PRAC 6665: PMHNP Care A cross the Lifespan I Essay

PRAC 6665: PMHNP Care A cross the Lifespan I Essay

Week  : Bulimia Nervosa

  Patient Details:

Emma Austen; Age 17 years; Female:Native American

Subjective:

CC (chief complaint): “I can’t stop eating a lot at night and making myself throw up. I want to stop, but I’m afraid I’ll gain weight if I do.”

HPI: E.A., a 17-year-old Native American female, presented with concerns about her eating behavior and body image. Emma reports experiencing difficulties with her body image in sixth grade. She binge eats snacks and candies to cope when angry, sad, or afraid. She described instances where she would consume large amounts of food late at night and then induce vomiting to control her weight. These episodes occur four nights a week, especially during stressful academic events or interpersonal conflicts. Despite having a BMI within the normal range, Emma is deeply concerned about gaining weight. She strongly desires to stop engaging in these binge eating and purging behaviors but is afraid that doing so will result in weight gain. This fear has started affecting her daily life and mental well-being, causing significant distress. The onset of early puberty, combined with classmate teasing, has negatively impacted Emma’s self-esteem.

Her parents divorced when she turned 15, which heightened her anxiety and led to mild depressive symptoms. Emma uses her eating habits as a source of emotional comfort, temporarily relieving her distress. Living with her mother poses difficulty for Emma to maintain these eating patterns without being noticed. Additionally, she mentioned having only a few friends and often isolating herself due to feelings of low self-esteem.

Substance Current Use:  Emma denies using any nicotine, illegal drugs, or alcohol currently or in the past. She occasionally consumes caffeine through sodas but does not experience any withdrawal symptoms when she does not have it.

Medical History:

• Current Medications: Currently, Emma is not taking any prescribed medications, over-the-counter medicines, or homeopathic remedies.
• Allergies: Emma has no known allergies to medications, foods, or environmental factors.
• Reproductive Hx: Emma experienced an early onset of menstruation compared to her peers. However, she reports having regular periods. Her last menstrual period occurred around 28 days ago. She is not pregnant or nursing, and contraceptive use or sexual activity was not explored.

ROS:

• GENERAL: Thepatient does not experience any weight loss, fever, body weakness, or fatigue.
• HEENT:
  • Head:  No reported headaches or head injuries.
  • Eyes: Thepatient had not noticed any vision changes.
  • Ears: No hearing loss was observed or reportedby the patient.
  • Nose:  Noreports of a runny nose or
  • Throat: The patient does not havedifficulties with
• SKIN: No rash oritching
• CARDIOVASCULAR: No palpitations or shortness of breath
• RESPIRATORY: No coughing or difficulty breathing
• GASTROINTESTINAL: Regular episodes of overeating followed by self-induced vomiting. No abdominal pain or blood.
• GENITOURINARY: Nopainful urination was experienced.
• NEUROLOGICAL: Denies symptoms like lack of coordination/muscle control, weakness/extreme fatigue causing fainting spells, dizziness/loss of balance sensation/tinnitus, or limb tingling sensations—regular bowel movements.
• MUSCULOSKELETAL: Freefrom stiffness/discomfort in joints/bones and has not experienced fractures/back pain/muscular soreness.
• HEMATOLOGIC: Doesnot exhibit bruising/bleeding tendencies
• LYMPHATICS: No swollenlymph nodes were reported.
• PSYCHIATRIC: No history/experiencewith depression/anxiety disorders
• ENDOCRINOLOGIC: No signs/symptoms associated with excessive sweating/cold/hot intolerance. No polyuria or polydipsia.

Objective:

General Examination: The patient presents with a generally favorable state of health and maintains a typical body weight. There are no apparent indications of physical discomfort or distress. Furthermore, the condition of her skin, hair, and nails does not exhibit any recognizable signs indicative of inadequate nutrition.

Vital Signs: Blood Pressure: 115/75 mmHg, Pulse: 80 beats/min, regular, Temperature: 98.2 F (36.8 C), Respiratory Rate: 16 breaths/min, BMI: 21 kg/m2 (within normal range)

Diagnostic results:

Assessment:

Mental Status Examination: Emma, a 17-year-old Native American girl, appears her stated age and appropriately cooperates with the examiner. Her appearance is tidy and well-groomed, with no abnormal motor activity observed. She communicates clearly and coherently at an average volume and tone when speaking. Emma’s thought processes appear focused on achieving goals and are logical. Her mood reflects anxiety, while her affect aligns with her current emotional state. She expresses significant concern regarding body weight and image, fearing weight gain even though she falls within a healthy weight range. No signs of auditory or visual hallucinations or delusional thinking are apparent during the examination. Emma demonstrates insight into her condition by expressing a desire to cease unhealthy eating habits related to self-image concerns.

