A patient with a history of anorexia nervosa presents with electrolyte imbalances, including low potassium and magnesium levels, and is started on a refeeding protocol. Which nursing intervention is most critical to prevent complications during the refeeding process?

B) Monitor the patient's vital signs and cardiac rhythm closely.

A) Encourage the patient to consume high-calorie snacks between meals.

B) Monitor the patient's vital signs and cardiac rhythm closely.

C) Increase the patient's fluid intake to promote hydration.

D) Educate the patient about the importance of a balanced diet.

A 27-year-old female patient with anorexia nervosa presents with electrolyte imbalances, including low potassium and magnesium levels. She exhibits signs of malnutrition, including pallor, brittle hair, and dry skin. Based on these findings, which nursing intervention is the priority in her care plan?

A) Initiating a gradual refeeding protocol to prevent refeeding syndrome.

B) Administering intravenous fluids to correct electrolyte imbalances.

C) Educating the patient on the importance of iron-rich foods to address anemia.

D) Scheduling regular psychiatric evaluations to address underlying anxiety.

A patient undergoing nutritional rehabilitation for anorexia nervosa develops hypophosphatemia and persistent fatigue during the first week of refeeding. Which nursing intervention is most appropriate to address these findings and prevent further complications?

B) Administer phosphate supplements as prescribed and monitor electrolyte levels closely.

A) Increase the caloric intake to accelerate weight gain.

B) Administer phosphate supplements as prescribed and monitor electrolyte levels closely.

C) Encourage the patient to engage in moderate exercise to increase energy levels.

D) Reduce fluid intake to prevent fluid overload.

A patient undergoing nutritional rehabilitation for anorexia nervosa is experiencing fatigue and palpitations. Lab results show hypophosphatemia and elevated serum glucose levels, indicative of refeeding syndrome. Which of the following nursing interventions is most appropriate to address the patient's current condition?

B) Administer phosphate supplements as prescribed and monitor electrolyte levels closely.

A) Increase the caloric intake to promote faster weight gain.

B) Administer phosphate supplements as prescribed and monitor electrolyte levels closely.

C) Encourage the patient to increase physical activity to reduce fatigue.

D) Withhold phosphate supplements until serum glucose levels stabilize.

A patient undergoing nutritional rehabilitation presents with elevated glucose levels and intermittent palpitations despite improving phosphate and potassium levels. What is the most appropriate nursing intervention to address the patient's cardiac symptoms?

A) Increase the frequency of glucose monitoring and report any significant changes to the endocrinologist.

B) Educate the patient on the importance of maintaining a consistent carbohydrate intake to stabilize glucose levels.

C) Administer a potassium-rich supplement to further correct electrolyte imbalances.

D) Encourage the patient to perform relaxation techniques to reduce anxiety-related palpitations.

A patient undergoing nutritional rehabilitation presents with elevated serum glucose levels and intermittent palpitations. Which nursing intervention is most appropriate to address these symptoms while considering the patient's current treatment plan?

A) Increase the frequency of blood glucose monitoring and report significant changes to the healthcare provider.

B) Administer an antiarrhythmic medication to manage the premature ventricular contractions.

C) Encourage the patient to engage in physical activity to help stabilize blood glucose levels.

D) Restrict the patient's fluid intake to manage potential electrolyte imbalances.

A 24-year-old female patient with a history of anorexia nervosa is being treated for mild mitral valve prolapse and insulin resistance. As the nurse, you are responsible for educating her about her new medication regimen. Which statement by the patient indicates a need for further teaching?

B) 'I should avoid foods high in potassium while taking metformin.'

A) 'I will take my beta-blocker every morning to help manage my heart palpitations.'

B) 'I should avoid foods high in potassium while taking metformin.'

C) 'Regular meals with complex carbohydrates can help stabilize my blood sugar levels.'

D) 'I need to have my blood sugar levels monitored regularly while starting metformin.'

A patient with anorexia nervosa has been diagnosed with mild mitral valve prolapse and insulin resistance during refeeding. Which nursing intervention is the priority to prevent potential complications related to her current conditions?

B) Monitoring vital signs and cardiac rhythm closely to detect any changes in heart function.

A) Educating the patient on the importance of a low-sodium diet to prevent fluid retention.

B) Monitoring vital signs and cardiac rhythm closely to detect any changes in heart function.

C) Administering metformin with meals to enhance its absorption and efficacy.

D) Encouraging frequent, small meals high in simple sugars to rapidly increase blood glucose levels.

A patient with anorexia nervosa is undergoing treatment and presents with hypokalemia and stabilized cardiac symptoms. Which nursing intervention is the most appropriate to address the hypokalemia and prevent cardiac complications?

B) Administer an oral potassium supplement and recommend potassium-rich foods

A) Increase the dosage of her beta-blocker to stabilize cardiac function

B) Administer an oral potassium supplement and recommend potassium-rich foods

C) Initiate continuous cardiac monitoring to detect arrhythmias

D) Discontinue beta-blocker therapy to prevent further electrolyte imbalance

A patient with anorexia nervosa undergoing nutritional rehabilitation has developed hypokalemia with a serum potassium level of 3.2 mmol/L. Which nursing intervention should be prioritized to address the risk of cardiac arrhythmias associated with this electrolyte imbalance?

