Conc of Pathophys of NSg peers response

· respond to peers thoughtfully, add value to the discussion, and apply ideas, insights, or concepts from scholarly sources, such as: journal articles, assigned readings, textbook material, lectures, course materials, or authoritative websites. For specific details and criteria, refer to the discussion rubric in the Menu (⋮) or in the Course Overview Weekly Discussion Guidelines. 

1st peer post

Samantha WootenSep 11, 2023 at 9:31 AM

Marshall (2022) reports “In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences” (P. 1). Marshall also surmises that lab work up on a patient may look normal, but this does not rule out impending death, death could happen quickly by cardiac arrest caused by electrolyte imbalances (2022. P. 1). 

Cultural and environmental implications affect a large amount of people within all ethnicity, gender, and age however women are largely targeted, the University of East Anglia state “his quite obvious connection between eating disorders and cultural expectations surrounding femininity is woefully neglected in much treatment” (P. 1).  With the technology boom in recent years this is ever more present for this population, a social media environment instills these behaviors in today’s society.  

Financial implications that cause anorexia include lack of income and homelessness. Underprivileged populations have no choice but to sacrifice food to prioritize other necessities. Chan (2023) reports 64.7 billion being spent on eating disorders per year, with 23,560 hospitalizations yearly (p. 1). 

In the ED with 16-year-old Jonathan Collins coming into the facility for anorexia nursing interventions would include evaluating the patients diet/exercise regimen and educate on proper diet and exercise with adequate fluid intake. Identify coping strategies and emotions related to weight, allowing the patient time to think and express how they’re feeling. This will allow underlying causes to surface for treatment. Lastly, addressing body images issues. Targeting these fears will allow the patient to accept a healthy body weight to maintain health and stay out of the hospital (Belleza, August 9, 2023. P. 1). 

According to Miller, Grinspoon, and Ciampa (2020) vital signs with anorexia tend to include a slower than normal heart rate, hypotension, and hypothermia. Lab values tend to include anemia and in some cases thrombocytopenia. Sodium levels average around 122, with normal levels being 135-145. Average potassium in patients with anorexia being 1.9 with normal values being 3.4-4.8. All of these values contribute to cardiac arrest via electrolyte imbalance. In some anorexia patients there are dysrhythmias due to electrolyte imbalances and hypovolemia. Also of note with women populations are menstrual dysfunction and osteoporosis (P. 1). 

Treatment includes a combination of psychotherapy, family therapy, and medicine according to St. Lukes Hospital (2015), they also state “A combination of treatments can give the person the medical, psychological, and practical support they need. Cognitive behavioral therapy, along with antidepressants, can be an effective treatment for eating disorders. Complementary and alternative (CAM) therapies may help with nutritional deficiencies” (P. 1). 

references

Belleza, M. August 9, 2023. Eating disorders: Anorexia & Bulimia Nervosa. Nurse Labs.
Eating Disorders: Anorexia & Bulimia Nervosa – Nurseslabs

Chan, T. H. 2023. Report: Economic Costs of Eating Disorders. Harvard School of Public Health.
Report: Economic Costs of Eating Disorders | STRIPED | Harvard T.H. Chan School of Public Health

Marshall, D. 2022. Anorexia Nervosa. National eating disorders association.
Anorexia Nervosa | National Eating Disorders Association

Miller, K. Grinspoon, S. Ciampa, J. (Marh 14, 2020). Medicla Findings in Outpatients with Anorexia Nervosa. JAMA internal medicine. Doi:10.1001/archinte.165.5.561.

St. Lukes Hospital. April 23, 2015. Complementary and Alternative Medicine of Anorexia Nervosa. A Division of Ebix.
Anorexia nervosa | Complementary and Alternative Medicine | St. Luke’s Hospital (stlukes-stl.com)

University of East Anglia. November 13, 2017. Eating disorder treatments need to consider social, cultural implications of the illness. Science Daily.
Eating disorder treatments need to consider social, cultural implications of the illness | ScienceDaily

2nd peer post

Kira DespinsSep 11, 2023 at 3:20 PM

1. Thoroughly explain the pathophysiology of anorexia. Use a scholarly or authoritative source to support your answer.

Anorexia is a medical condition summarized by an inadequate intake of nutrients to regulate an individual’s weight to reduce their BMI and be ‘thin’.  It causes physiological imbalances such as amenorrhea and psychological imbalances such as an obsessive-compulsive need to exercise or an all-encompassing fear of gaining weight. This population exhibits body dysmorphia.  Once begun, this disease is persistent in select populations (Klein, 2004).

1. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.

Cultural:  Western culture perpetuates a standard of beauty based on being thin.  This standard is propagated through social media outlets. Klein (2004) summarizes that popular media not only emphasizes the need to be a thing but perpetuates it through advertisements such as marketing diet fads and fitness trends.

Financial: Relating to the treatment of anorexia, a study by Gatt et al. (2014) found significant household financial stress for those seeking treatment for their eating disorder.  They compared treatment costs to being the second highest after cardiac artery bypass surgery.  As the disease is notoriously difficult to manage by oneself, it would be prudent to establish funding for this patient population so all individuals can access treatment without causing significant burdens on themselves and their families.

Environmental implications: Nature vs. nature has been heavily debated in pursuing the best understanding of anorexia. Klinger (2012) highlights that from an environmental perspective, children who have been neglected and/or abused are more prone to develop anorexia.

1. Identify 3-5 priority nursing interventions for the client in the emergency department.

-Cardiac monitoring due to electrolyte imbalance

-Fall risk prevention related to weakness

-Blood glucose monitoring related to low nutrient intake

1. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.

Metevir, a nutrition counselor, highlights the importance of the following lab and diagnostic tests in anorexic patients (2022):

1. Vital sign monitoring, such as bradycardia, can signify a weak heart-conserving energy.

2. EKG to detect abnormal heart rhythm due to weakened heart muscles.

3. Complete metabolic panel to look for electrolyte imbalances in kidney and liver health. Hypokalemia would be a critical indicator.

4. Blood glucose tests as low food intake results in less glucose, which our brains depend upon

5. Hematology detects if our blood carries enough oxygen to perfuse our organs adequately.

6. Bone density test as low food intact can result in reduced hormone output, leading to weak and brittle bones.

1. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.

I believe that family members and friends are included in any team to support and care for those treated with anorexia.  Knowing the care plan, these individuals can best provide care and support to the patient while out of the hospital, setting them up for success.  Joy et al. (2003) believe that a physician, mental health professional, and nutritionist are also integral components of the care team as it affect an individual physically and mentally, and each has an overlapping specialty to assist the patient best.  In an emergency department setting, involving a social worker or case management is integral to establishing resources for patients seeking help in an outpatient or in-patient setting. 

References

Gatt, L., Jan, S., Mondraty, N., Horsfield, S., Hart, S., Russell, J., Laba, T. L., & Essue, B. (2014). The household economic burden of eating disorders and adherence to treatment in Australia. BMC Psychiatry, 14. 
https://doi.org/10.1186/s12888-014-0338-0

Joy, E., & Wilson, C., & Varechok, S. (2004). The multidisciplinary team approach to the outpatient treatment of disordered eating. Curr Sports Med Rep, 331(6), 6. https://pubmed.ncbi.nlm.nih.gov/14583163/#:~:text=Team%20members%20include%20a%20physician,of%20individuals%20with%20disordered%20eating.

Klein, D. A., & Walsh, B. T. (2004). Eating disorders: clinical features and pathophysiology. Physiology & Behavior, 81(2), 359–374. 
https://doi.org/10.1016/j.physbeh.2004.02.009

Klinger, D. (2012). Genes or environment: What causes eating disorders? GoodTherapy. 
https://www.goodtherapy.org/blog/genes-environment-what-causes-eating-disorders

Metevier, J. (2022). The eating disorder medical test and nutrition lab guide. Integrated Care Clinic. https://integratedcareclinic.com/blog/the-eating-disorder-medical-test-and-nutrition-lab-guide/#:~:text=Metabolic%2FElectrolyte%20Labs,your%20sugar%20and%20protein%20levels