NURSING 432 FA Davis Donna West

Erika Hightower Donna West Donna West | Interview the Patient | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. 1. What are some changes that you have noticed in your health status lately? Rationale Relevancy Your Answer Determining the client’s history is important in assessing the physiological impact of the illness. Relevant Relevant Client: I have always struggled with my weight, but lately I just can’t seem to keep my eating or my weight under control. My doctor said that my electrolytes were abnormal. I also have had problems with dental decay and constipation. 2. Tell me about your eating and exercise patterns. Rationale Relevancy Your Answer It is important to assess the client’s perspective about her own health. Relevant Relevant Client: I know I don’t eat right. I just can’t stop myself. I eat until I feel sick and then the only way to feel better is to make myself vomit and take laxatives. I usually don’t exercise; I just don’t have the energy, and I feel self-conscious when I go to the gym. 3. Do you ever experience feelings of sadness, hopelessness, or anxiety? Rationale Relevancy Your Answer Individuals with bulimia are at an increased risk for mood disorders. Relevant Relevant Client: I feel like my life is suddenly out of control. I can’t even control what I do with my body. Everything seems so overwhelming right now. 4. Tell me about the impact your binging and purging has on your self-esteem and self-concept. Rationale Relevancy Your Answer Assessing the client’s self-esteem and self-concept, as well as the emotions that she experiences in relation to her binging and purging, can assist her to identify the connection between Relevant Relevant her feelings, self-concept, and eating patterns. Client: I feel so ashamed and guilty that I cannot control myself. I can’t compete with younger women. Now that my marriage is over, I will probably be alone the rest of my life. 5. Are there voices that tell you when to binge and purge? Rationale Relevancy Your Answer The client has not indicated that she hears voices. Irrelevant Irrelevant Client: No, I just feel overwhelmed and guilty. Copyright @2017 by FA Davis Donna West | Assess the Patient | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. • Inspection • Auscultation • Palpation • Percussion When the client is in distress, or is overly apprehensive or anxious, the examiner will want to make the exam as short as possible while still gathering necessary data. Relevant Relevant Assessment Data/Patient Results: Donna is currently experiencing mild anxiety and is in no acute distress. 2. Assess Donna’s respirations. Rationale Relevancy Your Answer Assessing baseline vital signs is important. Relevant Relevant Individuals with bulimia can experience weight fluctuations ranging from underweight to overweight. Therefore, an accurate baseline BMI and weight are essential in planning Relevant Relevant and providing care. Assessment Data/Patient Results: Donna’s BMI is 29. 4. Perform an abdominal assessment. Rationale Relevancy Your Answer Individuals with bulimia often exhibit issues related to chronic constipation as a result of laxative abuse. Relevant Relevant Individuals with eating disorders exhibit issues related to self-esteem and distorted body image. Relevant Relevant Irrelevant Irrelevant Feelings of depression and anxiety are common with individuals diagnosed with bulimia. It would also be important to complete a suicide risk assessment if the client indicates that she is also experiencing thoughts of suicide or self-harm. Relevant Relevant Conflicts with family and friends can reinforce unhealthy eating patterns. Relevant Relevant Copyright @2017 by FA Davis Donna West | Assess the Patient | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. • Inspection • Auscultation • Palpation • Percussion 1. Assess Donna’s blood pressure. Assessing baseline vital signs is important. Relevant Relevant Assessment Data/Patient Results: Donna’s blood pressure is lower than normal. 2. Perform an abdominal assessment. Rationale Relevancy Your Answer Individuals with bulimia often exhibit issues related to chronic constipation as a result of laxative abuse. Relevant Relevant Individuals with bulimia can experience cardiac symptoms and complications as a result of their diuretic and laxative abuse. Relevant Relevant Copyright @2017 by FA Davis Donna West | Assess the Patient | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. • Inspection • Auscultation • Palpation • Percussion Assessing baseline vital signs is important. Relevant Relevant Assessment Data/Patient Results: Donna’s pulse is slightly elevated. 2. Perform an abdominal assessment. Rationale Relevancy Your Answer Individuals with bulimia often exhibit issues related to chronic constipation as a result of laxative abuse. Relevant Relevant Copyright @2017 by FA Davis Donna West | Assess the Patient | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. • Inspection • Auscultation • Palpation • Percussion 1. Perform an abdominal assessment. Individuals with bulimia often exhibit issues related to chronic constipation as a result of laxative abuse. Relevant Relevant Copyright @2017 by FA Davis Donna West | Labs / Diagnostic Tests | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. 