CASE STUDY: EATING DISORDER

SCENARIO
You are a nurse in an inpatient psychiatric unit. J.M., a 23-year-old woman, was
admitted to the psychiatric unit last night after assessment and treatment at a local
hospital emergency department (ED) 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.”

1. How is the diagnosis of anorexia nervosa determined?

ANSWER:
It's necessary to keep in mind that a person suffering from anorexia or another eating
disorder has the best chance of recovery if they seek treatment as soon as possible, because
early identification and treatment expedites recovery, reduces symptoms to a greater extent,
and increases the likelihood of remaining free of the condition.

2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next
to those that J.M. has.
ANSWER:
● Malnourished appearance - Anorexics have a distorted body image and a
preoccupation with thinness that causes them to refuse to maintain a healthy
weight.
● Hypotension - The patient blacked out, which could be a sign of
hypotension-inadequate calorie intake, could cause the body to break down
tissue for fuel. A body that is under-fueled struggles to pump blood. Hypotension
is caused by a lack of oxygen to the heart.
● Excessive hair loss and dryness - By depriving the scalp of nutrients, anorexia
can promote hair loss. Hair development can be hampered by a lack of nutrients,
organ dysfunction, or stomach issues.
● Cold extremities - Malnutrition lowers the body's core temperature, causing
patients to feel cold, particularly in their hands and toes.
● Poor muscle tone - Muscle health can be jeopardized. Muscle loss can occur as
a result of malnutrition.
● Perception of being obese despite weight loss - Despite the fact that she is
dangerously thin, the patient may believe she is overweight.
 3. What other disorders might occur along with anorexia nervosa?
ANSWER:
- Depression is defined by an intense state of sadness, changes in sleep, changes in
appetite, loss of interest, feelings of guilt, decreased energy, poor concentration,
psychomotor agitation, and suicidal ideations that last at least two weeks.
- Anxiety disorders are characterized by excessive worry that does not go away once
the stressor is removed.
- Obsessive-compulsive disorder (OCD) is a type of anxiety disorder characterized
by intrusive unwanted thoughts known as obsessions that are relieved by repetitive
acts known as compulsions.

4. How does bulimia nervosa differ from anorexia nervosa?

ANSWER:
Anorexia often stems from a distorted body image, which may result from
emotional trauma, depression, or anxiety. Some people may view extreme dieting or
weight loss as a way to regain control in their lives.
● skipping meals
● lying about how much food they’ve eaten
● adopting unusual eating habits, like sorting food on the plate or cutting food
into tiny pieces talking badly about their body

Someone with bulimia may develop an unhealthy relationship to food over time.
They may get caught up in damaging cycles of binge eating and then panic about the
calories they’ve consumed. This may lead to extreme behaviors to prevent weight
gain.
● constantly worrying about weight or appearance
● eating to the point of discomfort
● going to the bathroom immediately after eating

5. Name behaviors that J.M. or any other patient with anorexia may engage in other
than self-starvation.
ANSWER:
● Hiding food
● Use of laxatives, diuretics, or enemas
● Excessively working out
● Fasting

6. What common family dynamics are associated with anorexia nervosa?

ANSWER:
Eating disorders are more than inherited genetics, personality, and coping skills.
These variables interact with family and environmental issues. They work together to
create and maintain eating disorders. They may attempt to gain independence and
freedom by exerting control over their bodies. Consider an adolescent girl who wants
to join the cheerleading squad at her high school. This would necessitate her being
away from home every day after school for practices. An overly involved parent may
 find this separation emotionally distressing. The mom then tries to instill her
daughter's cheerleading identity by attending daily practices, games, and other
relevant social events. The daughter is unable to establish a separate identity from
her mother. She tries to regain control in the only way she knows how: by restricting
the amount of food she consumes. This type of behavior can progress into an eating
disorder over time. People who grew up in overly controlling and protective households are
more likely to develop anorexia. As they grow older, the patient does not feel as if they have
any control over anything in their lives. The patient may develop an eating disorder because
they believe they have control over their eating

Case Study Progress

You review her admission laboratory studies. An ECG has also been ordered.
Admission Lab Work
Sodium 135 mEq/L
Potassium 3.4 mEq/L
Chloride 99 mEq/L
BUN 18 mg/dL
Creatinine 1.0 mg/dL
Hemoglobin 11 g/dL
Hematocrit 35%

7. Which lab results might be of concern at this time? Explain your answers.
ANSWER:
● Hemoglobin 11 g/Dl - Low hemoglobin due to low iron levels and anorexia is an
eating disorder that can bring about anemia.
● Hematocrit - Low hematocrit may reflect a deficiency in protein and iron.
● Potassium - The potassium is slightly lower than normal and can lead to
hypokalemia, a low concentration of potassium ions that should be watched carefully.

