Question

In: Nursing

Gary is an accounting major at a local college. At one point in his childhood, he...

Gary is an accounting major at a local college. At one point in his childhood, he was overweight. Other children teased him and called him “fatty hatty.” This made a deep impression on Gary, negatively effecting his self-esteem. In middle school, he felt isolated and was described as a “loner” by teachers. He did not join any clubs or engage in activities with peers.
In high school, his physical education teacher encouraged Gary to join the wrestling team. He thought Gary’s weight would not matter in this event. But, they needed a wrestler at a lower weight class. Gary’s coach encouraged him to lose weight and told the other boys on the team that they were counting on Gary. Gary felt significant peer pressure to make it to the lower weight class, and he really enjoyed wrestling. He began a strict diet after the coach has checked with his parents. He was eating lean protein and vegetables, some fruit, and drinking lots of water. He lost weight, and he was really good at wrestling. In fact, he lost enough weight to go down two weight classes and do a good job for his team. His identity, in high school, was totally wrapped up in wrestling. He still was quiet and shy and did not express much with peers, but he appeared happier and to have finally found a place for himself.
Gary was not able to make his college wrestling team, and he was sad. Also, he was finding it was difficult to socialize with others. He was still feeling like he was fat, even though, after all the dieting, he was quite thin. He was having difficulty losing more weight, and he turned to laxatives to help him lose weight. He was now significantly underweight. He eats one meal a day and exercises at least 90 minutes a day, often doing heaving cardio (e.g., running and jumping rope). He has a stress fracture in his ankle and is still jumping rope as part of his exercise regimen. Gary was recently diagnosed with anorexia nervosa, he is 30 pounds underweight.
Please answer the five questions about this case:
1. What are symptoms related to Anorexia Nervosa? List at least five symptoms related to Anorexia Nervosa.
2. Nutrition therapy is recommended in the treatment of Anorexia Nervosa. What are some ideas that you might have for nutrition therapy or improving nutrition for Gary? Also, address some ideas you might have for gaining Gary’s trust as this can be critical for nutrition therapy.
3. Gray faced teasing when he was younger and faced a weight stigma. What are your ideas for helping him cope with the after-effects of this weight shaming and the stigma he faced as a youngster? Do you thin our culture in America, emphasizes a “thin ideal?” Are there other body “ideals” for men (such as being muscular and athletic)? How can we combat these ideals?
4. Discuss some questions you can ask to determine if a client has an eating disorder. What might be a first step if you have a client you suspect has an eating disorder (i.e., whom is a referral source and whom could you try to contact)?
5. Should Gary continue his heavy exercise regimen? What type of education does he need in this area? What might you recommend for Gary, in terms of exercise?

Solutions

Expert Solution

ANOREXIA NERVOSA symptoms

body weight less than normal

fear of gaining weight

purging behaviour (self-induced vomiting and use of laxatives )

tendency to do fasting or excessive exercise

Q 2

START A DIET PLAN OF 20 kcal/KG/DAY for weight gain

THEN IT CAN INCREASE TO 30-40 kcal/kg/day

the continuous restrictive eating and malnutrition can end upin many diseases such as cardiovascular and gastro intestinal

if client like vegetarianism try to include more caloie dense foods

egg whites, casein ,  whey,flushy fish and poultry can be encouraged

the client should repulsed by eating ,that is, the eating relieves tension but does not produce pleasure

monitor clients elimination pattern

monitor and restore fluid and electrolyte balance

encourage patient to ventilate feelings and clear all conerns

give a counseling with help of specialist to relieve excessive negative feeling and use medications according to prescription for treating depression and anxiety

positive support from loved ones can be essential for an individual sucess

Some QUESTIONNAIRE

Have you ever felt the need to gain weight?

have ever been annoyed at criticism of your body weight?

have you ever felt guilt about something you have done to reduce your body weight?

EXERCISE

educate the patient that excessive exercise can exacerbate physical damage done by anorexia

encourage patient to plan light exercise with help of nutritionalist as well as physician

ensure that patient is medically fit before planning exercise regimen.

examples of light physical activity include- walking slowly, washing dishes


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