Krause\'s Food & the nutrition care process 14th edition Case Study Chapter 22 A
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Question
Krause's Food & the nutrition care process 14th edition Case Study Chapter 22
Anorexia Nervosa
Melissa has just been admitted to an inpatient hospital unit. She is 19 years old and reports the onset of anorexia nervosa at 12. Upon admission, Melissa’s weight is 68lb 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 (50th-75th percentile). She learned she could restrict through seeing her mom diet at home and began counting calories. She would aim for no less than 100 per day and began walking for 30-60 minutes daily. After 6 months, halfway through 6th grade, 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 worrying 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 can. By the age of 17, she had gained some weight back and graduated from high school weighing 105 lb with a height of 62 inches (10th percentile for weight and 10th-25th for height.
After her first year away at college, Melissa began restricting again, this time down to 500 calories. Her typical daily intake is 1 cup of coffee in the morning with an apple. For lunch she has salad from the dining hall with 3oz of sliced turkey on it with ½ cup of brown rice with balsamic vinegar. For dinner she has two pieces of laughing cow cheese with steamed vegetable from the dining hall. If she gets hungry at night, she will have an individual bag of fat-free popcorn. She reports 60-90 minutes of walking or running per day. She gets her period on average 2-3 times per year. It has now been 1 year since her last period (age 18). She denies purging or laxative use.
Since being in the hospital, she has struggled with eating 100% of her meals. She fears foods high in fat and regular milk. She is consuming about 50-60% of her 1800 kcal meal plan and has not taken recommended supplements.
Medical history: amenorrhea, hypokalemia
Medications: MVI with trace minerals, thiamine daily.
Calorie prescription: 1800kcal/day.
B/P: 89/58
Pulse: 58
Tests:
Sodium: 129
Potassium: 3.3
Chloride: 94
Calcium: 8.2
CO2: 32
Glucose: 65
BUN: 23
Creatinine: 1.2
Phosphorous: 3.2
Magnesium: 2.2
Cholesterol: 240
Statement: Underweight by restricted calories and excessive exercise.
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?
Explanation / Answer
Anorexia Nervosa also commonly known as Anorexia is a psychological eating disorder wherein an individual lives with a constant and irrational fear of adding weight. It is characterised by abnormally low body weight and compulsive exercise. Individuals suffering from anorexia often perceive themselves as "FAT", when in reality they are underweight or have low body weight.
There are two types of Anorexia, namely; Binge and Restrictive.
Binge Type is when an individual goes on a bingeing spree, and eats what comes their way due to overwhelming feelings and later it is compensated by either vomiting, laxatives or maybe even excessive exercise.
Restrictive Type is when an individual limits the quantity of the food to be taken which is below their body's caloric needs.
Anorexia Nervosa can be diagnosed by referring to the Diagnostic Statistical Manual of Mental Disorders(DSM). DSM contains a set of diagnostic criteria which needs to be matched against an individual's symptoms before concluding whether a person suffers from a certain disorder or not.
The following are the criteria to be matched against an individual's symptoms to make diagnoses for Anorexia Nervosa:
(Straight from the DSM-V)
1. Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for BMI).
2. Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though the significantly low weight).
3. Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
An individual needs to meet the above criteria in order to have said to be suffering from Anorexia Nervosa.
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