Furthermore, her cognition remains intact, evidenced by alertness and orientation to time, place, and person throughout the assessment. Recent and remote memory functions adequately for Emma without any noticeable deficits reported; similarly, she exhibits good concentration levels during testing procedures. Importantly, Emma does not express any present suicidal or homicidal ideation. Besides her body image and eating habits, she seems to retain sound judgment in other aspects of her life.

Diagnostic Impression:

Bulimia Nervosa F50.2

Based on Emma’s clinical presentation and medical history, the primary consideration for diagnosis is Bulimia Nervosa. Bulimia nervosa is characterized by episodes of binge eating followed by compensatory behaviors aimed at weight control, which can have severe consequences (Mohajan & Mohajan, 2023). This conclusion is supported by Emma’s frequent episodes of binge eating, her use of self-induced vomiting as a form of compensatory behavior, and her intense fear of gaining weight despite having an average body weight. According to Chan et al. (2021), these symptoms align with the diagnostic criteria outlined in DSM-V for Bulimia Nervosa, which include recurrent episodes of binge eating, regular inappropriate compensatory behaviors to prevent weight gain, and an excessive influence on body shape and weight when evaluating oneself.

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Anorexia Nervosa F50.02

Emma’s behavior displays some attributes consistent with anorexia nervosa, such as her intense fear of weight gain and distorted body image. Anorexia nervosa is a condition where a person restricts their food intake, leading to a significantly low body weight. People with this eating disorder often have a distorted perception of their body, a fear of gaining weight, and struggle to comprehend the seriousness of their illness fully (Mahr et al., 2022). However, Emma does not have anorexia nervosa because her BMI is within the normal range, and she is not underweight. Additionally, although she does participate in unhealthy eating habits such as binge eating and compensatory behaviors to avoid gaining weight, these actions do not match the main characteristic of anorexia nervosa, which is consistent food restriction. Based on the information provided, we can conclude that Emma does not meet the criteria for a diagnosis of anorexia nervosa.

Binge Eating Disorder F50.8

Binge Eating Disorder is typified by repetitive consumption of a notably more significant amount of food within a short span than most individuals would eat under similar circumstances (Agüera et al., 2020). These episodes are accompanied by feelings of being unable to control one’s eating behavior. Although Emma does experience episodes of binge eating, the crucial distinction that excludes this diagnosis is her compensatory action – self-induced vomiting. This behavior is not symbolic of Binge Eating Disorder since it lacks the habitual employment of compensatory behaviors to prevent weight gain, commonly observed in bulimia nervosa.

Reflections:

This case serves as a reminder of the significance of considering physical symptoms and psychological and behavioral factors when evaluating a patient’s condition. In future cases like Emma’s, I would focus on further exploring her social connections and support systems due to the potential worsening of eating disorder symptoms caused by social isolation, ensuring that Emma feels heard and supported ethically while respecting her autonomy (Kim, 2023). Conversations about her diagnosis and treatment options must be age-appropriate and sensitive to her cultural background as a Native American individual. Furthermore, considering Emma’s age and possible vulnerability raises concerns about confidentiality, obtaining consent for treatment, and potentially involving child protective services if there are worries regarding her safety. To ensure a comprehensive evaluation, it is crucial to investigate any potential financial or socio-economic obstacles that may hinder access to treatment. Additionally, understanding the impact of cultural background on her body image concerns and eating behaviors is essential. It is imperative to assess whether socio-economic circumstances or cultural factors could influence her perception of her weight and shape and contribute to disordered eating patterns.

Case Formulation and Treatment Plan:

Emma displays symptoms indicative of Bulimia Nervosa, including body image issues, a fear of gaining weight and engaging in episodes of binge eating followed by purging behaviors. The treatment plan will focus on various interventions to address these concerns and improve her overall mental well-being. During our discussion with Emma, we thoroughly explained the benefits and risks associated with psychotherapy and any potential medication options. Emma must be aware of possible side effects from medications, such as how they may interact with other drugs or pose risks in case of pregnancy. We stressed the importance of not abruptly discontinuing any medicine without consulting her healthcare providers and promptly reporting any adverse reactions experienced. In addition, we pointed out how drug and alcohol use can harm mental and physical health, underscoring the importance of abstaining from them.

