A patient with anorexia nervosa presents with hypokalemia and bradycardia. Which nursing intervention is the priority to address the patient's current conditions?

B) Administer oral potassium supplements as prescribed.

A) Initiate nutritional rehabilitation with a high-calorie diet.

B) Administer oral potassium supplements as prescribed.

C) Monitor the patient for signs of refeeding syndrome.

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

A patient with anorexia nervosa presents with significant electrolyte imbalances, including hypokalemia and hyponatremia, as well as bradycardia. Which nursing intervention is the priority to address her current clinical condition?

A) Initiate cardiac monitoring to observe for arrhythmias.

B) Encourage the patient to participate in group therapy sessions.

C) Administer oral potassium supplements as prescribed.

D) Provide patient education on the importance of nutrition.

A patient with a history of an eating disorder is experiencing gastrointestinal discomfort and reluctance to adhere to her nutritional plan due to increased food intake. Her current vital signs include a heart rate of 50 bpm and a blood pressure of 92/60 mmHg. Which nursing intervention is most appropriate to address her current condition?

B) Collaborate with the dietitian to adjust the nutritional plan and provide small, frequent meals.

A) Discontinue the current nutritional plan to allow her gastrointestinal symptoms to subside.

B) Collaborate with the dietitian to adjust the nutritional plan and provide small, frequent meals.

C) Initiate a high-calorie diet immediately to accelerate weight gain and prevent further complications.

D) Focus solely on psychological interventions to address her anxiety and body image concerns.

A patient undergoing nutritional rehabilitation for anorexia nervosa begins experiencing abdominal pain and bloating after an increase in her food intake. Her heart rate is bradycardic, and she continues to have premature ventricular contractions. What should be the nurse's priority intervention to address these symptoms while continuing to monitor for complications?

C) Collaborate with the dietitian to adjust the nutritional plan and monitor for refeeding syndrome.

A) Increase the caloric intake further to promote weight gain more rapidly.

B) Administer antiemetic medications to alleviate gastrointestinal discomfort.

C) Collaborate with the dietitian to adjust the nutritional plan and monitor for refeeding syndrome.

D) Discontinue the current nutritional plan and introduce a liquid diet to ease gastrointestinal symptoms.

A patient with a history of malnutrition and recent introduction of a prokinetic agent is experiencing orthostatic hypotension, bradycardia, and premature ventricular contractions. What is the most appropriate nursing intervention to prioritize for this patient?

C) Increase the frequency of cardiac monitoring to detect and manage arrhythmias promptly.

A) Administer an antiemetic to manage nausea and improve nutritional intake.

B) Educate the patient about slowly rising from a sitting or lying position to help manage orthostatic hypotension.

C) Increase the frequency of cardiac monitoring to detect and manage arrhythmias promptly.

D) Adjust the nutritional plan to include more high-sodium foods to address electrolyte imbalances.

A patient with a history of gastrointestinal discomfort and early satiety is experiencing orthostatic hypotension with a blood pressure of 88/58 mmHg upon standing, and a heart rate of 48 bpm with premature ventricular contractions. Based on this clinical presentation, what is the priority nursing intervention?

B) Increase the frequency of cardiac monitoring to assess for worsening arrhythmias.

A) Administer the prescribed prokinetic agent to alleviate gastrointestinal symptoms.

B) Increase the frequency of cardiac monitoring to assess for worsening arrhythmias.

C) Encourage the patient to increase fluid intake to manage orthostatic hypotension.

D) Collaborate with the dietary team to adjust the nutritional plan to a higher caloric intake.

A patient with sinus bradycardia and frequent premature ventricular contractions has been experiencing episodes of dizziness and near-syncope when transitioning from sitting to standing. Which nursing intervention should be prioritized to address the patient's cardiovascular instability?

B) Educate the patient on slow positional changes to minimize orthostatic hypotension.

A) Administer a beta-blocker to control ventricular arrhythmias.

B) Educate the patient on slow positional changes to minimize orthostatic hypotension.

C) Increase the patient's fluid intake to improve blood volume and reduce dizziness.

D) Prepare the patient for a pacemaker insertion to manage the bradycardia.

A patient with sinus bradycardia and episodes of ventricular tachycardia is experiencing orthostatic hypotension and persistent dizziness. Considering her current symptoms and treatment plan, what is the most appropriate nursing intervention to prioritize for this patient?

B) Initiate continuous cardiac monitoring to detect any further arrhythmias promptly.

A) Educate the patient on slowly rising from a sitting to a standing position to prevent dizziness.

B) Initiate continuous cardiac monitoring to detect any further arrhythmias promptly.

C) Encourage increased oral fluid intake to support blood volume and reduce orthostatic hypotension.

D) Collaborate with the dietitian to enhance nutritional intake given her early satiety and weight gain goals.

A 65-year-old female patient with persistent bradycardia and episodes of ventricular tachycardia is being considered for a low-dose beta-blocker. Given her clinical presentation and nutritional concerns, which nursing intervention is most appropriate to prioritize for ensuring her safety and optimizing her treatment plan?

A) Monitor the patient's heart rate and blood pressure closely after beta-blocker initiation and adjust dietary potassium intake.

