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Anorexia Nervosa

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by

Tim Bz

on 2 May 2014

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Transcript of Anorexia Nervosa

Concept Map: Anorexia Nervosa
Patient Assessment Data
1. Appearance
a. Very thin and fragile
b. Easily fatigued
2. Patient is 5 feet 6 inches in height and 92 pounds (41.73 kg) in weight
a. Loss of weight due to inadequate/restricted calorie
intake
b. Less than 25% ideal body weight
3. Low vitals:
a. Blood pressure: 89/52 mmHg
b. Pulse rate: 55 beats per minute
c. Temperature: 97.1 F or 36.2 C

Nursing Priority Diagnosis
"Imbalanced nutrition: less than body requirements related to decreased desire to eat secondary to Anorexia, nausea and vomiting" (Carpenito, 2013, p. 449).

"Intake of nutrients insufficient to meet metabolic needs" (Carpenito, 2013, p. 447).

Chief Complaint
Patient complains of fatigue, nausea, and vomiting, and absence of menses.

Diagnostics
(Gulanick & Myers, 2007)
1. Actual weight and height
2. Nutritional history
a. Include family, significant others, or caregiver in assessment
3. Etiological factors for reduced nutritional intake
4. Patient attitude towards eating and food
5. Lab values that indicate nutritional wellbeing or deterioration
a. Serum albumin – indicates degree of protein depletion (2.5 g/dL indicates severe depletion; 3.8 to 4.5 g/dL is normal)
b. Transferin - important for iron transfer and typically decreases as serum decreases
c. Red blood cell and white blood cell counts – usually decreased in malnourished patients; indicates anemia and decreased resistance to infection
d. Serum electrolyte values – potassium is typically increased and sodium is typically decreased in malnutrition
6. Weekly weights
a. During aggressive nutritional support, patient can gain up to 0.5 pound per day

Medications
1. Zofran - nausea or vomiting
a. 4mg IV q 6 hours
2. Megace – appetite stimulant
a. 400-800 mg PO qday
3. Marinol – produces multiple CNS effect,
stimulates appetite
a. 2.5-10 mg PO bid – 20mg/day
b. Give before lunch or dinner
4. Albumin – hypoalbuminemia
a. 25% IV
5. Multivitamins – supplement
a. 1 tab PO daily
6. Folic acid – supplement
a. 1 mg PO qday
7. Ferrous sulfate – for anemia
a. 325 mg PO bid
8. TPN (total parenteral nutrition) – if patient
unable to take PO
a. IV

Delegation of Interventions
Overview - Medical Condition
Anorexia Nervosa is defined as:

a psychosocial disorder with intentional loss of at least 25% of body weight. Signs and symptoms include muscle wasting; fat store depletion; dry, inelastic skin; loss of or change in hair; constipation; amenorrhea; hypotension; and bradycardia. You may also obseve loss of tooth enamel because of prolonged vomiting. ("Assessment," 2001, p. 47)
(Gulanick & Myers, 2007)
LVN
a. Monitor vital signs
b. Monitor patient attitude towards eating and food and reports to RN
c. Monitor patient weight

Registered Nurse
a. Document actual weight and height – do not estimate
b. Obtain nutritional history
c. Determine etiological factors for reduced nutritional intake
d. Administer medications
e. Monitor lab values
f. Closely monitor patient that they are following treatment plan
g. Consult dietician for further assessment and recommendations regarding food preferences and nutritional support
h. Establish appropriate short and long term goals
i. Improvement of nutritional status – food, fluid, and nutritional intake

UAP/CNA
a. Assist patient with ADLs
b. Serve meals on time and monitor patient’s intake
Full transcript