Eating Disorder/Electrolyte Imbalances Case Study PERSONAL/SOCIAL HISTORY

What data from the histories are relevant and has clinical significance to the nurse?

Relevant data from present problem: Self-injurious behavior (SIB), increasing weakness, lightheadedness and the likelihood of syncopal episode.

Clinical significance: The data would help identify personal/biological factors causing the patient’s condition.

Relevant data from social history: Sexual abuse by her stepfather, living with a single mom, and sexual behaviors.

Clinical significance: It would help identify social/family factors contributing to the condition.

What is the relationship of your patient’s past medical history (PMH) and current meds? What medications treat which conditions?

Anorexia nervosa

Depression

Self-injurious behavior (SIB)

Sexually abused as a child

Citalopram 20 mg PO daily

Selective Serotonin Reuptake Inhibitor (SSRI)

Reduction of depressive and eating disorder symptoms and protection against recurrence.

One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in his/her life?

· Circle what PMH problem likely started FIRST.

· Underline what PMH problem(s) FOLLOWED as domino(s).

PATIENT CARE BEGINS

What VS data is relevant and must be recognized as clinically significant by the nurse?

Relevant VS data: T: 96.2 F/35.7 C (oral), BP: 86/44 MAP: 58

Clinical significance: Low body temperature and blood pressure are indicators of hypothermia and hypotension, which are vital signs of anorexia nervosa.

What physical assessment data is relevant and must be recognized as clinically significant by the nurse?

Relevant assessment data: No menses for the past 6 months, dry skin with lanugo body hair, thinning hair on head, and vertical lacerations.

Clinical significance: Diagnosis of anorexia nervosa and other health conditions (dominos).

What MSE assessment data is relevant and must be recognized as clinically significant by the nurse?

Relevant assessment data: Emaciated appearance, generalized weakness, depression symptoms, lack of eye contact, suicidal ideation, and poor insight and poor judgment.

Clinical significance: Diagnosis of mental health issues affecting the patient.

Rhythm interpretation: Regular heart rate since the interval between the R waves is regular.

Clinical significance: Identification of any abnormal components on the EKG.

LAB RESULTS

1. Complete Blood Count (CBC)

What lab results are relevant and must be recognized as clinically significant by the nurse?

Relevant lab(s): Hgb (12–16 g/dL).

Clinical significance: Slightly exceeds the normal range.

Trend (Improve/Worsening/Stable): Stable

2. Basic Metabolic Panel (BMP)

What lab results are relevant and must be recognized as clinically significant by the nurse?

Relevant lab(s): Sodium (135–145 mEq/L), Potassium (3.5–5.0 mEq/L), Chloride (95–105 mEq/L), CO2 (Bicarb) (21–31 mmol/L), Glucose (70–110 mg/dL), BUN (7–25 mg/dl), and Creatinine (0.6–1.2 mg/dL).

Clinical significance: Understanding patient’s generalized weakness and other vital signs.

Trend (Improve/Worsening/Stable): Worsening

3. Liver Function Test

What lab results are relevant and must be recognized as clinically significant by the nurse?

Relevant lab(s): All tests are within normal range.

Clinical significance: Detect any abnormalities in liver function.

Trend (Improve/Worsening/Stable): Stable

4. Misc. Labs and Thyroid Profile

What lab results are relevant and must be recognized as clinically significant by the nurse?

Relevant lab(s): Magnesium (1.6–2.0 mEq/L) and Phosphorus (2.5-4.5 mg/dL)

Clinical significance: To determines any electrolyte disturbances.

Trend (Improve/Worsening/Stable): Stable

5. Urine Analysis

What lab results are relevant and must be recognized as clinically significant by the nurse?

Relevant lab(s): All signs are within normal range

Clinical significance: Detection of urinary tract symptoms

Lab Planning: Creating a Plan of Care with a PRIORITY Lab

Lab: Potassium Value:1.9

Normal Value: Critical Value: 3.7

Clinical significance: Low level of potassium in the blood could indicate hypokalemia.

