1. Eating Disorder Unfolding Case Study

2. Introduction
Jamie is a 14-year-old female that recently transfer to a new high school after her family moved across states. This is her third residence and school change in the last 5 years. Jamie’s father is in the military service and recently returned home after a tour in Iraq for 6 months. Jamie has a two year history of restricted food intake. Jamie is 5’6” tall and weighs 98 pounds. She is on the dance team at school and is an honor roll student.

3. Continued
The school nurse notices that Jamie frequently eats only an apple during lunch. The nurse is also concerned that Jamie seems to get easily fatigued during the dance team practices. Jamie is very thin and fragile in appearance. She does not seem as strong, physically, as she did in past practices during the beginning of the school year.

4. Reflect on the patient
What are the school nurse’s concerns about Jamie?
Reflect on Jamie’s background and the impact that her background may have on her present state.

5. In general, what are some predisposing factors for the development of eating disorders (ED)?1. 2. 3.

6. Which of these predisposing factors are specific to Jamie?

7. Which related medical diagnoses (DSM-IV-TR) do you suspect of Jamie?

8. Theory Burst
Symptomology associated with ……..

9. As the nurse, what are the next steps in regard to Jamie?

10. Answer .

11. Communication!
Talk with Jamie in private setting about concerns and observations. Therapeutic relationships are essential in the recovery process.
Make family contact in the presence of Jamie.

12. Give examples of therapeutic communication techniques to use during communication with Jamie and her family :

13. Answer

14. Theory Burst
The development of eating disorders are rarely about food. It is important for the patient to gain insight on the causes of the eating disorder.

15. Assess Jamie’s history
What questions would the nurse ask Jamie and her parents while assessing Jamie’s history?

16. Answer

17. Theory Burst
Depressive symptoms, severe anxiety, and purging in individuals with anorexia nervosa is a sign of elevated risk for suicide (Forcano et al., 2011)
Forcano, L. Alvarez, E., Santamaria, J.J., Jimenez-Murcia, S., Granero, R. Penelo, E. …Fernandez-Aranda, F. (2011). Suicide attempts in anorexia nervosa subtypes. Comprehensive Psychiatry, 52(4),

18. ***If suicidal ideation is present…..
What should the nurse do next?

19. Answer

20. What are the signs and symptoms/clinical presentation that the nurse should assess?

21. Physical signs and symptoms in anorexia nervosa

22. Psychological signs and symptoms in anorexia nervosa

23. Behavioral signs and symptoms in anorexia nervosa

24. What clinical symptoms of anorexia nervosa should have the highest priority?

25. Mental Health Hospital
Jamie is admitted to a mental health hospital. What are some of the criteria for hospitalization for individuals with an ED?

26. Answer

27. What are common nursing diagnoses for patients with an ED?

28. Answers: Nursing Diagnoses

29. Patient-centered Care: “Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.”

30. What lab and diagnosic test should the nurse evaluate or anticipate for Jamie?

32. Lab work: Sodium 135 mEq/L Potassium 3.4mEq/L Chloride 99 mEq/L
BUN 18mg/dl
Creatinine 1.0mg/dl
Hemoglobin 11g/dL
Hematocrit 35%
ECG results show normal sinus rhythm with no ST segment or other changes

33. Theory Burst Amylase level needs to be monitored.
Amylase level may increase due to secretions associated with purging behaviors.

34. What are common nursing interventions to include in the treatment plan for Jamie?

36. More interventions:

37. What are common medications that may be administered to a patient with a diagnosed eating disorder?

38. Common Medications for patients with an ED:

39. What other disorders might occur along with anorexia nervosa?

41. What are common treatment goals?

42. Treatment goals for Jamie:

43. Bulimia nervosa vs. anorexia nervosa