B) Increase the frequency of cardiac monitoring and collaborate with the dietitian to introduce a high-sodium diet to manage electrolyte imbalances.

C) Educate the patient on the importance of avoiding physical activity to prevent exacerbation of dizziness and near-syncope.

D) Encourage the patient to increase oral fluid intake to support blood pressure stabilization and prevent dehydration.

A patient with persistent bradycardia and episodes of ventricular tachycardia is being considered for a low-dose beta-blocker. What is the most appropriate nursing action prior to administering the medication?

A) Assess the patient’s electrolyte levels.

B) Prepare the patient for immediate cardioversion.

C) Instruct the patient to increase dietary sodium intake.

D) Schedule the patient for a follow-up echocardiogram.

anorexia nervosa - Nursing Case Study

Pathophysiology

• Primary mechanism: Anorexia nervosa primarily involves dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to altered hormone levels, including cortisol, which contributes to stress, anxiety, and appetite suppression.

• Secondary mechanism: Neurotransmitter imbalances, particularly serotonin and dopamine, affect mood and reward pathways, reinforcing restrictive eating behaviors and distorted body image.

• Key complication: Prolonged malnutrition results in multi-organ dysfunction, with notable impacts on cardiovascular health, such as bradycardia and hypotension, increasing the risk of severe complications.

Patient Profile

Demographics:

16-year-old female, high school student

History:

• Key past medical history: Diagnosed with anorexia nervosa 8 months ago, history of anxiety

• Current medications: Fluoxetine 20 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Increasing fatigue and dizziness

• Key symptoms: Significant weight loss (15% body weight in 6 months), amenorrhea for 4 months, cold intolerance, brittle nails, occasional palpitations

• Vital signs: Blood pressure 90/60 mmHg, heart rate 52 bpm, respiratory rate 18 breaths per minute, temperature 97.0°F

Section 1

During her follow-up visit, the patient presents with worsening symptoms, prompting further diagnostic evaluation. Laboratory studies reveal significant electrolyte imbalances, including hypokalemia with a potassium level of 2.9 mmol/L and hyponatremia with a sodium level of 130 mmol/L. These findings are consistent with the effects of prolonged malnutrition and potential purging behaviors, which she denies. The electrocardiogram (ECG) performed due to her bradycardia shows sinus bradycardia with a heart rate of 48 bpm and occasional premature ventricular contractions, raising concerns about increased risk for arrhythmias.

The physical assessment reveals dry skin with lanugo hair development, indicative of the body's adaptive response to conserve heat due to low body fat. Her blood pressure remains low at 88/58 mmHg, and she experiences orthostatic hypotension with a significant drop when transitioning from sitting to standing, further complicating her risk for syncope and falls. The psychological evaluation highlights heightened anxiety and persistent body image distortion, suggesting that her current pharmacotherapy with fluoxetine may require re-evaluation and possible augmentation with psychotherapy or adjustment in dosing.

The healthcare team recognizes the need for immediate intervention to address the electrolyte disturbances and cardiovascular risks. A multidisciplinary approach is initiated, including nutritional rehabilitation with close monitoring of refeeding syndrome, electrolyte replacement therapy, and cardiac monitoring. Regular psychiatric support is emphasized to address underlying anxiety and reinforce positive body image perception. These interventions aim to stabilize her physical condition while concurrently addressing the psychological aspects of anorexia nervosa, paving the way for a more comprehensive treatment plan.

Section 2

Change in Patient Status:

After initiating the multidisciplinary intervention plan, the patient's condition is monitored closely for changes. Over the next week, her nutritional intake is gradually increased under careful supervision to prevent refeeding syndrome. Despite these efforts, the patient begins experiencing gastrointestinal discomfort, including abdominal pain and bloating, which may be attributed to her body's adjustment to increased food intake. This discomfort leads to a reluctance to adhere to the nutritional plan, requiring further engagement from the dietitian and nursing staff to encourage compliance and address her concerns.

Clinically, there is a slight improvement in her electrolyte status; her potassium level rises to 3.2 mmol/L, and her sodium level normalizes at 135 mmol/L. However, her heart rate remains bradycardic at 50 bpm, and the occasional premature ventricular contractions persist, necessitating continued cardiac monitoring. Her blood pressure shows a marginal improvement, now at 92/60 mmHg, but she continues to experience episodes of orthostatic hypotension. These findings underscore the importance of sustaining the interventions while adjusting the approach to accommodate her discomfort and anxiety regarding weight gain.

Psychologically, the patient remains anxious, but weekly therapy sessions are beginning to show promise in addressing her body image distortion. The therapeutic team considers enhancing her treatment with cognitive-behavioral therapy (CBT) to help her develop healthier coping mechanisms and challenge distorted thoughts. As her physical condition stabilizes, the healthcare team remains vigilant for any signs of refeeding complications or arrhythmias, while planning for the next phase of her recovery journey, which will focus on longer-term strategies for relapse prevention and sustained psychological support.