Nursing assessments/interventions required: Management of vomiting tendencies, which causes loss of potassium.

Lab: Magnesium Value:1.2

Normal Value: Critical Value: 1.7

Clinical significance: Low level of magnesium in the...

What is the primary problem that your patient is most likely presenting with?
Anorexia Nervosa

2. What is the underlying cause/pathophysiology of this primary problem?

Low self-esteem, relationship problems and stressful life events.

Collaborative Care: Medical Management

Care Provider Orders

Rationale

Expected Outcome

Pelvic exam/obtain cultures to assess for STDs

Establish peripheral IV x2

0.9% Normal Saline (NS) 1000 mL IV bolus

Continuous cardiac monitor

Patient has shown signs of electrolyte imbalances

Signs of irregular heartbeat need urgent attention to improve the patient’s cardiac wellbeing and avoid further complications

Treatment process requires continuous monitoring to determine effectiveness and any need for changes

Patient shows signs of low levels of potassium in the blood

Patient shows signs of low levels of magnesium in the blood. Magnesium replacement is required before potassium replacement

COLLABORATIVE CARE: NURSING

3. What can the nurse do to establish a therapeutic rapport/relationship in this setting?

The nurse can establish a therapeutic rapport/relationship in this setting through demonstrating an interest in the patient’s life. Using persuasion, the nurse should provide insights regarding the disorder and clarify his/her role in caring for the patient.

4. What principles of therapeutic communication would be relevant to establish a therapeutic relationship?

Some principles of therapeutic communication that are necessary in this setting include ensuring the patient is the primary focus of interaction, maintaining a professional attitude, cautious use of self-disclosure, and avoiding social relationship with the patient.

5. How could the nurse explore her comments that suggest suicidal ideation?

Through asking the patient about her feelings regarding life and probable suicide thoughts.

6. What MENTAL HEALTH nursing priorities will guide your plan of care?

a. Mood and affect

b. Depressive symptoms

c. Suicide ideation

7. What interventions will you initiate based on this MENTAL HEALTH priority (ies)?

Nursing Interventions

Rationale

Expected Outcome

Cognitive-behavioral intervention

Supportive psychotherapy

To address altered mood, perceptions and depressive symptoms

Need to address the patient’s experience and emotional impact

Improve patient’s engagement in the care process and reduce depressive symptoms

Enhanced patient commitment to the recovery process

8. What PHYSICAL nursing priority (ies) will guide your plan of care? (if more than one-list in order of PRIORITY) NANDA-I as well as non-NANDA-I nursing diagnostic statements are relevant and need to be considered in this scenario:

a. Disturbed body image

b. Poor eating habits

c. Self-care deficit

9. What interventions will you initiate based on this PHYSICAL priority (ies)?

Nursing Interventions

Rationale

Expected Outcome

Patient education

Nutritional interventions

Motivational enhancement therapy

Patients with anorexia nervosa have little information regarding the condition and how to cope with it

Promoting appropriate eating habits is essential in management of anorexia nervosa

Positive self-image is critical toward avoiding depressive symptoms and self-injurious behaviors

Enhanced involvement in care and self-care practices by being fully informed

Development of suitable eating behaviors and habits

Improved self-esteem

10. What body system(s) will you assess most thoroughly based on the primary/priority concern?

Body mass index and cardiovascular system

11. What is the worst possible/most likely complication to anticipate?

Electrolyte imbalances and irregular heart beat

12. What nursing assessments will identify this complication EARLY if it develops?

Basic metabolic panel assessment and cardiac assessment

13. What nursing interventions will you initiate if this complication develops?

Treatment using recommended medications

Evaluation: Thirty Minutes later…

Rhythm interpretation: Irregular heart rate

Clinical significance: Could be an indicator of cardiac complications

Rhythm interpretation: Regular heart rate

Clinical significance: The cause of irregular heart rate lasted for a few seconds/minutes

1. What VS data is relevant and must be recognized as clinically significant by the nurse?

Relevant VS Data