and clearing your blood of toxic substances. Liver failure can be a life-threatening emergency. It can be either acute or chronic. Anorexia Case Study Magnesium- 1.2, 1.2 T3- 69, 64 T4- 0.6, 0.5 TSH- 0.2, 0.2 What do these values indicate? Anorexia Case Study What do these values indicate? Hypomagnesemia-Magnesium depletion usually results from inadequate intake plus impairment of renal conservation or gastrointestinal absorption. Hypomagnesemia is serum magnesium concentration < 1.8 mg/dL (< 0.70 mmol/L). Anorexia Case Study The nurse then reviews Lori’s urinalysis. Pregnancy test is negative The color is amber, clarity is clear, negative for bacteria, positive for ketones, negative for epithelium, negative for nitrates, leukocyte esterase negative, RBC-3, WBC- 5 Anorexia Case Study After reviewing all the relevant clinical data what are the nurse’s primary concerns for Lori? Anorexia Case Study After reviewing all the relevant clinical data what are the nurse’s primary concerns for Lori? Lori is suffering from a severe electrolyte imbalance hyponatremia, hypokalemia, hypomagnesemia, Fluid volume deficit and acute liver failure, hypoproteinemia with acute liver failure. Anorexia Case Study The nurse needs to formulate a plan of care for Lori. What treatments can the nurse anticipate the doctor will order that need to be included in the plan of care? Anorexia Case Study What treatments can the nurse anticipate the doctor will order that need to be included in the plan of care? Albuterol-ipratropium 2.5 mg via nebulizer Pelvic exam/obtain cultures for STD Establish IV sites x2 0.9 NS 1000 ml IV bolus Continuous Cardiac Monitor Magnesium sulfate 4 gm IVPB over 4 hours Potassium Chloride 10 mEq IVPB x4 each dose over one hour Referral and assessment for mental health 1 on 1 sitter/suicide watch Frequent laboratory draws for potassium and magnesium levels Anorexia Case Study What psychosocial holistic care priorities need to be addressed for Lori? Anorexia Case Study What psychosocial holistic care priorities need to be addressed for Lori? Establish a therapeutic nurse-patient relationship. Within a helping relationship, the patient can begin to trust and try out new thinking and behaviors. Promote self-concept without moral judgment. Patient sees self as weakwilled, even though part of a person may feel a sense of power and control (dieting, weight loss). Allow the patient to draw a picture of self. Provides an opportunity to discuss the patient’s perception of self and body image and realities of an individual situation. Encourage personal development program, preferably in a group setting. Provide information about the proper application of makeup and grooming. Learning about methods to enhance personal appearance may be helpful to a long-range sense of self-esteem and image. Feedback from others can promote feelings of self-worth. Anorexia Case Study What are some education and discharge priorities to promote health and wellness for Lori? Anorexia Case Study What are some education and discharge priorities to promote health and wellness for Lori? States rules clearly regarding weighing schedule, remaining in sight during medication and eating times, and consequences of not following the rules. Without undue comment, be consistent in carrying out rules. Encourage patient to take charge of own life in a more healthful way by making own decisions and accepting self as she or he is at this moment (including inadequacies and strengths). Patient often does not know what she or he may want for self. Parents (mother) often make decisions for the patient. Patient may also believe she or he has to be the best in everything and holds self-responsible for being perfect. Refer to occupational or recreational therapy. Can develop interest and skills to fill the time that has been occupied by the obsession with eating. Involvement in recreational activities encourages social interactions with others and promotes fun and relaxation.
