Author Question: You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the ... (Read 101 times)

Pineappleeh · **on:** Jun 25, 2018

You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the psychiat-ric unit last night after assessment and treatment at a local hospital emergency department 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 com-plains 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 comment-ing 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.

Using Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition (DSM-V) criteria,
how is the diagnosis of anorexia nervosa determined?

Identify eight clinical signs or symptoms of anorexia nervosa. Place a star or asterisk next to
those that J.M. has.

What other disorders might occur along with anorexia nervosa? Name at least four.

How does bulimia nervosa differ from anorexia nervosa?

Name five behaviors that J.M. or any other patient with anorexia may engage in other than
self-starvation.

What common family dynamics are associated with anorexia nervosa?

Question 2

As you go in to give R.B. his medication, he speaks to you in fragmented sentences. Is that a bird? the little flowers jump up and down. What says the moon?

Before you can say anything, he asks, do you see
that bird over my bed? she is telling me not to leave this room. If I move she will swoop down and try to
peck at my eyes. Be careful

Is he having a delusion or a hallucination? Explain your answer.

Which responses by the nurse are appropriate? Select all that apply.
a. I don't see a bird over your head, but I can understand how that would be upsetting to
you.
b. There is no bird over your bed.
c. Tell me more about what you are seeing.
d. The voice you are hearing is part of your illness. It can't hurt you.
e. I'll come back to talk to you when you are settled down.

Sammyo · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Restriction of energy intake relative to requirements leading to a significantly low body weight in
the context of age, sex, developmental trajectory, and physical health
Intense fear of gaining weight or becoming fat, even though underweight
Disturbance in the way in which one's body weight or shape is experienced, undue influence of
body weight or shape on self-evaluation, or denial of the seriousness of the current low body
weight

Emaciated and malnourished appearance
Hypotension (She has been blacking out, which can indicate hypotension. No vital signs were
provided, but students might star this item.)
Dysrhythmias, bradycardia
Pale conjunctivae and mucous membranes
Poor skin turgor and muscle tone
Peripheral edema
Excessive hair loss and dryness
Cold extremities
Lanugo
Yellow skin
Amenorrhea
Headaches, sore throat, vague physical complaints
Chronic urinary tract infections
Constipation
Memory deficits
Fatigue
Insomnia
Depressed immune system
Obese or overweight person: electrolyte imbalance, hypothermia, weight loss of more than 2
pounds per week, perception of being obese despite weight loss

Major depression
Posttraumatic stress disorder (PTSD) or other anxiety disorders
Bulimia nervosa
Obsessive-compulsive disorder (OCD)
Eating disorders not otherwise specified
Binge-eating disorder
Cardiac dysrhythmias

Anorexia nervosa is refusal to maintain body weight at a minimum level for age and height or
failure to gain weight during a period of growth, resulting in body weight less than 85 of what
is expected. The person has an intense fear of gaining weight or becoming fat, even though the
person is underweight. The person may have a persistent inability to recognize the seriousness
of the very low body weight and extreme weight loss. Some types of anorexia nervosa involve
periods of binging and purging behaviors.
Bulimia is characterized by recurrent periods of binge eating and recurrent, inappropriate
behaviors to prevent weight gain (such as self-induced vomiting; use of laxatives, enemas, and
diuretics to lose weight; fasting; or excessive exercise). This cycle occurs, on average, at least once a
week for 3 months.

Excessive daily exercise
Binging and purging
Intense food rituals
Use of diuretics
Laxative or enema abuse
Denial
Wearing loose clothing
Withdrawal from social activities

Middle- or upper-class background
Passive father and dominant mother
Expectations of perfection
Overly dependent child
Vague personal boundaries
People pleasers
High academic standards
Sexual abuse

Answer to Question 2

He is having a hallucination. Hallucinations involve perceiving a sensory experience for which there
is no external stimulus (he sees a bird over his bed and hears it talking to him). A delusion is a false
belief that a person thinks is true even with evidence to the contrary. For example, a person sees a
bed and becomes fearful because he believes it is his coffin.

Answer: a, c, d
Keep a calm demeanor and stay with the patient. If you do not understand what R.B. is saying, you
need to let him know. It is important to be gentle but clear. Tell R.B. that you are not understanding
him, and that you would like to be able to understand him. It is important not to negate what R.B. is
experiencing, yet you need to offer what you perceive. Tell him, I do not see a bird over your bed,
but I can understand how that would be upsetting to you. Do not argue with the patient. Notify the
physician if his behavior becomes aggressive.