Scenario

You are a nurse on an inpatient psychiatric unit. K.R., a 23-year-old woman, was admitted to the
psychiatric unit last night after assessment and treatment at a local hospital emergency department (ED)
for “blacking out at school.” She has been given a preliminary diagnosis of anorexia nervosa. As you
begin to assess her, you notice that she has very loose clothing, she is wrapped in a blanket, and her
extremities are very thin. She tells you, “I don't know why I'm here. They're making a big deal about
nothing.” She appears to be extremely thin and pale, with dry and brittle hair, which is very thin and patchy,
and she constantly complains about being cold. As you ask questions pertaining to weight and nutrition,
she becomes defensive and vague, but she does admit to losing “some” weight after an appendectomy 2
years ago. She tells you that she used to be fat, but after her surgery she did not feel like eating and
everybody started commenting on how good she was beginning to look, so she just quit eating for a
while. She informs you that she is eating lots now, even though everyone keeps “bugging me about my
weight and how much I eat.” She eventually admits to a weight loss of “about 40 pounds and I'm still fat.”

1. How is the diagnosis of anorexia nervosa determined?

2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next to those that K.R.
has.

3. What other disorders might occur along with anorexia nervosa?

4. How does bulimia nervosa differ from anorexia nervosa?

5. Name behaviors that K.R. or any other patient with anorexia may engage in other than self-starvation.
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NCM 117 LAB - CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR

6. What common family dynamics are associated with anorexia nervosa?

CASE STUDY PROGRESS

You review her admission laboratory studies. An ECG has also been ordered.
Admission Lab Work
Sodium 135 mEq/L
Potassium 3.4 mEq/L
Chloride 99 mEq/L
BUN 18 mg/dL
Creatinine 1.0 mg/dL
Hemoglobin 11 g/dL
Hematocrit 35%
7. Which lab results might be of concern at this time? Explain your answers.

8. What clinical symptoms of anorexia nervosa should have the highest priority? Explain your answers.

CASE STUDY PROGRESS

K.R.'s ECG results show normal sinus rhythm with no ST segment or other changes. You meet with K.R. to
formulate a plan of care.
9. In general, the care plans for patients with anorexia are detailed and include many psychological
aspects. What are they? You should be able to name at least 10.

10. What would indicate successful treatment with K.R.?

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NCM 117 LAB - CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR

CASE STUDY PROGRESS

After 3 weeks, you are providing discharge teaching for K.R. You ask her whether she is ready to go home.
K.R. states, “I'll be so glad to get out of this place. I'm so fat and ugly. I need to lose 10 pounds. I bet I can
do it in just a couple of days. Otherwise, I don't want to live anymore.”
11. What will you discuss with the physician before any further discharge teaching or plans?

12. You report K.R.'s statements to the physician. What do you expect to be ordered by the physician?

13. What medications would be indicated for K.R. to assist with resolution of both her anorexia nervosa
and major depression?

CASE STUDY OUTCOME

After 2 weeks, K.R. has gained 5 pounds and seems to be more willing to eat. She still expresses fears of “getting
fat,” but she states that she is ready to go home and back to school. The primary care provider (PCP) arranges for
K.R. to participate in an outpatient partial hospitalization program that specializes in eating disorders. K.R.
expresses interest in meeting others with the same problems.