8. What clinical symptoms of anorexia nervosa should have the highest

priority? Explain your answers
ANSWER:
The most significant clinical symptoms include:
● An extremely low body weight: without regaining a healthy weight and
learning correct eating, the patient will not recover from anorexia. A
nutritionist can help the patient get back into regular eating habits by offering
meal planning and calorie needs.
● Impaired mental state: To encourage weight gain, the main objective is to
normalize eating patterns and behaviors. The second purpose is to assist in
the transformation of incorrect attitudes and thoughts that keep people from
eating well.
Case Study Progress
J.M.'s ECG results show normal sinus rhythm with no ST segment or other changes.
You meet with J.M. to formulate a plan of care.

9. In general, the care plans for patients with anorexia are detailed and include
many psychological aspects. What are they? You should be able to name at
least 10.
ANSWER:
Other Possible Nursing Diagnosis:
● Chronic low-self esteem
● Defensive coping
● Disabled family coping
● Disturbed thought process
● Ineffective Denial
● Spiritual Distress
● Social Isolation
● Impaired social interactions
● Fear

10. What would indicate successful treatment with J.M.?

ANSWER:
A patient with anorexia nervosa will require long-term treatment that might include
periodic brief hospital stays and outpatient psychotherapy. The combination of
individual, group, couples, and family therapy (especially for younger patients)
provides the patient with the greatest chance for a successful outcome. Patients must
first become willing participants for treatment to succeed in the long run. If the
treatment succeeds, the following should be seen with J.M:

✓ She has shown a slow, progressive weight gain during hospitalization. Gained
at least 2-3 pounds a week, for the next 3 weeks.
✓ Remain free of signs and symptoms of malnutrition and dehydration (e.g.,
electrolytes and blood counts will be within normal limits; a steady weight gain will
be demonstrated; constipation will be corrected; client will exhibit increased energy
in participation in activities).
✓ Consume adequate calories as determined by a dietitian.
✓ Demonstrate regular, independent, nutritional eating habits.
✓ Demonstrated change in attitudes about food and eating.
✓ Verbalized knowledge of illness and medications.

Case Study Progress

After 3 weeks, you are providing discharge teaching for J.M. You ask her whether she is
ready to go home. J.M. states, “I'll be so glad to get out of this place. I'm so fat and ugly.
I need to lose 10 pounds. I bet I can do it in just a couple of days. Otherwise, I don't
want to live anymore.”
11. What will you discuss with the physician before any further
discharge teaching or plans?
ANSWER:
 The patient stated “I don’t want to live anymore” this needs to be
discussed with the physician because this statement places the patient at risk
for suicide. The patient needs further hospitalization and psychotherapy as
she is still stuck with the same false body imaging. Psychotherapy, or talk
therapy, is a way to help people with a broad variety of mental illnesses and
emotional difficulties. Psychotherapy can help eliminate or control troubling
symptoms so a person can function better and can increase well-being and
healing. Problems helped by psychotherapy include difficulties in coping with
daily life, the impact of trauma, medical illness or loss, like the death of a loved
one; and specific mental disorders, like depression or anxiety by doing so, the
physician will be able to help the patient gain self-confidence and later on take
way the risk of suicide and help the patient return her well-being.

12. You report J.M.'s statements to the physician. What do you expect to
be ordered by the physician?
ANSWER:
“I’ll be so glad to get out of this place. I'm so fat and ugly. I need to lose 10
pounds. I bet I can do it in just a couple of days. Otherwise, I don't want to
live anymore.“

Based on J.M's statement, the physician will probably postpone or delay

her discharge. Because it is evident that J.M will not be able to gain weight
with outpatient treatment due to failure to comply with treatment plan, and
suicidal behavior. Patient will be given proper psychotherapy and
psychopharmacological treatment.

13. What medications would be indicated for J.M. to assist with resolution of
both her anorexia nervosa and major depression?
ANSWER:
● Chlorpromazine (Thorazine) - To manage symptoms of psychotic disorders or
control manic manifestations of manic depression in outpatients. As well as to
treat nausea and vomiting and to treat intractable hiccups.

● Fluoxetine (Prozac) - To treat depression and also to treat moderate to

severe bulimia nervosa.
● Olanzapine (Zyprexa) - To treat schizophrenics. To treat manic phase of
bipolar I disorder (manic or mixed episodes)