Krause\'s Food & the Nutrition Care Process 14th edition Chapter 22 Case Study #
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Krause's Food & the Nutrition Care Process 14th edition Chapter 22 Case Study #1
Melissa has just been admitted to an inpatient hospital unit. She is 19 years old and reports the onset of anorexia nervosa at 12 years of age. Upon admission, Melissa’s weight is 68 lb, and her height is 61 inches.
Patient began menses early at the age of 11, and because of adolescent developmental changes reported feeling uncomfortable in her body. At this time she was 58 inches and weighed 100 lb (between 50th and 75th per- centile). She learned she could restrict through seeing her mom diet at home and began counting her calories. She would aim for less than 1000 calories per day and began walking for 30 to 60 minutes daily. After 6 months, halfway through her sixth grade year, Melissa had dropped to 82 pounds and did not grow in height during this time; she remained at the 25th percentile and stopped menstruating. Melissa’s parents began worry- ing and started to adapt a Maudsley/family-based therapy approach of eating at home in which she ate all of her meals at home with them. She would continue to restrict at school and exercise as much as she could. By the age of 17 Melissa had gained back some weight and graduated from high school, weighing 105 lb with a height of 62 inches (10th percentile for weight and 10th to 25th for height).
After her first year away at college, Melissa began restricting again, this time down to approximately 500 calories per day. Her typical daily intake now is 1 cup coffee in the morning with an apple. For lunch she has salad from the dining hall with 3 ounces of sliced turkey on it and a 12 cup of brown rice with balsamic vinegar. For dinner she has two pieces of laughing cow cheese with steamed vegetables from the dining hall. If she gets hungry at night, she will have an individual bag of fat-free pop- corn. She also reports 60 to 90 minutes of walking or running per day around campus or at the gym. Since her first onset of menses, Melissa was getting her period on average 2 to 3 times per year. It has now been 1 year since her last period (age 18). Melissa denies any purging or laxa- tive abuse.
Since being in the hospital, Melissa has struggled with eating 100% of her planned meals. She reports fearing any foods high in fat such as cheese, fried foods, desserts of any kind, meat, oils, and potato chips. Melissa is refusing to drink regular milk as well. The nursing staff on the unit told you that Melissa has been consuming approximately 50% to 60% of her 1800 kcal meal plan and has not taken any of the recommended supplements.
Medical history: amenorrhea, hypokalemia
Current medications: MVI with trace minerals, thiamine daily
Inpatient calorie prescription: 1800 kcal/day
B/P: 89/58
Pulse: 58
Laboratory Values:
Nutrition Diagnostic Statement:
Underweight related to abnormal eating pattern as evidenced by a restric- tive caloric intake and excessive exercise in the setting of being below 75% IBW.
1. What are the essential criteria for anorexia nervosa diagnosis?
2. List behavioral or psychologic treatment approaches that could be used to help Melissa?
3. What is the first priority in MNT for anorexia nervosa?
4. Calculate Melissa’s goal weight
5. What are common complications to assess when monitoring for refeeding syndrome?
6. What will influence Melissa’s rate of weight gain?
7. What questionnaire is useful to assess for the presence of eating disorders?
8. Why does hypercarotenemia occur with AN?
9. What is monitored for AN patient treatment?
10. What should be Melissa’s target weight gain rate?
Test Sodium Potassium Calcium Glucose BUN Creatinine Phosphorous Magnesium Cholesterol Result Reference Range 135-147 mEq/L, 129 3.5-5.2 mEq/L. 3.3 95-107 mEq/L 8.7-10.7 mg/dL 8.2 22- 29 mmol/L. 60- 69 mg/dl (fasting) 8-21 mg/dl 0.65-1.00 mg/dl 1.2 2.5-1.6 mg/dl 3.2 1.7.2.3 2.2 240Explanation / Answer
1. What are the essential criteria for anorexia nervosa diagnosis?
1. Significant Loss of weight or lowbody weight .
2.Fear of weight gain.
3.Interfering behaviour leading to low body weight.
4.Not seriously acknowledging loss of body weight or not taking any action to improve body weight.
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2. List behavioral or psychologic treatment approaches that could be used to help Melissa?
1)Behaviour therapy (BT).
2)Cognitive analytic therapy (CAT).
3)Interpersonal psychotherapy (IPT).
4)Family therapy and family interventions.
5)Psychodynamic psychotherapy.
3. What is the first priority in MNT for anorexia nervosa?
The first priority in MNT for anorexia nervosa is diagonising , addressing , treating and stabilizing
major health problems .
4. Calculate Melissa’s goal weight
Melissa's goal weight at 50PERCENTILE = 100*2= 200 lbs.
Melissa's goal weight at 75 percentile= 100* 3 = 300lbs.
5. What are common complications to assess when monitoring for refeeding syndrome?
Fluid and electrolyte related problems
hypophosphatemia, neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.
6. What will influence Melissa’s rate of weight gain?
The calorie intake in Kcal per Kg body weight per day will influence Melissa’s rate of weight gain.
7. What questionnaire is useful to assess for the presence of eating disorders?
The Eating Disorder Inventory (EDI) is the questionnaire that is useful to assess for the presence of eating disorders.
8. Why does hypercarotenemia occur with AN?
hypercarotenemia occur with AN , because carotenoids intake is minimal or absent in AN Patients.
9. What is monitored for AN patient treatment?
Weekly weight gain is monitored for AN patient treatment.
10. What should be Melissa’s target weight gain rate?`
Melissa's weight gain rate should be 1100 pounds (22 kgs *500lbs).
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