Section 3

Change in Patient Status:

In the following week, the patient's clinical picture continues to evolve, presenting new challenges for the healthcare team. Her gastrointestinal discomfort persists and is now accompanied by intermittent nausea and early satiety, which further complicates adherence to the nutritional regimen. Despite these challenges, the dietary plan is adjusted slightly with the incorporation of smaller, more frequent meals that are easier to digest, and the introduction of a prokinetic agent to help alleviate her symptoms. These adjustments help improve her caloric intake marginally, though her anxiety around eating remains a significant barrier.

Clinically, her laboratory results show encouraging trends: her potassium level has increased to 3.5 mmol/L, and her phosphorus levels are now within the lower normal range at 2.5 mg/dL, indicating a reduced immediate risk of refeeding syndrome. However, her heart rate continues to be concerning, now slightly lower at 48 bpm, with persistent premature ventricular contractions. Her orthostatic hypotension also remains unresolved, with her blood pressure dropping to 88/58 mmHg upon standing. These cardiovascular symptoms highlight the need for ongoing cardiac monitoring and potential adjustments in her electrolyte supplementation.

The patient's psychological condition shows subtle signs of improvement, as evidenced by her increased engagement in therapy sessions. The introduction of cognitive-behavioral therapy (CBT) begins to assist her in challenging negative thought patterns and developing more adaptive coping strategies. Despite the physical and psychological hurdles, the team remains optimistic that with continued multidisciplinary support and tailored interventions, the patient will gradually advance in her recovery journey. The next phase will focus on further stabilizing her physical health and strengthening her psychological resilience to prevent relapse.

Section 4

As the healthcare team continues to monitor the patient, new complications begin to emerge that require careful clinical attention. Over the next several days, the patient's heart rate remains persistently low, now averaging around 45 bpm, and her premature ventricular contractions are becoming more frequent. An ECG is performed, which reveals sinus bradycardia and occasional runs of ventricular tachycardia, prompting the cardiology team to consider more aggressive interventions to manage her cardiac instability. Her orthostatic hypotension shows some improvement with compression stockings and increased fluid intake, but episodes of dizziness and near-syncope continue to be a concern, especially when transitioning from sitting to standing.

In terms of gastrointestinal symptoms, the prokinetic agent has provided some relief, reducing her nausea slightly, but the early satiety persists, limiting her ability to meet nutritional goals. This has resulted in only a modest weight gain, which is below the projected target for her recovery plan. A repeat abdominal ultrasound is ordered to rule out any underlying structural abnormalities contributing to her symptoms, and it reveals delayed gastric emptying, validating the ongoing use of the prokinetic treatment and suggesting the potential benefit of further nutritional adjustments.

The patient's psychological engagement continues to improve, though she remains highly anxious about her physical symptoms. Her CBT sessions have become more productive, as she starts to identify specific triggers for her anxiety and develop strategies to manage them. The therapy team focuses on building her resilience and improving her self-efficacy, recognizing that addressing her psychological well-being is crucial in preventing relapse. The next steps include exploring additional behavioral interventions and considering the introduction of a low-dose anxiolytic, if her anxiety becomes a significant barrier to her treatment progress. With these evolving challenges, the interdisciplinary team remains committed to providing comprehensive care, ensuring that all aspects of her health are addressed in a coordinated manner.

Section 5

Over the following days, the healthcare team observes a change in the patient's status, which prompts further investigation and adjustment of the treatment plan. Her heart rate continues to be a major concern, with persistent bradycardia at 43 bpm and episodes of ventricular tachycardia occurring more frequently. Despite these cardiac challenges, her blood pressure shows slight improvement, stabilizing at 100/65 mmHg, but her symptoms of dizziness and near-syncope persist. Given her cardiac instability, the cardiology team recommends initiating a low-dose beta-blocker to manage her ventricular arrhythmias while carefully monitoring her heart rate and blood pressure for any adverse effects. This decision is weighed against the risk of exacerbating her bradycardia, necessitating close collaboration between the cardiology and primary care teams.

In parallel, the nutritional team observes that the patient's continued early satiety and limited weight gain raise concerns about her overall nutritional status. Her recent lab results indicate mild electrolyte imbalances, with a potassium level of 3.2 mmol/L and magnesium at 1.5 mEq/L, suggesting a need to adjust her dietary plan to address these deficiencies. The team considers introducing a high-calorie, nutrient-dense oral supplement to boost her caloric intake and correct these imbalances. The prokinetic agent remains part of her regimen, as it provides some relief from her gastrointestinal symptoms. Additionally, the team discusses the potential benefits of smaller, more frequent meals to improve gastric emptying and enhance her nutritional intake.

The interdisciplinary team continues to support the patient's psychological progress, recognizing the interconnectedness of her physical and mental health. Her increased participation in CBT sessions is encouraging, and she begins to express a stronger sense of self-awareness regarding her anxiety triggers. The therapy team explores additional behavioral interventions, such as relaxation techniques and mindfulness exercises, to further empower her in managing her anxiety. The possibility of introducing a low-dose anxiolytic remains on the table, contingent on her response to non-pharmacological strategies. As her journey unfolds, the team's coordinated approach aims to address her evolving challenges, ensuring a comprehensive and holistic plan for her recovery.