Eating Disorder/Electrolyte Imbalances Keith RN UNFOLDING Reasoning Case Study:

Eating Disorder/Electrolyte Imbalances Mandy White, 16 years old Primary Concept Fluid and Electrolyte Balance Interrelated Concepts (In order of emphasis) 1. Acid-base 2. Nutrition 3. Perfusion 4. Coping 5. Mood and Affect 6. Clinical Judgment 7. Communication 8. Collaboration 9. Patient education © 2016 Keith Rischer/www.KeithRN.com UNFOLDING Reasoning Case Study: STUDENT Eating Disorder/Electrolyte Imbalances History of Present Problem: Mandy White is a 16-year-old adolescent who has struggled with anorexia nervosa since the age of 11. She admits to drinking several large glasses of water daily. Mandy has also been recently engaging in self injurious behavior (SIB) of cutting both forearms and thighs with broken glass, causing numerous lacerations and scars. Mandy presents to the emergency department (ED) with increasing weakness, lightheadedness and a near syncopal episode this evening. She admits to inducing vomiting after meals the past three weeks. She is 5’ 5” and weighs 83 lbs/37.7 kg (BMI 13.8). Mandy is reluctantly brought in by her mother and does not want to be treated. As the primary nurse responsible for the care of Mandy, you overhear her say to her mother, “I hate everything about me! I am so tired of living, I wish I were dead!” Personal/Social History: Mandy was sexually abused by her stepfather from the age of six to twelve. She confided what was taking place to her mother and lives with her mother, who is now divorced. Mandy is sexually active and promiscuous. She uses the Tinder app to meet older men for anonymous sexual encounters when her mother is working. What data from the histories are RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: -Struggled with anorexia nervosa since age 11, now is 16 (so for 5 years) -Drinks several large glasses of water daily -Recently engaging in self harming behavior, she is cutting both forearms and thighs with broken glass (numerous lacerations and scars -Presents to the ED with increasing weakness, lightheadedness and a near syncopal episode this evening - admits to inducing vomiting after meals the past three weeks -She is 5’ 5” and weighs 83 lbs/37.7 kg (BMI 13.8) - brought in by her mother and does not want to be treated - overhear her say to her mother, “I hate everything about me! I am so tired of living, I wish I were dead!” -It is important to note that the patient has a history of anorexia nervosa because this could mean that she could possibly have more serious side effects because of the length of her ED -It is important to note that she drinks water because the patient is at risk for fluid and electrolyte problems. If she is drinking a lot of water she could experience fluid overload which makes her at risk for hyponatremia and seizures -The patient is cutting herself, which shows that she is at risk for self-harm and could be a high risk for suicide. -The fact that she has increasing weakness, lightheadedness and near syncopal episode shows that she may be experiencing electrolyte imbalances which can be deadly -The fact that her BMI is very low shows that she could be experiencing extreme electrolyte imbalances which could lead to organ failure and even death -The fact that she was brought in by her mother shows that she has a support system at home and it is important to note that she is resistant to treatment so may need to be hospitalized involuntarily -She is stating suicidal thoughts and therefore is a high risk for suicide, suicide ideation RELEVANT Data from Social History: Clinical Significance: -was sexually abused by her stepfather from the age of six to twelve -confided what was taking place to her mother and lives with her mother, who is now divorced -is sexually active and promiscuous - uses the Tinder app to meet older men for anonymous sexual encounters when her mother is working -She experienced sexual abuse as a child, which is a major emotional trauma, and these types of trauma can cause the development of eating disorders, anxiety, and depression. She could be using the anorexia nervosa to cope -The patient has a support system at home, her mother. The nurse may need to include family education as well. -The patient may be using sexual activities as a coping mechanism for her past sexual abuse What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome: Anorexia nervosa Citalopram 20 mg PO daily This is an antidepressant and The patient’s depression and Depression Self-injurious behavior (SIB) Sexually abused as a child more specifically an SSRI anxiety will reduce, this will hopefully help stop her self harming behavior and improve her ED What medications treat which conditions? Draw a line to identify what illness is being managed by what medication? Citalopram is helping treat her depression and anxiety, which is correlated to her ED 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). ..................................................continued................................................