NU 665B Week 14 Assignment 1: iHuman Simulation

Sample Answer for NU 665B Week 14 Assignment 1: iHuman Simulation

Assessment

  • Anorexia Nervosa; Binge Eating/Purging F50.02 – is considered a mental disorder that is more prevalent among females compared to males (Klein, Sylvester & Schvey, 2021). Without early diagnosis and intervention, it has a poor prognosis. Patients report episodes of binge eating with an apparent loss of control, feeling embarrassed about individual eating behaviors, feeling of distortion of body image, and restriction of food intake resulting to a significantly low body weight (Klein, Sylvester & Schvey, 2021). These symptoms must have occurred for at least three months significantly impacting an individual’s social, academic, or occupational life.
  • Anorexia Nervosa: Restricting type F50.01 – patients with this eating disorder primarily report symptoms consistent with avoidance of food intake for reasons such as; food characteristics, lack of interest, or consequences of eating that result to unmet energy or nutritional needs (Klein, Sylvester & Schvey, 2021). As a result, individuals have nutritional deficiencies, intense weight loss, high dependence on supplemental feeding, and psychological dysfunction (Klein, Sylvester & Schvey, 2021). Generally, the symptoms reported by patients cannot be attributed to an underlying mental disorder or medical condition and rarely are individuals disturbed by the changes in body shape and weight.
  • Major Depressive Disorder F33.1 – is primarily diagnosed among individuals with at least six months of the following symptoms; a persistently depressed mood, lack of energy, changes in appetite, poor concentration, feeling worthless, having a decreased interest in activities that were previously pleasurable, sleep disturbances, psychomotor agitation, suicidal or homicidal thoughts (American Psychiatric Association, 2013).  Its etiology has been associated with genetic, environmental, biological, and psychosocial factors with a higher prevalence rate among women compared to men.  
  • Social Anxiety Disorder F40.11 – is a mental disorder primarily characterized by excess fear of humiliation, embarrassment, or rejection following exposure to negative evaluation in social or public interaction (Leichsenring & Leweke, 2017). Its etiology is associated with genetic and environmental factors with similar prevalence rates among children, adolescents, and adults (Leichsenring & Leweke, 2017). However, it commonly affects women than men. SAD has also been associated with being unmarried, led education, and a lower socio-economic status.

Final Diagnosis: Anorexia Nervosa; Binge Eating/Purging    

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Management Plan

Pharmacological (Klein, Sylvester & Schvey, 2021)

  • Admit patient to the Med Telemetry Unit
  • Start Fluoxetine 10 mg PO daily to re-evaluate in 4 weeks
  • Start patient on IVP D50 25gm if blood glucose <70 and patient demonstrates hypoglycemic signs
  • Start Normal Saline 1000cc bolus and if patient remains intolerant to oral intake, continue with 100cc/hr.
  • Administer Thiamine 100mg PO daily for 5 days
  • Consider oral magnesium replacement should levels < 1.3 mmol/L
  • IV potassium replacement if levels <2.9mmol/L or oral potassium replacement if levels <3.5mmol/L (Klein, Sylvester & Schvey, 2021).
  • Should serum phosphorous <3mg/dL, start oral replacement and IV replacement if <2mg/dL considering refeeding syndrome (Klein, Sylvester & Schvey, 2021).
  • Multivitamin I tab by mouth 24 hourly
  • For fevers or pain, acetaminophen 625mg 6hourly PRN  by mouth

Non-Pharmacological (Klein, Sylvester & Schvey, 2021).

 

  • Immediately notify the provider if the patient is not eating
  • Close monitoring of vital signs 4 hourly
  • Daily measurement of weight; before breakfast and after the first void (Klein, Sylvester & Schvey, 2021).
  • Daily measurement of pulse rate and orthostatic pressure until return to normal
  • Strict monitoring of the patient’s input/output
  • Closely monitor and record meal compliance and oral fluid intake
  • If electronic gadgets and personal mobile devices are considered a source of anxiety, encourage complete removal
  • Close monitoring of electrolytes, notify the provider once there is an imbalance and implement strict replacement protocols (Klein, Sylvester & Schvey, 2021).
  • 6 hourly finger stick blood glucose levels in the initial 24 hours
  • Immediately notify the care team for considerations of a sitter if the patient induces vomiting, hides food, or lies about her food intake (Klein, Sylvester & Schvey, 2021).
  • Daily Urinalysis, blood electrolytes, comprehensive metabolic panel
  • Due to syncope, repeat ECG until there’s normalization of intervals
  • Educate patient and her family about anorexia nervosa, its management, complications, and prognosis with and without intervention (Klein, Sylvester & Schvey, 2021).
  • Incorporate patient and family in the planning of care for success
  • Emphasize the need to comply with the care plan including psychotherapy, calorie intake, medications, and post-discharge care (Klein, Sylvester & Schvey, 2021).
  • For further support and a good outcome, provide the patient with additional resources; help line for NEDA (National Eating Disorders Association), and link to an online social support group/community of patients recovering from anorexia nervosa.

Diagnostics

  • No additional diagnostic tests are needed at this time

Consults/Referrals (Hektor et al., 2023)

  • Refer patient to a psychologist for possible family based therapy and psychotherapy.
  • For the management of dental carries resulting from self-induced vomiting, consult with a dentist
  • Considering the need  for weight restoration therapy, consult with a nutritionist for possible dietary management, refeeding techniques, and nutrition education

Follow Up (Hektor et al., 2023)

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  • Patient to be discharged once she’s stable.
  • Follow up for repeat blood electrolytes and serum comprehensive metabolic panel (CMP) with PCP post discharge
  • Follow up with your nutritionist for the recommended nutrition rehabilitation programs
  • To continue with thiamine 100mg 24 hourly for 5 days and multivitamin I tablet by mouth 24 hourly post discharge
  • Post discharge, immediately visit the nearest emergency room if you experience fainting episodes, suicidal/homicidal ideations, feel dizzy/lightheadedness, thoughts of self-harm/injury, confusion or drowsiness, chest pain or seizures.
  • Follow up with your psychologist for all scheduled psychotherapy appointments

References

American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.

Hektor, D. L. M., Winland-Brown, J. E., Porter, B. O., &amp; Thomas, D. J. (2023). Primary care:

The art and science of advanced practice nursing – an interprofessional approach. F.A.

Davis

Klein, D. A., Sylvester, J. E., & Schvey, N. A. (2021). Eating disorders in primary care: diagnosis and management. American family physician, 103(1), 22-32. https://www.aafp.org/pubs/afp/issues/2021/0101/p22.pdf

Leichsenring, F., & Leweke, F. (2017). Social anxiety disorder. New England Journal of Medicine, 376(23), 2255-2264. https://www.nejm.org/doi/full/10.1056/NEJMcp1614701

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