Question

A nurse in an outpatient clinic is reviewing the medical record of a client who has anorexia nervosa.

Vital Signs
6/4/XX (Visit 1):Blood pressure 100/64 mm HgHeart rate 62/minRespiratory rate 16/minTemperature 36.3° C (97.3° F)Oxygen saturation 98%6/18/XX (Visit 2):Blood pressure 102/66 mm HgHeart rate 56/minRespiratory rate 18/minTemperature 36.4° C (97.5° F)Oxygen saturation 99%

Diagnostic Results
Visit 1:ECG Normal sinus rhythmCholesterol 196 mg/dLPlatelet count 155,000/mm3 (150,000 to 400,000/mm3)Visit 2:ECG QT prolongationCholesterol 238 mg/dLPlatelet count 140,000/mm3 (150,000 to 400,000/mm3)

Nurses' Notes
Visit 1:Client reports taking laxatives daily and inducing vomiting 3 or 4 days per week. Client states, "I have always been a nervous person, even as a kid. I feel like I need to be perfect, or everyone will think I'm a complete failure. I can't believe I let myself gain this much weight - I look awful." BMI 16.8.Visit 2:Client reports no longer taking laxatives. Client also reports inducing vomiting most days and new onset of hematemesis. Petechiae noted on face and sclera. Client states, "I started therapy and have had two sessions so far. I also got some exercise equipment

Answer 1

1: The nurse's examination of the client's records indicates a worrisome progression in anorexia nervosa symptoms, with low blood pressure, increased heart rate, and initial laxative use. 2: Despite a normal ECG, Visit 2 reveals QT prolongation, elevated cholesterol, decreased platelets, and alarming signs like hematemesis. While therapy engagement is positive, persistent harmful behaviors highlight the need for comprehensive medical and psychiatric interventions.

Step-by-step explanation:

The nurse's review of the client's medical record reveals a concerning progression in symptoms associated with anorexia nervosa.

1: The initial vital signs at Visit 1 show a low blood pressure of 100/64 mm Hg, a heart rate of 62/min, and reports of laxative use and induced vomiting.

2: Despite a normal ECG, subsequent diagnostics at Visit 2 reveal QT prolongation, suggesting cardiac complications.

The client's cholesterol levels have increased, and platelet count has decreased.

Notably, the transition from laxative use to increased vomiting raises concerns, as hematemesis and petechiae emerge.

The client's engagement in therapy is a positive step, but the persistence of harmful behaviors underscores the complexity of managing anorexia nervosa, necessitating comprehensive medical and psychiatric interventions for improved outcomes.