1. CXR (chest x-ray) Rationale Relevancy Your Answer A chest x-ray is not of value when diagnosing or treating bulimia. Irrelevant Irrelevant 2. ECG (electrocardiogram) Rationale Relevancy Your Answer Individuals with bulimia may have cardiac arrhythmias as a result of their electrolyte imbalance. Relevant Relevant 3. Gastroscopy Rationale Relevancy Your Answer Individuals with bulimia may experience tears in the gastric or esophageal mucosa as a result of self- induced vomiting. Relevant Relevant 4. Urinalysis Rationale Relevancy Your Answer Individuals with bulimia may have kidney and urinary problems related to their binging and purging behavior including laxative and diuretic abuse. Relevant Relevant 5. BUN (blood urea nitrogen) Rationale Relevancy Your Answer Individuals with bulimia may have kidney damage. This test will determine renal function. Relevant Relevant 6. Creatinine Rationale Relevancy Your Answer Individuals with bulimia may have kidney damage. This test will determine real excretory function. Relevant Relevant 7. Creatinine clearance Rationale Relevancy Your Answer Creatinine clearance is a measure of the glomerular filtration rate (GFR). Dehydration would affect the GFR as the amount of blood present to be filtered would be decreased. Relevant Relevant 8. Electrolytes Rationale Relevancy Your Answer Individuals with bulimia often develop electrolyte imbalances as a result of the binging and purging behavior. Relevant Relevant 9. DAS (drugs of abuse screen) Rationale Relevancy Your Answer Individuals with bulimia are subject to substance abuse or dependence, frequently involving amphetamines or alcohol. Relevant Relevant 10. TSH (thyroid-stimulating hormone) Rationale Relevancy Your Answer There is no indication that the client has hypothyroidism. Irrelevant Irrelevant Copyright @2017 by FA Davis Donna West | Clustering Assessment Data | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. When you are finished reviewing, click "Continue" to proceed to next section. 1. Cluster A Rationale Correct Answer Your Answer Rationale: Hypotension and tachycardia can be indicators of dehydration. Abnormal electrolyte levels can occur in individuals who abuse laxatives and diuretics, and self-induce vomiting. Donna’s blood pressure is lower than normal. Donna’s pulse is slightly elevated. Donna’s respirations are within normal limits. Donna’s BMI is 29. Donna has indicated that she has had problems in the past with constipation, and she has a history of laxative abuse as well Donna’s blood pressure is lower than normal. Donna’s pulse is slightly elevated. Donna’s respirations are within normal limits. Donna’s BMI is 29. Donna has indicated that she has had problems in the past with constipation, and she has a history of laxative abuse as well as self-induced vomiting. Donna’s abdomen is soft and she has slightly diminished bowel sounds. Donna’s electrolytes were slightly abnormal, her pulse is slightly elevated, and she has hypotension. as self-induced vomiting. Donna’s abdomen is soft and she has slightly diminished bowel sounds. Donna’s electrolytes were slightly abnormal, her pulse is slightly elevated, and she has hypotension. 2. Cluster B Rationale Correct Answer Your Answer Rationale: It is important to ensure that the client is feeling comfortable during the interview. Individuals with bulimia identify a lack of control over eating behaviors and may experience signs and symptoms of mood disorders, anxiety disorders, and/or substance abuse disorders. Donna is currently experiencing mild anxiety and is in no acute distress. Donna has indicated that she feels like her life is out of control. Donna states that she feels anxious and hopeless when she thinks about the loss of her relationship. Donna is currently experiencing mild anxiety and is in no acute distress. Donna has indicated that she feels like her life is out of control. Donna states that she feels anxious and hopeless when she thinks about the loss of her relationship. 3. Cluster C Rationale Correct Answer Your Answer Rationale: Individuals with eating disorders often express feelings related to low self-esteem, lack of control, loss, and isolation which contribute to their low self- concept and inability to cope with life stressors in a healthy manner. Donna has indicated that she has self-esteem issues related to her inability to maintain a healthy weight. Donna has identified that her marriage recently ended and she is in the process of obtaining a divorce. Donna is concerned that she will spend the rest of her life Donna has indicated that she has self-esteem issues related to her inability to maintain a healthy weight. Donna has identified that her marriage recently ended and she is in the process of obtaining a divorce. Donna is concerned that she will spend the rest of her life alone. alone. Copyright @2017 by FA Davis Donna West | Assign Diagnoses | Review Back Continue Answers and Rationale Your responses are displayed below. When you are finished reviewing, click "Continue" to proceed to next section. 