A nurse is caring for a client.

Exhibits

For each assessment finding, click to specify if the finding is consistent with ulcerative colitis, diverticulitis, or Crohn's disease. Each finding may support more than 1 disease process.

Potential Condition: Anorexia nervosa Actions to Take:

• Focus on the client's underlying feelings of dysphoria and lack of control.
• Provide a structured meal environment. Parameters to Monitor:
• Weight on a daily basis.
• Cardiac function with ECG. Rationale

Potential Condition:

Anorexia Nervosa

The client is presenting with significant weight loss (weighing 37.2 kg or 82 lb and having a BMI of 15, which is extremely low), refusal to eat, and anxiety around meals. These are hallmark signs of anorexia nervosa, a psychological disorder characterized by a distorted body image and an intense fear of gaining weight, leading to restrictive eating behaviors. The anxiety during mealtime and the refusal to eat or very limited intake (10% of the meal) are also consistent with this condition.

Actions to Take:

• Focus on the client's underlying feelings of dysphoria and lack of control

Anorexia nervosa often involves underlying psychological issues, including dysphoria, anxiety, and a lack of control over the disorder. Addressing the psychological aspects of the disorder is crucial in helping the client work through their fear of eating and regain control over their behaviors in a healthier way.

• Provide a structured meal environment

Anorexic patients often feel out of control and overwhelmed during meals, leading to avoidance and anxiety. A structured meal environment where the patient is encouraged to eat in a controlled, supportive manner is critical. A structured approach, along with meal monitoring (observing eating behaviors), helps ensure adequate nutrition and reduces anxiety around eating.

Parameters to Monitor:

• Weight on a daily basis

Monitoring weight daily is essential for tracking the client’s progress in terms of nutrition and weight restoration, which is a key treatment goal in anorexia nervosa. Daily weight checks provide feedback on how well the client is accepting nutrition and managing their eating disorder.

• Cardiac function with ECG

Severe weight loss in anorexia nervosa can lead to electrolyte imbalances, which, in turn, can affect cardiac function and lead to arrhythmias. The low BMI and nutritional deficiencies (such as low potassium or magnesium levels) increase the risk of cardiac complications, including bradycardia and hypotension.

Rationale for other conditions;

Avoidant Restrictive Food Intake Disorder (ARFID) is not the most likely condition because the client's symptoms are more consistent with anorexia nervosa, particularly the preoccupation with weight and body image. ARFID typically involves food aversion and eating difficulties without the same concerns about body weight or a distorted body image.

Bulimia Nervosa is ruled out because the client does not exhibit behaviors such as binge eating followed by compensatory purging (e.g., vomiting, excessive exercise, or laxative use). Instead, the client is actively refusing food and experiencing anxiety around eating, which fits better with anorexia nervosa.

Binge Eating Disorder does not fit the client's behavior either, as this disorder is characterized by episodes of overeating without compensatory behaviors, and the client is not exhibiting such patterns. The client is avoiding food and struggling with restriction, which aligns with anorexia nervosa.

The client is at risk for developing transient tachypnea of the newborn andhypoglycemia.

Rationale

Target 1: Transient Tachypnea of the Newborn (TTN)

• Transient tachypnea of the newborn (TTN) is a condition characterized by rapid breathing (tachypnea) in the first few hours after birth, typically caused by delayed clearance of fetal lung fluid. It often resolves within 24-48 hours.
• The newborn in the exhibit has a respiratory rate that is increasing: at 64 minutes, the rate is 68/min, and it increases to 76/min by 0700. This is significantly higher than the normal respiratory rate for a newborn (30-60/min) and is a key sign of tachypnea.
• Given the increased respiratory rate and the newborn’s age, transient tachypnea of the newborn is a likely concern. This condition is particularly common in late preterm and full-term infants who experience some delay in clearing fetal lung fluid after birth.

Target 2: Hypoglycemia

• Hypoglycemia in newborns can occur due to several factors, such as increased metabolic demand (which could be indicated by the tachycardia and respiratory rate), poor feeding, or stress during delivery.
• Tachycardia is one of the early signs of hypoglycemia in newborns, as the body responds to low blood sugar by increasing the heart rate to compensate for the lack of energy.
• The heart rate is consistently high, with values of 154/min and 156/min during the assessment. This tachycardia could be indicative of hypoglycemia, as the body works harder to compensate for low glucose levels.

Rationale for other conditions;

Bronchopulmonary Syndrome:

This condition refers to lung diseases like bronchopulmonary dysplasia (BPD), which typically occurs in premature infants who have had prolonged mechanical ventilation. There are no signs of this condition in the current assessment, such as the need for respiratory support or signs of chronic lung disease.

The newborn's respiratory rate and tachycardia are more consistent with transient tachypnea rather than a chronic condition like bronchopulmonary syndrome.

Tachycardia:

Tachycardia itself is a symptom, not a diagnosis. The infant's tachycardia could be a response to hypoxia or hypoglycemia, so the condition causing the tachycardia needs to be addressed (which is hypoglycemia and transient tachypnea of the newborn).