A) Initiate a continuous cardiac monitoring and administer prescribed oral potassium supplements.

B) Encourage the patient to increase physical activity to naturally boost potassium levels.

C) Withhold the beta-blocker medication until potassium levels normalize.

D) Increase the patient's fluid intake to facilitate potassium homeostasis.

anorexia - Nursing Case Study

Pathophysiology

• Primary mechanism: Dysregulation of neurotransmitters such as serotonin and dopamine is crucial in anorexia, affecting mood and reward pathways, leading to altered perceptions of hunger and satiety, and reinforcing restrictive eating behaviors.

• Secondary mechanism: Psychological factors, including perfectionism and anxiety, interact with genetic predispositions to influence the development of obsessive behaviors surrounding food, body image, and self-worth, perpetuating the cycle of restriction.

• Key complication: Malnutrition from chronic caloric restriction results in multi-system effects, including bradycardia, osteoporosis, and electrolyte imbalances, which can lead to severe complications like cardiac arrhythmias and increased risk of fractures.

Patient Profile

Demographics:

17-year-old female, high school student

History:

• Key past medical history: Diagnosed with anorexia nervosa 18 months ago, history of anxiety

• Current medications: Fluoxetine 20 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Persistent fatigue and dizziness

• Key symptoms: Significant weight loss (15% of body weight over 3 months), amenorrhea for 6 months, cold intolerance, and abdominal pain

• Vital signs: Heart rate 52 bpm, blood pressure 92/58 mmHg, temperature 96.8°F, respiratory rate 16 breaths per minute

Section 1

Following the current presentation, the healthcare team conducted an initial assessment to evaluate the extent of the patient's condition. During the physical examination, the patient appeared pale and frail, with dry skin and brittle hair, indicative of malnutrition. Upon auscultation, a faint heart murmur was detected, raising concerns about potential cardiac complications. The nurse noted the patient's slow capillary refill time and cool extremities, consistent with poor peripheral circulation. Neurological assessment revealed mild orthostatic hypotension, as evidenced by her dizziness and lightheadedness when transitioning from lying to standing, suggesting volume depletion and possible dehydration.

Laboratory tests were ordered to further investigate her nutritional and metabolic status. The results showed significant electrolyte imbalances, with low potassium (3.0 mEq/L) and magnesium levels (1.5 mg/dL), which could predispose her to cardiac arrhythmias. Her complete blood count indicated mild anemia with a hemoglobin level of 10.2 g/dL, likely due to insufficient intake of iron-rich foods. Additionally, her bone density scan revealed early signs of osteoporosis, a common complication of prolonged anorexia nervosa. These findings highlight the urgent need for nutritional rehabilitation and careful monitoring to prevent further deterioration.

The healthcare team initiated a multidisciplinary approach to address these issues, involving a dietitian, psychiatrist, and cardiologist to develop a comprehensive care plan. The patient was started on a gradual refeeding protocol to replenish her nutritional stores while minimizing the risk of refeeding syndrome, a potentially life-threatening condition. Electrolyte replacement therapy was initiated to correct her imbalances, and her fluoxetine dosage was re-evaluated to manage her anxiety and stabilize her mood. These interventions aim to stabilize her current condition and facilitate a holistic recovery process, setting the stage for ongoing monitoring and support.

Section 2

As the patient embarked on her nutritional rehabilitation, the healthcare team closely monitored her progress to identify any changes in her status. Within the first week of her refeeding protocol, her vital signs began to show subtle improvements: her heart rate stabilized at around 60 beats per minute, and her blood pressure readings improved to 100/70 mmHg. However, despite these positive changes, the patient experienced persistent fatigue and episodes of palpitations, prompting further evaluation. A repeat set of laboratory tests revealed some concerning developments: while her potassium levels had increased slightly to 3.3 mEq/L, her phosphate levels had dropped to 2.0 mg/dL, indicative of evolving refeeding syndrome. Additionally, her serum glucose levels were elevated at 150 mg/dL, suggesting impaired glucose metabolism as her body adjusted to increased caloric intake.

In response to these new findings, the healthcare team adjusted her care plan to address the emerging complications. Phosphate supplementation was initiated to correct her hypophosphatemia, and her refeeding protocol was carefully modified to slow the rate of caloric increase, reducing the risk of further metabolic disturbances. The dietitian worked closely with the patient to ensure her nutritional intake was optimized while balancing her electrolyte needs. Furthermore, the cardiologist recommended continuous cardiac monitoring to detect any arrhythmias that might arise due to her ongoing electrolyte imbalances or the strain of nutritional rehabilitation on her compromised cardiovascular system.