Psychotherapy: When it comes to treatment, the usual suggestion for people with Bulimia Nervosa is to start with Cognitive-behavioral therapy as the first type of psychotherapy. CBT aims to assist patients like Emma in developing healthier eating habits, managing stress effectively, and improving their body image and self-esteem (Moore & Waller, 2023).

Pharmacotherapy: Medication options such as selective serotonin reuptake inhibitors can also be considered (Edinoff et al., 2021). However, the decision to pursue pharmacotherapy should be based on factors such as Emma’s progress in therapy, her personal preferences, and a comprehensive discussion about potential benefits and risks.

Referrals: A multidisciplinary approach may involve referrals to a registered dietitian for nutritional counseling and evaluation by a psychiatrist for medication assessment alongside ongoing therapy.

Education: Emma received comprehensive information about Bulimia Nervosa and its effects on both physical and mental well-being. This involved discussing the importance of maintaining healthy eating habits, implementing effective strategies to manage stress, and recognizing the benefits of regular exercise for overall health (Jain & Yilanli, 2020). Emma was encouraged to continue attending school activities and engaging in social interactions to enhance her self-esteem and improve her psychological state.

Follow-up: Regular follow-up appointments are scheduled to closely monitor Emma’s progress, modify treatment plans if necessary, and ensure that her physical condition remains stable throughout recovery. Diagnostic examinations, including blood tests, may be periodically ordered to assess Emma’s general health status due to potential physiological consequences associated with Bulimia Nervosa. Emma was informed about available services she could contact or instructed to visit the nearest ER should she ever experience a crisis. A sufficient amount of time was allocated for inquiries and responses, during which Emma comprehended the discussions. She agreed with the proposed course of treatment and was willing to embark on her path toward recovery.

PRECEPTOR VERIFICATION:

I confirm that the patient used for this assignment is a patient that was seen and managed by the student at their Meditrek-approved clinical site during this quarter’s course of learning.

 

Preceptor signature: ________________________________________________________

 

Date: ________________________

 

References

Agüera, Z., Lozano-Madrid, M., Mallorquí-Bagué, N., Jiménez-Murcia, S., Menchón, J. M., & Fernández-Aranda, F. (2020). A review of binge eating disorder and obesity. Neuropsychiatrie, 35(2). https://doi.org/10.1007/s40211-020-00346-w

Chan, M. F., Al Balushi, R., Al Falahi, M., Mahadevan, S., Al Saadoon, M., & Al-Adawi, S. (2021). Child and adolescent mental health disorders in the GCC: A systematic review and meta-analysis. International Journal of Pediatrics and Adolescent Medicine, 8(3), 134–145. https://doi.org/10.1016/j.ijpam.2021.04.002

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038

Jain, A., & Yilanli, M. (2020). Bulimia nervosa. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562178/

Kim, M. (2023). Effects of a comprehensive person-centered care education program for nursing students. Medicina, 59(3), 463. https://doi.org/10.3390/medicina59030463

Mahr, F., Bunce, S. C., Meyer, R. E., & Halmi, K. A. (2022). Affect modulated startle response in anorexia nervosa, restricting type: Implications for theory and practice. Cureus. https://doi.org/10.7759/cureus.27304

Mohajan, D., & Mohajan, H. K. (2023). Bulimia nervosa: A psychiatric problem of disorder. Innovation in Science and Technology, 2(3), 26–32. https://www.paradigmpress.org/ist/article/view/582

Moore, E., & Waller, G. (2023). Brief group cognitive‐behavioral therapy for bulimia nervosa and binge‐eating disorder: A pilot study of feasibility and acceptability. International Journal of Eating Disorders. https://doi.org/10.1002/eat.23935

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Select a child or adolescent patient that you examined during the last 3 weeks who presented with a disorder for which you have not already created a Focused SOAP Note in Weeks 3 or 7. (For instance, if you selected a patient with anorexia nervosa in Week 7, you must choose a patient with another type of disorder for this week – previously used alcohol abuse disorder and anxiety)

Create a Focused SOAP Note on this patient using the template provided.

Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.