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Anorexia Nervosa: A Case Study and Treatment Approach, Schemes and Mind Maps of Nursing

A case study of a 23-year-old woman, j.m., diagnosed with anorexia nervosa. It explores the diagnostic criteria, clinical symptoms, and associated disorders. The document delves into the treatment approach, highlighting various therapies, medication management, and relapse prevention strategies. It also discusses the importance of family therapy and support groups in the recovery process.

Typology: Schemes and Mind Maps

2023/2024

Uploaded on 02/12/2025

alisher-khowaja
alisher-khowaja 🇺🇸

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SCENARIO:
You are a nurse on an inpatient psychiatric unit. J.M., 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 didn’t 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?
Answer: The diagnosis of anorexia and nervosa is typically determined by healthcare
professionals, like doctors or psychiatrists, based on a person’s symptoms and behaviors. To be
diagnosed with anorexia nervosa, someone usually has an intense fear of gaining weight and a
distorted view of their body shape or size. The individual physically may be fit and their weight
and height may also be adequate based on their age; however mentally they believe they are not
fit, which lead to missing meals, and eating a meal and forcefully throwing up and usage of
maladaptive methods. Other signs might include excessive exercising, constantly thinking about
food or using methods to try to lose weight. These are some ways its determined if the patient is
suffering from anorexia nervosa.
2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next to those
that J.M. has.
*Being very scared of gaining weight.
Seeing themselves as fat even if they’re fit or thin for their age.
*Eating very little leads to losing a lot of weight.
Thinking a lot about food, calories, and diets.
*Exercising a lot, even when tired or hurts.
*Not realizing how serious being underweight is.
*Avoiding being around food or eating with others.
Doing things like cutting food into tiny pieces or moving it around on the plate.
3. What other disorders might occur along with anorexia nervosa?
Depression: When the patient feels that they are not fit and even with the weight they have lost
its still not enough to satisfy their needs, this can lead to feeling sad, hopeless, or losing interest
in things they used to enjoy.
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SCENARIO :

You are a nurse on an inpatient psychiatric unit. J.M., 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 didn’t 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? Answer: The diagnosis of anorexia and nervosa is typically determined by healthcare professionals, like doctors or psychiatrists, based on a person’s symptoms and behaviors. To be diagnosed with anorexia nervosa, someone usually has an intense fear of gaining weight and a distorted view of their body shape or size. The individual physically may be fit and their weight and height may also be adequate based on their age; however mentally they believe they are not fit, which lead to missing meals, and eating a meal and forcefully throwing up and usage of maladaptive methods. Other signs might include excessive exercising, constantly thinking about food or using methods to try to lose weight. These are some ways its determined if the patient is suffering from anorexia nervosa.
  2. Identify eight clinical symptoms of anorexia nervosa. Place a star or asterisk next to those that J.M. has.  *Being very scared of gaining weight.  Seeing themselves as fat even if they’re fit or thin for their age.  *Eating very little leads to losing a lot of weight.  Thinking a lot about food, calories, and diets.  *Exercising a lot, even when tired or hurts.  *Not realizing how serious being underweight is.  *Avoiding being around food or eating with others.  Doing things like cutting food into tiny pieces or moving it around on the plate.
  3. What other disorders might occur along with anorexia nervosa? Depression: When the patient feels that they are not fit and even with the weight they have lost its still not enough to satisfy their needs, this can lead to feeling sad, hopeless, or losing interest in things they used to enjoy.

Anxiety: Feeling worried or anxious, sometimes about things that might not seem scary to others. This can cause anxiety and not knowing what will happen next. Substance Abuse: Turning to drugs or alcohol to cope with their feelings or try to control their eating. Several times there are substance that can lead to weight loss, which might be used if the individual desires to lose weight. Suicide Ideation: Hurting themselves on purpose, like cutting or burning their skin, to deal with emotional pain. Several times individuals are not sure how they will cope, which can lead to suicide ideation. Social Isolation: Avoiding spending time with friends or family and feeling isolated. Being afraid that if they were to go out, they might get judged which leads to social isolation.

