AHMED BA ELAIAN BSN-VI October 26,2021

CASE SCENARIO:

Pauline is a seventeen year old girl who has severely restricted

her dietary intake. She is currently forty nine kilograms and height
163cm. Her mother says she was 60kgs six months ago.

At age fifteen, Pauline was removed from the public school she
was attending and put into a private school, where she was
awarded the dux prize. She did not have any friends during this
year as she spent all recesses in the library, reporting that ate
alone as she ‘had no friends to eat with anyway’.

Her mother says that she attends roller skating sessions up to five
nights a week and believes she does this to lose weight. She is
pre-occupied with food and is constantly cooking for the family.
She does not sit down with the family to eat, saying that she has
eaten enough while cooking. An argument with her parents
precipitated the diet as she decided that there was ‘one area of
her life that she could control and that was what she ate’.

She has commenced medication for sleep stating that she is

unable to sleep after studying till late at night.

She recently took an overdose of sleeping pills and whilst in

Emergency Department expressed a desire to die. The family live
on a ten acre block and are ten kilometres from town. Her father
is an accountant. Her mother is a school teacher and has a
diagnosis of bipolar affective disorder.

She says she fights a lot with her mother and does not seem to
be able to please her father. Her brother, two years younger, left
home to join the navy earlier this year.
Make a case study on the above scenario
Present the following:
1. Patient Profile:
 Pauline is 17 years old, has severely restricted her dietary
intake, she is 49kg and 163cm. as verbalize by the mother
she was 60kg six months ago. At age fifteen, Pauline was
removed from the public school she was attending and put
into a private school, she did not have any friends during this
year as she spent all recesses in the library, reporting that
ate alone as she ‘had no friends to eat with anyway’. Her
mother says also that she attends roller skating sessions up
to five nights a week and believes she does this to lose
weight. And she thinks that the only area of her life that she
could control and that was what she ate’. She is pre-
occupied with food and is constantly cooking for the family.
She does not sit down with the family to eat. she fights a lot
with her mother and does not seem to be able to please her
father. She has commenced medication for sleep stating that
she is unable to sleep after studying till late at night. And
recently she took an overdose of sleeping pills.

2. Provide a summary of the diagnosis and describe the

course of the illness including chief complaints
 Medical Diagnosis: is anorexia nervosa,
 Nursing Diagnosis: is Disturbed body related to being
excessively underweight as evidence of loss of weight.
 Causes of illness: the exact cause is unknown. it’s maybe a
combining effort of biology, psychological, interpersonal,
environmental factors. in biological, it’s still being heavily
researched what gene triggers anorexia. in psychological,
some factors that contributes to anorexia include low self-
esteem, anxiety, depression, anger, loneliness. in
 interpersonal, those included a history of being ridiculed
based on weight and size, childhood sexual abuse, several
traumas. in the environmental, social factors can cause
anorexia.
 Chief complaints: loss of weight, feeling lonely, difficulty
sleeping

3. State Past and Family History:

 The family live on a ten-acre block and are ten kilometers
from town. Her father is an accountant. Her mother is a
school teacher and has a diagnosis of bipolar affective
disorder. Her brother, two years younger, left home to join
the navy earlier this year.

4. Discuss Disease Entity including pathophysiology

 Amenorrhea is one of the necessary criteria for diagnosis of
anorexia nervosa in female adolescents, but its exact
pathophysiology remains controversial. Involvement of hyper
thalamic dysfunction may be due to malnutrition or to an
underlying neurotransmitter abnormality. The association of
anorexia nervosa with both osteopenia and hypoestrogenism
gives clinical and therapeutic significance to an
understanding of the underlying pathophysiology. The
authors base recommendations for intervention on the
current state of knowledge.

5. Identify and explain Diagnostic Test- describe the test:

 early indicators of anorexia may by the family, doctor,
pediatrician.
 Physical exam. This may include measuring your height and
weight; checking your vital signs, such as heart rate, blood
pressure and temperature; checking your skin and nails for
problems; listening to your heart and lungs; and examining
your abdomen.
  Lab tests. These may include a complete blood count (CBC)
and more-specialized blood tests to check electrolytes and
protein as well as functioning of your liver, kidney and
thyroid. A urinalysis also may be done.
 Psychological evaluation. A doctor or mental health
professional will likely ask about your thoughts, feelings and
eating habits. You may also be asked to complete
psychological self-assessment questionnaires.
 X-rays may be taken to check your bone density, check for
stress fractures or broken bones, or check for pneumonia or
heart problems. Electrocardiograms may be done to look for
heart irregularities.

