Question

Erin is a 19-year-old university student in her second year at university. Erin is bright and has always been a high achiever at school, and her parents have been keen to prompt her to follow her dreams and encourage her pursuits. Erin loves cooking for her family, particularly her older brother Josh. In order to achieve the best possible Year 12 score, Erin’s parents decided to move her to a private school for girls that had a good reputation for university acceptance. Erin’s mother took on extra work to pay for the school fees. While Erin was sad to leave her old school and friends, she agreed that this was the best choice for her academically. Things did not go as well as planned, however, and Erin was subjected to distressing bullying from the beginning of Year 12 until she finished the school year. Erin has always been conscious of her health and weight but was targeted because she had ‘fat legs’

and the bullies sent her text messages of ‘fat people’ and memes with derogatory messages about her. Because her parents had made sacrifices for her to attend this school, Erin didn’t want to tell them that she was being bullied, so she kept it to herself. This bullying had a devastating impact on Erin’s self-esteem, and she began dieting. People would comment on how great she looked, so she continued dieting. She felt she had some control over what she ate, and this made her feel better. When her local gym had a special rate for new members, Erin joined. When she wasn’t at the gym, she was studying. Because she was working out so much, and restricting her diet, Erin became seriously constipated. So, she went to her local pharmacy and began buying laxatives. Erin noticed that they helped with her constipation, but they also reduced her weight (Erin would weigh herself daily), so she began taking them all the time. It got to the point where her local pharmacy would not sell them to her anymore, so she began buying them from multiple pharmacies and online. Despite the turmoil at school, Erin did well academically and achieved exceptionally high marks in her final exams. She got her first preference for courses and enrolled in a Bachelor of Dietetics at a well-regarded university. Recently, however, wearing baggy clothing and restricting her food intake has been causing suspicions. Her mother has told her she is too thin, and her brother and father have expressed concern about her –but Erin doesn’t see it this way. When Erin looks in the mirror, she sees the fat girl who was bullied in Year 12. Erin has collapsed at her gym several times, and staff have expressed concern about her weight. Erin worried that as with the pharmacy, she will need to find another gym. At 1.62 cm tall and weighing 41 kg, Erin’s BMI is 15.6.

1. What are some of the physical risksassociated with Erin’s behaviours?
2. Erin is exhibiting many different behaviours consistent with ED. Describe what these are;
3. EDs can be upsetting for family and friends of the consumer, and family members who are concerned about their loved one are almost always correct in their ED concerns. What are the impacts on the familyare common when a member has an ED;
4. Investigate longer term issues that may impact recoveryfrom an Eating Disorder.
5. Develop three questionsyou would ask Erin during an interview to complete an MSE. They could be from any MSE area.
6. Complete a risk assessment;
7. Develop a nursing care plan.

Answer 1

Eating Disorders:

Any psychosocial disorder characterised by abnormal eating habits are called Eating disorders. Major Eating disorders are Anorexia nervosa, bulimia nervosa and Pica.

1. Physical risks:

The clients with eating disorders, usually suffer from weight loss, fatigue, heart burn, gastritis, dental problems , abdominal bloating, constipation etc. Eating disorders may lead to the physical risks/ complications such as

* Hypotension or Orthostatic hypotension ( due to fluid loss and electrolyte imbalance)

* Cariac abnormalities such as arrhythmia, decreased heart beats.

* Anemia

* Dehydration and possible renal damages

* Amenorrhea

* Hypothyroidism

* Osteoporosis

* Depression

2. Different behaviours consistent with ED:

Errin may exhibit the symptoms, as a part of her Eating disorders, such as :

* Restricting the food and fluids / intake of very less amount of food. They may even show binge eating and purging behaviour ( induced vomiting) as in case of Bulimia nervosa.

* Excessive exercise pattern

* Daily / frequent weight checking

* repeated usage of laxatives.

* low self esteem

* vie themselves as overweight

* anxiety and distress

* Obsession with fat content and calories of food

* moving the food to the sides of plate

* Depression

3. Impacts on family:

Eating disorder can impact the family negatively and the eating habits of the client will be distressing for the family members and friends too. Often the family members and friends did not understand the disease process and they will wonder ' why the patient can't change the eating habit..just eat well get better'. They may think that the patient is not obeying or listening their words. This will add more pain.

Parents may think they may be the cause of the disease or suffering of the child. ( some studies show that childhood trauma or physical abuse may make the adolescent prone to Eatingdisorders. ). Siblings may get influenced by the eating habits of the client.

Family members and friends should get a clear understanding about the disease process, them only they can help Errin to recover from her disease.  

4. Longer term issues:

Even though Eating disorders are mental illness, it may affect the physical health badly. The client's health may deteriorate day by day. Since the continous bullying from Year 12 , she developed low self esteem and negative self image. So it may take years for recovering her Eating disorders as the mental damage should get healed. Otherwise there are chances of recurrence. Eating disorders may have longer effects on physical health such as cardiac issues and heart attack, emaciated appearance, dry skin, osteoporosis etc.It may affect relationshilps negatively, especially friendship, marriages etc.

5. Three questions :

* Does you body weight affect the your self esteem?

* Do you have a tendency to induce vomiting after eating, to get rid of extra calories.?

* Do you feel that laxatives can help to get rid of excess body weight ?

( Due to time limitation, can't answer to all questions. hope you understand. Thank you)

Key points of 6 and 7

6. Risk assessment :

* Check for signs of complications

* Physical examination

* Vital signs

7. Nursing care plan

Nursing diagnosis:

* Imbalanced nutrition less than body requirements related to inadequate food intake and excessive laxative use as evidenced by body weight Below expected ( 15%).

* Disturbed thought process related to sense of low self worth as evidenced by non reality based verbalization.

* Disturbed body image related to morbid fear of fatness as evidenced by distorted body image.