1. Cluster A Rationale Correct Answer Your Answer True Fluid Volume Deficit Fluid Volume Deficit 2. Cluster B Rationale Correct Answer Your Answer True Ineffective Coping Ineffective Coping 3. Cluster C Rationale Correct Answer Your Answer True Low Self-Esteem Low Self-Esteem Copyright @2017 by FA Davis Donna West | Nursing Outcomes / Individualized Goals | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. 1. The client’s vital signs will be within normal limits and urinary output will be adequate. Rationale Relevancy Your Answer Rationale: Adequate fluid intake is essential to restore hydration. Fluid Volume Deficit Fluid Volume Deficit 2. The client will begin verbalizing positive personal attributes. Rationale Relevancy Your Answer Rationale: Identification of positive personal attributes can improve a client’s sense of self-worth. Low Self- Esteem Low Self- Esteem 3. The client will verbalize adaptive coping mechanisms that can be incorporated into her lifestyle. Rationale Relevancy Your Answer Rationale: Clients who develop adaptive coping mechanisms feel in control of their lives and are less likely to utilize maladaptive eating patterns to achieve a sense of control. Ineffective Coping Ineffective Coping 4. The client will not exhibit aggressive behavior. Rationale Relevancy Your Answer Rationale: There is no indication that Donna is exhibiting aggression toward others. None 5. The client will resume a normal bowel routine without the use of laxatives. Rationale Relevancy Your Answer Rationale: Although Donna has had problems with constipation in the past due to her abuse of laxatives, this would not be a priority at this time. None 6. The client and her spouse will participate in family counseling. Rationale Relevancy Your Answer Rationale: Donna’s relationship has ended and she is in the process of obtaining a divorce. Therefore, relationship counseling would be ineffective at this time. None Copyright @2017 by FA Davis Donna West | Nursing Interventions / Activities | Review Back Continue Answers and Rationale Your responses and feedback are displayed below. For more information regarding feedback, click "Help". When you are finished reviewing, click "Continue" to proceed to next section. 1. Encourage Donna to reexamine negative self-perceptions and identify her positive attributes. Rationale Relevancy Your Answer Rationale: Clients who are able to recognize the impact of their negative self-assessment on self-esteem and begin to identify personal, positive attributes can elevate their sense of self-worth. Low Self- Esteem Low Self- Esteem 2. Encourage Donna to identify areas in her life that she can control without resorting to maladaptive eating patterns. Rationale Relevancy Your Answer Rationale: When clients feel in control over major life issues, the need to gain control through maladaptive eating patterns will diminish. Ineffective Coping Ineffective Coping 3. Assist Donna to identify areas of her life that she can control. Rationale Relevancy Your Answer Rationale: Identification of areas of life that are within her control will encourage the client to develop strategies that will address those areas. Ineffective Coping Ineffective Coping 4. Donna should be observed for at least 1 hour after meals. Rationale Relevancy Your Answer Rationale: Vomiting causes active loss of body fluids and can precipitate fluid volume deficit. Fluid Volume Deficit Fluid Volume Deficit 5. Help Donna identify angry feelings she is experiencing due to her marital breakup and impending divorce. Rationale Relevancy Your Answer Rationale: Unexpressed anger is often turned inward, resulting in a decrease in self-esteem. Low Self- Esteem Low Self- Esteem 6. Encourage Donna to verbalize her feelings regarding her family role and her recent marital breakup. Help her to recognize that maladaptive eating behaviors may be related to these emotional issues. Rationale Relevancy Your Answer Rationale: Emotional issues need to be resolved in order to eliminate maladaptive eating behaviors. Ineffective Coping Ineffective Coping 7. Assist Donna to identify areas of her life that are out of her control. Rationale Relevancy Your Answer Rationale: Recognition that it is not possible to control all aspects of life will encourage the client to focus on the things she can control. Ineffective Coping Ineffective Coping 8. Teach Donna the importance of a daily fluid intake between 2000 and 3000 ml. Rationale Relevancy Your Answer Rationale: This promotes client safety and actively engages the client in the treatment plan. Fluid Volume Deficit Fluid Volume Deficit 9. Teach Donna the long-term impact of laxative and/or diuretic abuse. Rationale Relevancy Your Answer Rationale: Educating the client about the long-term negative consequences of abusing laxatives and/or diuretics will encourage her to make healthier choices. Fluid Volume Deficit Fluid Volume Deficit 10. Encourage Donna to identify several positive aspects about herself unrelated to her appearance. Rationale Relevancy Your Answer Rationale: Identification of positive characteristics encourages the client to recognize that appearance does not define her. Low Self- Esteem Low Self- Esteem