Assessing and caring for a patient like E.B., an 18-year-old high school senior with a diagnosis of anorexia nervosa and depression, requires a comprehensive and empathetic approach

QUESTION

You are a nurse on an inpatient psychiatric unit. E.B, an 18-year-old high school senior was admitted to the unit after being seen in the Emergency department yesterday afternoon following a fainting episode at school. She has been given a diagnosis of anorexia nervosa and depression. As you begin to assess her you notice she is wearing very loose clothing, 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, I just got lightheaded for a second.” She appears to be extremely thin and pale, with dry brittle hair, which is very thin and patchy, and she constantly complains about being cold. As you complete her admission assessment you find out that E.B lives with her mom and new stepdad, is a straight A student, plays the flute in the school band and is a cheerleader for the high school football team. E.B tells you that her and her boyfriend recently broke up because they plan to attend college in different states and “don’t want the hassle of a long-term relationship.” As you question E.B about weight and nutrition she becomes defensive and

ANSWER

Assessing and caring for a patient like E.B., an 18-year-old high school senior with a diagnosis of anorexia nervosa and depression, requires a comprehensive and empathetic approach. Anorexia nervosa is a complex mental health disorder characterized by extreme dietary restriction, an intense fear of gaining weight, and distorted body image. It often co-occurs with depression, making the assessment and care plan even more critical.

Here’s an essay-format response outlining the key aspects of assessing and caring for E.B.:

Introduction

Caring for individuals with anorexia nervosa and depression, like E.B., presents unique challenges due to the interplay between physical and mental health. This essay explores the essential components of assessing and providing care for such patients, considering the physical, psychological, and social aspects of their well-being.

Physical Assessment

Physical Health Evaluation: Begin by assessing E.B.’s physical health. Note her vital signs, nutritional status, and signs of dehydration, electrolyte imbalances, or cardiac complications that are common in anorexia nervosa.

 Nutritional Assessment: Collaborate with a registered dietitian to evaluate her dietary intake, weight history, and signs of malnutrition. Monitor her body mass index (BMI) and determine the severity of her nutritional deficiency.

Lab Tests: Order necessary laboratory tests to assess electrolyte levels, complete blood count, liver function, and other relevant parameters to identify potential complications.

Psychological Assessment

Mental Health Evaluation: Conduct a comprehensive mental health assessment, considering E.B.’s depressive symptoms, suicidal ideation, and emotional well-being. Utilize standardized assessment tools to gauge the severity of depression.

Body Image and Distorted Cognition: Explore her perception of body image and cognitive distortions related to weight and appearance. Assess her level of insight into her condition.

Psychosocial Factors: Investigate the presence of stressors, such as the recent breakup, academic pressures, or family dynamics, which may contribute to her mental health issues.

Social Assessment

Family and Social Support: Engage E.B.’s family, especially her mother and stepdad, to understand their roles, relationships, and potential sources of support or conflict. Collaborate with them to create a supportive environment.

School and Peer Dynamics: Assess her school life, extracurricular activities, and peer relationships, as they can influence her self-esteem and emotional well-being.

Treatment Goals and Motivation: Discuss E.B.’s treatment goals, readiness for change, and motivation for recovery. Identify any barriers to engagement in treatment.

Conclusion

Assessing and caring for individuals like E.B. with anorexia nervosa and depression require a holistic approach, considering their physical, psychological, and social well-being. A multidisciplinary team, including nurses, physicians, dietitians, and mental health professionals, should collaborate to develop a tailored care plan that addresses the complexities of this dual diagnosis. Patient-centered care, empathy, and ongoing monitoring are crucial to promote recovery and improve the overall quality of life for individuals like E.B.