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, -It is important to note that the patient has a history of anorexia nervosa
now is 16 (so for 5 years) because this could mean that she could possibly have more serious side
-Drinks several large glasses of water daily effects because of the length of her ED
-Recently engaging in self harming behavior, -It is important to note that she drinks water because the patient is at risk
she is cutting both forearms and thighs with for fluid and electrolyte problems. If she is drinking a lot of water she
broken glass (numerous lacerations and scars could experience fluid overload which makes her at risk for hyponatremia
-Presents to the ED with increasing weakness, and seizures
lightheadedness and a near syncopal episode -The patient is cutting herself, which shows that she is at risk for self-harm
this evening and could be a high risk for suicide.
- admits to inducing vomiting after meals the -The fact that she has increasing weakness, lightheadedness and near
past three weeks syncopal episode shows that she may be experiencing electrolyte
-She is 5’ 5” and weighs 83 lbs/37.7 kg (BMI imbalances which can be deadly
13.8) -The fact that her BMI is very low shows that she could be experiencing
- brought in by her mother and does not want to extreme electrolyte imbalances which could lead to organ failure and even
be treated death
- overhear her say to her mother, “I hate -The fact that she was brought in by her mother shows that she has a
everything about me! I am so tired of support system at home and it is important to note that she is resistant to
living, I wish I were dead!” 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 -She experienced sexual abuse as a child, which is a major emotional
the age of six to twelve trauma, and these types of trauma can cause the development of eating
-confided what was taking place to her mother disorders, anxiety, and depression. She could be using the anorexia nervosa
and lives with her mother, who is now to cope
divorced -The patient has a support system at home, her mother. The nurse may need
-is sexually active and promiscuous to include family education as well.
- uses the Tinder app to meet older men for -The patient may be using sexual activities as a coping mechanism for her
anonymous sexual encounters when her past sexual abuse
mother is working
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 more specifically an SSRI anxiety will reduce, this will
Self-injurious behavior (SIB) hopefully help stop her self
Sexually abused as a child 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).
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, -It is important to note that the patient has a history of anorexia nervosa
now is 16 (so for 5 years) because this could mean that she could possibly have more serious side
-Drinks several large glasses of water daily effects because of the length of her ED
-Recently engaging in self harming behavior, -It is important to note that she drinks water because the patient is at risk
she is cutting both forearms and thighs with for fluid and electrolyte problems. If she is drinking a lot of water she
broken glass (numerous lacerations and scars could experience fluid overload which makes her at risk for hyponatremia
-Presents to the ED with increasing weakness, and seizures
lightheadedness and a near syncopal episode -The patient is cutting herself, which shows that she is at risk for self-harm
this evening and could be a high risk for suicide.
- admits to inducing vomiting after meals the -The fact that she has increasing weakness, lightheadedness and near
past three weeks syncopal episode shows that she may be experiencing electrolyte
-She is 5’ 5” and weighs 83 lbs/37.7 kg (BMI imbalances which can be deadly
13.8) -The fact that her BMI is very low shows that she could be experiencing
- brought in by her mother and does not want to extreme electrolyte imbalances which could lead to organ failure and even
be treated death
- overhear her say to her mother, “I hate -The fact that she was brought in by her mother shows that she has a
everything about me! I am so tired of support system at home and it is important to note that she is resistant to
living, I wish I were dead!” 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 -She experienced sexual abuse as a child, which is a major emotional
the age of six to twelve trauma, and these types of trauma can cause the development of eating
-confided what was taking place to her mother disorders, anxiety, and depression. She could be using the anorexia nervosa
and lives with her mother, who is now to cope
divorced -The patient has a support system at home, her mother. The nurse may need
-is sexually active and promiscuous to include family education as well.
- uses the Tinder app to meet older men for -The patient may be using sexual activities as a coping mechanism for her
anonymous sexual encounters when her past sexual abuse
mother is working
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 more specifically an SSRI anxiety will reduce, this will
Self-injurious behavior (SIB) hopefully help stop her self
Sexually abused as a child 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).
