Mental Health Nursing

A 21-year-old in oversized clothing presents to the hospital with of felling dizzy and faint.

The hair and nail appear thin and dry. The skin appears pale and she has sunken eye sockets and tenting skin. Her body mass index is 16. She often induces vomiting after eating blood is collected for analysis (see lab results). BP 90/52 mmHg HR 118 /min RR 26/min T 37.2 ͦ C Oxygen saturation 97% Test Result Normal value ABG¹ HCO₃ ̵ 31 22 – 88mmol/L ABG PCO₂ 10.3 4.7-6.0 kPa PH 7.50 7.36-7.45 Which nursing problems stem is the most appropriate?

  1. A Impaired nutrition الإجابة الصحيحة
  2. B Decreased cardiac output
  3. C Infective airway clearance
  4. D Ineffective breathing pattern

الشرح

Core Concept: The patient exhibits classic signs of an eating disorder (Anorexia Nervosa binge-eating/purging type or severe Bulimia Nervosa) with profound malnutrition (BMI 16, thin/dry hair, skin tenting). The ABG shows metabolic alkalosis (pH 7.50, high HCO3), a classic consequence of frequent self-induced vomiting (loss of gastric hydrochloric acid). The primary, overarching nursing problem driving all these physiological and structural derangements is "Impaired nutrition: less than body requirements."

Clinical Presentation:

  • Severe weight loss, lanugo (fine body hair), amenorrhea, bradycardia, and hypotension.
  • Electrolyte imbalances (hypokalemia, hypochloremia), dental enamel erosion, and Russell's sign (calluses on knuckles).
  • Complications include fatal cardiac arrhythmias (due to hypokalemia), esophageal tears (Mallory-Weiss), and refeeding syndrome.

Diagnosis:

  • First-line diagnostic tool: Comprehensive psychiatric evaluation using DSM-5 criteria, BMI calculation, and a thorough physical exam.
  • Gold standard diagnostic test: 12-lead ECG to check for QT prolongation/arrhythmias, comprehensive metabolic panel (electrolytes, renal function), and endocrine workup to assess the medical severity of the malnutrition.

Management:

  • Acute management: Medical stabilization, correcting severe electrolyte imbalances (especially potassium), cautious nutritional rehabilitation to avoid refeeding syndrome, and continuous cardiac monitoring.
  • Gold standard long-term/definitive management: A multidisciplinary approach including nutritional counseling, psychotherapy (CBT, Family-Based Therapy), and psychiatric medications (e.g., SSRIs like fluoxetine) to address the underlying psychopathology.

40 سؤالاً مجاناً مع حساب

الأسئلة المنشورة هنا عيّنة ثابتة. أنشئ حساباً مجانياً لتتدرب على بنك الأسئلة الكامل، مع تحليل أدائك حسب التخصص وصفحة لمراجعة أخطائك.

إنشاء حساب مجاني

بدون بطاقة دفع