Primary Concept
Fluid and Electrolyte Balance
Interrelated Concepts (In order of emphasis)
1. Acid-base
2. Nutrition
3. Perfusion
4. Coping
5. Mood
... [Show More] and Affect
6. Clinical Judgment
7. Communication
8. Collaboration
9. Patient education
© 2016 Keith Rischer/www.KeithRN.com
UNFOLDING Reasoning Case Study: STUDENT
Eating Disorder/Electrolyte Imbalances
History of Present Problem:
Mandy White is a 16-year-old adolescent who has struggled with anorexia nervosa since the age of 11. She admits to
drinking several large glasses of water daily. Mandy has also been recently engaging in self injurious behavior (SIB) of
cutting both forearms and thighs with broken glass, causing numerous lacerations and scars.
Mandy presents to the emergency department (ED) with increasing weakness, lightheadedness and a near syncopal
episode this evening. She admits to inducing vomiting after meals the past three weeks. She is 5’ 5” and weighs 83
lbs/37.7 kg (BMI 13.8). Mandy is reluctantly brought in by her mother and does not want to be treated. As the primary
nurse responsible for the care of Mandy, you overhear her say to her mother, “I hate everything about me! I am so tired
of living, I wish I were dead!”
Personal/Social History:
Mandy was sexually abused by her stepfather from the age of six to twelve. She confided what was taking place to her
mother and lives with her mother, who is now divorced. Mandy is sexually active and promiscuous. She uses the Tinder
app to meet older men for anonymous sexual encounters when her mother is working.
What data from the histories are RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
-Struggled with anorexia nervosa since age 11,
now is 16 (so for 5 years)
-Drinks several large glasses of water daily
-Recently engaging in self harming behavior,
she is cutting both forearms and thighs with
broken glass (numerous lacerations and scars
-Presents to the ED with increasing weakness,
lightheadedness and a near syncopal episode
this evening
- admits to inducing vomiting after meals the
past three weeks
-She is 5’ 5” and weighs 83 lbs/37.7 kg (BMI
13.8)
- brought in by her mother and does not want to
be treated
- overhear her say to her mother, “I hate
everything about me! I am so tired of
living, I wish I were dead!”
-It is important to note that the patient has a history of anorexia nervosa
because this could mean that she could possibly have more serious side
effects because of the length of her ED
-It is important to note that she drinks water because the patient is at risk
for fluid and electrolyte problems. If she is drinking a lot of water she
could experience fluid overload which makes her at risk for hyponatremia
and seizures
-The patient is cutting herself, which shows that she is at risk for self-harm
and could be a high risk for suicide.
-The fact that she has increasing weakness, lightheadedness and near
syncopal episode shows that she may be experiencing electrolyte
imbalances which can be deadly
-The fact that her BMI is very low shows that she could be experiencing
extreme electrolyte imbalances which could lead to organ failure and even
death
-The fact that she was brought in by her mother shows that she has a
support system at home and it is important to note that she is resistant to
treatment so may need to be hospitalized involuntarily
-She is stating suicidal thoughts and therefore is a high risk for suicide,
suicide ideation
RELEVANT Data from Social History: Clinical Significance:
-was sexually abused by her stepfather from
the age of six to twelve
-confided what was taking place to her mother
and lives with her mother, who is now
divorced
-is sexually active and promiscuous
- uses the Tinder app to meet older men for
anonymous sexual encounters when her
mother is working
-She experienced sexual abuse as a child, which is a major emotional
trauma, and these types of trauma can cause the development of eating
disorders, anxiety, and depression. She could be using the anorexia nervosa
to cope
-The patient has a support system at home, her mother. The nurse may need
to include family education as well.
-The patient may be using sexual activities as a coping mechanism for her
past sexual abuse
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
Anorexia nervosa Citalopram 20 mg PO daily This is an antidepressant and The patient’s depression and
Depression
Self-injurious behavior (SIB)
Sexually abused as a child
more specifically an SSRI anxiety will reduce, this will
hopefully help stop her self
harming behavior and
improve her ED
What medications treat which conditions?
Draw a line to identify what illness is being managed by what medication?
Citalopram is helping treat her depression and anxiety, which is correlated to her ED
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in his/her
life?
Circle what PMH problem likely started FIRST.
Underline what PMH problem(s) FOLLOWED as domino(s). [Show Less]