NR 326 Eating Disorder Case Study

NR 326 Eating Disorder Case Study

Profile Introduction

J.D. is a 16-year-old female who recently transferred to a new high school after her family moved from out of state. This is her fourth residence and school change in the last six years. J.D.’s father is in the army and recently returned home after a 9-month tour in Iraq. Over the past 18 months, J.D. has been restricting her food intake. Despite being 5’6″ tall, she weighs only 98 pounds. She is involved in the school’s dance team and maintains good academic standing as an honor roll student. The school nurse notices that J.D. often eats only a single piece of fruit during lunch. Additionally, the nurse is concerned about J.D.’s fatigue during dance team practices and her overall frail and thin appearance.

What medical diagnosis does the school nurse suspect J.D. is experiencing? What leads the school nurse to that conclusion?

The school nurse suspects J.D. may be experiencing anorexia nervosa, an eating disorder. The nurse’s suspicion is based on several factors: J.D.’s persistent restriction of energy intake, her status as a female adolescent, her significantly low BMI of 15.8 (indicating underweight), her appearance of fatigue, and her fragile and thin physical appearance. These signs and symptoms align with the characteristic features of anorexia nervosa.

NR 326 Eating Disorder Case Study

What are the risk factors for developing an eating disorder (including personal, family, and sociocultural aspects)? Which risk factors apply to J.D.?

Various risk factors contribute to the development of an eating disorder. These factors encompass personal, family, and sociocultural aspects. Some risk factors include occupation choices that promote thinness, like fashion modeling or participation in elite-level athletics that prioritize a lean body build. Other factors entail a history of obesity, being a “picky” eater during childhood, family genetics, being an adolescent female, experiencing stressful life events, biological influences (such as biochemical imbalances), interpersonal relationships, psychological influences, environmental factors, and temperamental factors.

In J.D.’s case, several of these risk factors are applicable. She is an adolescent female who has recently moved and experienced multiple relocations during childhood. Moreover, her participation in the dance team, a sport that values a lean body build, puts her at risk. Environmental factors, including media influence and societal pressure to attain the ideal body, also contribute to her vulnerability to developing an eating disorder.

NR 326 Eating Disorder Case Study

Expected clinical manifestations of anorexia nervosa encompass a range of physical, psychological, and behavioral symptoms. These may include appetite loss and refusal to eat, denial of hunger, and feelings of lack of control. Individuals with anorexia nervosa may engage in compulsive exercising and exhibit traits of overachievement and perfectionism. Physical alterations may include decreased body temperature, pulse, and blood pressure, significant weight loss; gastrointestinal disturbances such as constipation, dental and gum deterioration; esophageal varices from induced vomiting, electrolyte imbalances, dry and scaly skin; the presence of fine hair (lanugo) on extremities, sleep disturbances, hormone deficiencies, amenorrhea for at least three consecutive menstrual periods, cyanosis and numbness of extremities, and bone degeneration.

When addressing J.D., the first intervention the school nurse should implement is establishing a one-to-one therapeutic relationship. This involves creating a supportive and trusting environment where J.D. feels comfortable expressing her concerns and experiences related to her eating disorder. Building trust and recognizing any reluctance from J.D. to establish a relationship is crucial in providing adequate care and support. Therapeutic communication techniques are essential in engaging with individuals like J.D. Some examples of these techniques include active listening, where the nurse demonstrates genuine interest and attentiveness; using open-ended questions to encourage J.D. to express her thoughts and feelings in more detail; reflecting, which involves repeating or paraphrasing J.D.’s statements to convey understanding and encourage further exploration; and summarizing, where the nurse provides a concise overview of the conversation to ensure mutual understanding. Other techniques include clarifying, focusing, offering self to help, paraphrasing, restating, silence to allow for reflection, and validating J.D.’s experiences and emotions.

NR 326 Eating Disorder Case Study

After establishing a rapport with J.D. and hearing her express feelings of hopelessness, and contemplating life’s worth, the school nurse must prioritize assessing for suicide potential. The nurse should ask J.D. if she has any thoughts or ideas of harming herself or others and if she has a specific plan. As J.D. is brought to the Emergency Department for evaluation, the ED nurse anticipates the doctor ordering several lab values. These may include a complete blood count (CBC), a basic metabolic panel (BMP) to assess electrolyte levels, cholesterol levels, thyroid function tests, blood glucose levels, and an arterial blood gas analysis to check for metabolic acidosis or alkalosis. Upon J.D.’s admission to the inpatient behavioral health unit, the admission nurse begins setting up her treatment plan. Three nursing diagnoses that would apply to J.D. are as follows, prioritized by importance:

Imbalanced Nutrition:

Less Than Body Requirements – This is the top priority, as J.D.’s insufficient food intake puts her at risk of severe malnutrition and potential death. Risk for Fluid Volume Deficit – Second in focus, as J.D.’s inadequate fluid intake could lead to imbalances in her body’s fluid and electrolyte levels. Risk for Impaired Skin Integrity – Third in importance, as the lack of nutrients and hydration can cause dry, flaky skin, increasing the risk of infection if proper skin integrity is not maintained.

J.D.’s care plan should include various nursing interventions such as:

  • Establishing a daily nutritional plan
  • Assisting J.D. in identifying triggers for her eating disorder
  • Implementing behavior modification techniques
  • Providing individual, group, and family therapy
  • Supervising mealtimes and monitoring intake and output
  • Weighing J.D. daily under consistent conditions
  • Monitoring and restoring fluid and electrolyte balance
  • Assessing and managing elimination patterns
  • Limiting J.D.’s activity level
  • Administering prescribed antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine.

The treatment goals for J.D. include the following:

  • Verbalizing an understanding of her nutritional needs
  • Establishing a dietary pattern with an adequate caloric intake to regain and maintain a healthy weight
  • Demonstrating weight gain toward the individually expected range.

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