6. Enumerate Medical management and describe the

therapeutic management used on the above scenario
 Fluid intake to prevent dehydration and restoring of
normal range of electrolytes.
 NG tube or tube feeding may perform to Restoring a
healthy weight if pt. can't perform self-eating.
 providing specific meal plans and calorie requirements
that help you meet your weight goals with monitor patient
during and after eating.
 Have the patient be a part of the decision making to
increase self esteem and sense of control.
 Assess for complications or health issues like unstable
heartbeat, malnutrition, and amenorrhea.
 Some of Psychotherapy like
1. Family-based therapy: because the teenager with
anorexia is unable to make good choices about eating and
health while in the grips of this serious condition, this
therapy mobilizes parents to help their child with re-
feeding and weight restoration until the child can make
good choices about health.
 2. Individual therapy: to normalize eating patterns and
behaviors to support weight gain. The second goal is to
help change distorted beliefs and thoughts that maintain
restrictive eating.
3. Group therapy: to have the behavior to engage with
people and society and have a friend.

7. Identify 1st drug to be given in anorexia nervosa & make at

least 1 drug study
Generic Indication Action Adverse Interaction Contraindication Patient Nursing
name reaction teaching implication
TRIAZOLA Short-term Benzodiazepin CNS: Alcohol, CNS Hypersensitivity Do not Be aware that
M managemen e derivative Drowsiness, DEPRESSANTS, to triazolam and drive or signs of
t of light- ANTICONVULSAN benzodiazepine engage in developing
with hypnotic tolerance or
insomnia effects with headedness T s; pregnancy potentially
adaptation (with
Route & characterize fewer residual , headache, -S, nefazodone, (category X), hazardous long-term use)
Dosage: d by daytime dizziness, BENZODIAZE- lactation; activities. include
Adult: PO difficulty in effects. Its ataxia, PINES potentiate concurrent Avoid use increased
0.125–0.25 falling visual CNS depression: administration of alcohol daytime anxiety,
blockade of
mg h.s. asleep, disturbance cimetidine with the or other increased
cortical and wakefulness
(max: 0.5 frequent s, increases following CNS
mg/d) wakeful limbic arousal confusional triazolam plasma medications depressant during last one
results in third of the
G periods. states, levels, thus which impair s.
hypnotic night.
Following memory increase- cytochrome Do not Lab tests:
long-term activity. impairment, ing its toxicity; may P450 3A (e.g. increase Obtain periodic
use, "rebound decrease ketoconazole, dose blood counts,
tolerance or insomnia," antiparkinsonism itraconazole, without urinalysis, and
adaptation anterograde effects of and physician's blood
may amnesia, levodopa. Herbal: nefazodone. advice chemistries
develop.also paradoxical Kava-kava, during long-term
use.
Depression; reactions, valerian may
Do not use with
older adults minor potentiate addiction-prone
and changes in sedation. patients (drug
debilitated EEG addicts,
patients; patterns. GI: alcoholics)
patients with Nausea, unless careful
suicidal vomiting, surveillance by
tendency; constipation health
personnel is
.
available.
Habituation and
dependence
can occur.
Evaluate
smoking habit.
As with other
benzodiazepine
s, smoking may
decrease
hypnotic effects.
Monitor for
symptoms of
overdosage:
Slurred speech,
somnolence,
 confusion,
impaired
coordination,
and coma.

8. Nursing care plan ( 1 actual priority problem)

Assessment Nursing Planning Intervention Rationale Evaluations
Diagnosis
Imbalanced After 8hours Supervise the To ensure The patient
Nutrition: of nursing patient during compliance was able to
Less Than intervention mealtimes and for with the dietary feel relieved.
Body , the patient a specified period treatment
Requirements will after meals (usually program. For a
related to demontrate one hour). hospitalized
Inadequate relaxation patient with
food intake; skills, other anorexia, food
self-induced methods to is considered a
vomiting promote medication.
comfort.
Liquids are more Fluids eliminat
acceptable than e the need to
solid choose between
foods –
something the
patient with
anorexia may
find difficult.

If edema or She may fear

bloating occurs that she’s
after the patient becoming fat
has returned to and stop
normal eating complying with
behavior, reassure the plan of
her that treatment.
this phenomenon i
s temporary..

9. Discharge Planning/Health teaching with rationale:

 Instruct the patient to Adequate nutrition and fluid intake
maintained to provide the body nutritional needs.
 Instruct on Maladaptive coping behaviors and stressors that
precipitate anxiety recognized.
 Teaching Adaptive coping strategies and techniques for
anxiety reduction and self-control implemented.
 Encourage Self-esteem increased.
 Explain Disease process, prognosis, and treatment regimen
understood.
 Plan in place to meet needs after discharge