Week 2 Discussion: Anorexia and fluid and electrolyte imbalances (USLOs 1, 2, 3, 4)
You are a nurse caring for 16-year-old Jonathan Collins. He was admitted to the emergency department after passing out during gym class. During your admission assessment, he admits he has not been eating much and exercising more to lose weight. Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of anorexia and fluid and electrolyte imbalances, respond to the following prompts:
1. Thoroughly explain the pathophysiology of anorexia. Use a scholarlyor authoritative source to support your answer.
2. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
o cultural
o financial
o environmental implications
3. Identify 3-5 priority nursing interventions for the client while in the emergency department.
4. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
5. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.
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1. The pathophysiology of anorexia involves a complex interplay of biological, psychological, and socio-cultural factors. In individuals with anorexia, there is an intense fear of gaining weight or becoming fat, which leads to significant restriction of food intake and often excessive exercise. This restriction of food leads to a state of severe malnutrition, as the body is not receiving the necessary nutrients to function properly. The body responds to this malnutrition by slowing down the metabolism, which further contributes to weight loss. Additionally, the body may start to break down muscle tissue for energy, leading to muscle wasting and weakness.
Anorexia also affects the brain, leading to alterations in neurotransmitter levels and imbalances in the reward pathways. This can contribute to distorted body image, perfectionism, and obsessive thoughts about food and weight. The exact cause of anorexia is not known, but a combination of genetic, environmental, and psychological factors are believed to play a role.
Source:
National Institute of Mental Health. (2019). Eating disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
2. Cultural, financial, and environmental implications can all impact the development and course of anorexia.
- Cultural factors: Cultural ideals of beauty and thinness can greatly influence the development of anorexia. Societies that place a high value on being thin may contribute to body dissatisfaction and drive individuals towards extreme dieting behaviors. Cultural norms may also play a role in the persistence of anorexia, as individuals may face pressures to conform to these ideals.
- Financial factors: Anorexia can be financially burdensome, as individuals may spend large sums of money on excessive exercise equipment, diet pills, food supplements, or even medical treatments related to their eating disorder. Financial constraints can limit access to appropriate treatment and support resources, which can worsen the prognosis for individuals with anorexia.
- Environmental factors: The home and social environment can influence the development and maintenance of anorexia. Environmental factors such as parental attitudes towards weight, family dynamics, peer pressure, and exposure to dieting behaviors can all contribute to the development and persistence of anorexia. Additionally, the availability and accessibility of food can impact an individual's ability to seek appropriate nutrition and recovery.
Sources:
Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology, Course, and Outcome of Eating Disorders. Current Opinion in Psychiatry, 25(6), 521–526. doi: 10.1097/YCO.0b013e32835b14b8
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D.C: American Psychiatric Association.
3. Priority nursing interventions for the client while in the emergency department may include:
- Ensuring the client's safety: An assessment of the client's physical and psychological stability should be conducted to determine the level of risk. If there is an immediate threat to the client's safety, appropriate measures should be taken, such as close observation or considering a psychiatric consultation.
- Stabilizing fluid and electrolyte imbalances: As anorexia often leads to severe dehydration and electrolyte imbalances, prompt interventions to restore fluid balance and correct electrolyte abnormalities should be implemented. This may include intravenous fluid administration and electrolyte replacement under the guidance of a healthcare provider.
- Nutritional support: Initiating appropriate nutritional support is crucial, especially in cases of severe malnutrition. This may involve starting enteral or parenteral nutrition, depending on the client's condition and medical needs.
- Psychosocial support: Anorexia is a complex disorder with significant psychological aspects. Providing empathetic and non-judgmental support, as well as establishing rapport with the client, is important. Referring the client for psychiatric evaluation or counseling services may also be necessary.
- Collaborative care planning: The nurse should collaborate with other healthcare professionals involved in the client's care to ensure a comprehensive and coordinated treatment plan. This may involve consulting with a dietitian, psychologist, psychiatrist, and other members of the interdisciplinary team.
4. In the client's plan of care, the following labs and diagnostic testing may be included:
- Complete blood count (CBC): This can help identify abnormal red and white blood cell counts, which may indicate nutritional deficiencies or other complications.
- Comprehensive metabolic panel (CMP): This panel includes tests such as electrolyte levels, liver function tests, and kidney function tests. These tests can help identify any electrolyte imbalances or abnormalities in organ function.
- Thyroid function tests: Thyroid dysfunction is commonly associated with anorexia. Testing thyroid hormone levels can help identify any abnormalities that may require treatment.
- Bone density scan: Anorexia can lead to decreased bone density and osteoporosis. A bone density scan can help assess the client's bone health and guide treatment decisions.
Critical indicators in these lab tests may include electrolyte imbalances (such as low potassium or sodium levels), abnormalities in liver or kidney function, and signs of malnutrition or nutritional deficiencies.
Source:
Velázquez, A. (2020). Anorexia Nervosa. Retrieved from https://emedicine.medscape.com/article/912238-overview
5. Holistic patient-centered care for a client with anorexia involves the collaboration of various members of the interdisciplinary team, including:
- Psychiatrist: A psychiatrist can provide psychiatric evaluation, diagnosis, and medication management for any co-existing mental health conditions, such as depression or anxiety.
- Psychologist or therapist: These professionals can provide psychological evaluation, counseling, and therapy specific to eating disorders. They can help address any underlying psychological factors contributing to anorexia and aid in the development of healthy coping strategies.
- Registered dietitian: A dietitian can provide nutritional assessment and guidance, meal planning, and education on healthy eating habits. They can also help develop a meal plan specific to the client's needs and preferences.
- Social worker: A social worker can help address any psychosocial factors contributing to the client's condition, provide support and resources for the client and their family, and assist with discharge planning.
- Primary care physician: The primary care physician plays a crucial role in managing the client's overall health and monitoring any medical complications associated with anorexia.
Collaboration among these professionals is essential to provide comprehensive care that addresses the physical, psychological, and social aspects of the client's condition.
Source:
Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P. S., & Zerbe, K. J. (2014). Practice Guideline for the Treatment of Patients With Eating Disorders (3rd ed.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK248108/
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