As the patient continued her treatment, the multidisciplinary team remained vigilant, recognizing the delicate nature of her recovery process. The ongoing adjustments to her care plan demonstrated the importance of individualized treatment and close monitoring in managing the complexities of anorexia nervosa. The patient's journey underscored the significance of interdisciplinary collaboration, as each team member contributed their expertise to support her gradual return to health and prevent further complications.

Section 3

As the patient continued her nutritional rehabilitation, her response to the interventions became a focal point for the healthcare team. Within the next week, there were both encouraging signs and new challenges. The phosphate supplementation appeared effective, as repeat lab tests showed her phosphate levels had risen to 3.4 mg/dL. Despite this improvement, her serum glucose levels remained elevated, fluctuating between 140 and 160 mg/dL, indicating persistent challenges in glucose metabolism. Her potassium levels had also improved modestly to 3.5 mEq/L, suggesting a positive response to the adjusted refeeding protocol.

Clinically, the patient reported feeling slightly more energetic, though she still experienced intermittent palpitations. Continuous cardiac monitoring revealed occasional premature ventricular contractions, likely linked to her ongoing electrolyte imbalances. Her vital signs showed stability: heart rate at 62 beats per minute, blood pressure at 105/72 mmHg, and respiratory rate at 18 breaths per minute. These findings prompted the healthcare team to consider further adjustments in her electrolyte management and explore potential underlying cardiac issues that could be contributing to her symptoms.

Recognizing the complexity of her recovery, the healthcare team decided to collaborate with an endocrinologist to address her glucose metabolism issues. The team also emphasized the importance of psychosocial support, as her psychological resilience was crucial to her continued progress. By integrating these additional specialties into her care, the team aimed to enhance the patient's overall treatment plan, ensuring a comprehensive approach to her recovery. This strategy set the stage for the next phase of her treatment, where fine-tuning her care plan would be essential to prevent further complications and support her journey toward holistic health.

Section 4

As the interdisciplinary team continued to refine the patient's treatment plan, new diagnostic results provided further insight into her condition. A recent echocardiogram was performed to investigate the cause of her intermittent palpitations and occasional premature ventricular contractions. The results revealed mild mitral valve prolapse, which, while not uncommon in patients with anorexia nervosa, necessitated careful monitoring to prevent potential exacerbation of cardiac symptoms. This finding prompted the cardiology team to recommend low-dose beta-blocker therapy to manage her palpitations and stabilize her heart rhythm, with a plan to reassess her cardiac status regularly.

Concurrently, the endocrinologist's evaluation shed light on her glucose metabolism issues. An oral glucose tolerance test indicated insulin resistance, a condition that can occur during the refeeding process as the body adjusts to increased nutritional intake. The team decided to initiate a low-dose metformin regimen to improve her insulin sensitivity, while cautiously monitoring her glucose levels to prevent hypoglycemia. This intervention was paired with continued nutritional support, emphasizing the consumption of complex carbohydrates and proteins to stabilize her blood sugar levels.

These developments highlighted the intricate interplay between her nutritional status, cardiac health, and metabolic function. By addressing these interconnected issues, the healthcare team aimed to mitigate the risk of further complications and support the patient's gradual recovery. As they moved forward, emphasis was placed on regular monitoring and adjustment of her treatment plan, allowing for responsive care tailored to her evolving needs. This proactive approach underscored the importance of ongoing assessment and collaboration among her medical providers to ensure a safe and effective path toward recovery.

Section 5

As the patient continued her treatment, the interdisciplinary team closely monitored her response to the interventions. Initially, she showed improvement in her cardiac symptoms, with a noticeable reduction in the frequency of palpitations, confirmed by a 24-hour Holter monitor showing fewer episodes of premature ventricular contractions. Her resting heart rate stabilized around 60-70 beats per minute, indicating a positive response to the low-dose beta-blocker therapy. However, her latest laboratory results revealed a concerning drop in her serum potassium levels, now at 3.2 mmol/L, indicating hypokalemia, a known risk in patients with anorexia nervosa, especially during refeeding and when on beta-blockers.

The hypokalemia raised alarms about potential exacerbation of cardiac arrhythmias, prompting an urgent reassessment of her electrolyte management. The team decided to implement an oral potassium supplement regimen, alongside dietary adjustments to increase her intake of potassium-rich foods. Additionally, her glucose levels remained stable with the current metformin dosage, but her hemoglobin A1c, measured at 5.8%, suggested her glucose metabolism was still adapting. Regular monitoring of her electrolytes and glucose levels was emphasized to prevent further metabolic derangements, ensuring her treatment plan remained dynamic and responsive to her changing clinical status.

The emergence of hypokalemia highlighted the delicate balance required in managing her nutritional rehabilitation, cardiac health, and metabolic function. This development prompted the team to reinforce the importance of vigilant monitoring and interdisciplinary communication. They planned to reassess her cardiac and metabolic status at more frequent intervals, adjusting her treatment plan as necessary to prevent further complications. This proactive strategy underscored the critical need for ongoing clinical reasoning and adaptability in her care, setting the stage for the next phase of her recovery journey.