  1. How does bulimia nervosa differ from anorexia nervosa? Answer: With anorexia nervosa, an individual often eats very little, leading to significant weight loss, and they may see themselves as overweight even when they’re very thin. With bulimia nervosa, a person might eat a lot of food in a short time, and this could be referred to as binge eating and then try to get rid of the food by vomiting, using laxative, or excessive exercising. Both can lead to severe complications; however with anorexia nervosa the patient may be more malnourished, because of the lack of their food intake.
  2. Name behaviors that J.M. or any other patient with anorexia may engage in other than self-starvation. Answer: Individuals with anorexia nervosa may engage in several behaviors beyond self- starvation that can negatively impact their health. These behaviors include excessive exercise, where they might spend long hours working out their body beyond its limits to any calories and fat that they have intake throughout their day. Some individuals may also try to vomit forcefully to try to get any food that they might have eaten, and this can be seen most in patients with bulimia anorexia. The most common thing is restricting foods from their diet so that that they may not intake any fats or anything that may cause weight gain. Finally individuals’ may also socially isolate themselves, because they have a fear of facing people and getting judged by them.
  3. What common family dynamics are associated with anorexia nervosa? Answer: Families with anorexia nervosa often have traits like high expectations for success, strong involvement in each other’s lives, and difficulty with communication. There might also be a lot of pressure to be perfect and avoid conflict, leading to a lot of anxiety and stress. If parents are involved, they might be overly protective, which can make it difficult for the patient with independence, and sometimes roles within the family can get mixed up, with the person with anorexia taking care of others. Several times the patient with anorexia might not spend as much time with family and always be avoidant with them. CHART VIEW

healthier coping strategies. This is important, because therapy can identify ways in which it can be helpful to change the patient thinks and help establish and better thinking process. Body Image Therapy: Working on improving body image perception and self-esteem are significant for this patient, because this will help them feel better about themselves and the way their appearance is. This will be helpful for the patient in developing effective coping strategies that can help them with how they see their body image by exercising and positive affirmations. Interpersonal Therapy: Addressing relationship difficulties and interpersonal conflicts that may contribute to the development or maintenance of eating disorder. This will help them share their thoughts and make them realize their own things that need to be improved. Emotion Regulation Skills: This will help teach the patient to help identify and manage emotions in healthier ways, reducing reliance on disorder eating behaviors as a coping mechanism. Mindfulness and Relaxation Techniques: Practicing mindfulness exercises and relaxation techniques to reduce stress and anxiety levels, promoting overall well-being. This is a great coping technique for helping just being in the present time and not thinking about past worries and future anxieties. Family Therapy: Involving family members in therapy sessions to address family dynamics, improve communication, and provide support for individuals recovery process. It helps they stay connected within the family and help with their relationship as well. Support Groups: support groups are a great way to help these patients connect with other individuals that may have suffered or experienced something like what they might have gone through related to anorexia nervosa. This also helps with shared coping strategies. Medication Management: In some cases, medication may be prescribed to address co-occurring conditions such as depression, anxiety, or OCD or even with social isolation. Relapse Preventing Planning: Developing strategies and coping skills to prevent relapse and maintain progress achieved during treatment, including identifying triggers, building a support network, and establishing healthy routines.

  1. What would indicate successful treatment with J.M.? Answer: Successful treatment of J.M would be indicated by various factors showing improvements in both her physical and psychological well-being. This might include achieving a healthy weight and nutritional status, with stable vital signs and normal laboratory results indicating that her body is functioning properly. Additionally, she would demonstrate improved attitudes and behaviors related to food, such as developing a more balanced approach to eating and engaging in regular, nourishing meals without excessive concerns or anxiety. Overall these indication will show that J.M would experience improved quality of life.
  1. What will you discuss with the physician before any further discharge teaching or plans? Answer: This will include reviewing J.M’s current medical status and ongoing concerns, such as her electrolyte levels, nutritional states, and overall physical health. It’s also significant to discuss with the physician about her level of understanding educational material, because if you are educating J.M and they aren’t ready to learn the knowledge than that teaching will not work, and the patient will not understand anything and even if they have understood they might not lesson to what you have to say. It’s significant to discuss with the physician about JMs emotional stability, coping skills, and risk of relapse into disordered eating behaviors.
  2. You report J.M.’s statements to the physician. What do you expect to be ordered by the physician? Answer: I would expect the physician to order a comprehensive assessment to further evaluate her medical and psychiatric status. This may include ordering additional laboratory tests to monitor her electrolytes levels, nutritional status, and overall health. The physician may also recommend assessment of her mental health, including her current symptoms, level of distress and risk of self-harm or relapse. The goal of all this is to ensure that J.M receives appropriate care and support for her individual needs and promoting her recovery and well-being.
  3. What medications would be indicated for J.M. to assist with resolution of her Anorexia Nervosa? Answer: When it comes to Anorexia Nervosa there is no medication for this disorder; however, there are medications of disorders that may occur due to the condition of anorexia nervosa. If J.M experiences symptoms of depression or anxiety, antidepressants medications such as SSRI may be prescribed to help improve her mood and reduce anxiety levels. In addition to this some other medications that may be prescribed are antianxiety medications such as benzodiazepines to manage acute distress or crises. She also may be prescribed antipsychotic medications to help stabilize her mood and reduce her symptoms of anxiety or agitation. After 2 weeks, J.M. has gained 5 pounds and seems to be more willing to eat. She still expresses fears of “getting fat,” but states that she is ready to go home and back to school. The PCP arranges for J.M. to participate in an outpatient partial hospitalization program that specializes in eating disorders. J.M. expresses interest in meeting others with the same problem.