J.M.'s eCG results show normal sinus rhythm with no stsegment or other changes. you meet with J.M. ...

The answer to question 1   Refer to a registered dietitian (RD) for medical nutrition therapy. Calories should start at basal
needs of 300 to 400 kcal/day, and the diet should be referred to as low calorie.Gradually increase to
1200 kcal/day or more.
 Sit with the patient during mealtimes; don't prompt to eat. Normal conversation can help increase
appetite.
 Discuss food choices.
 Weigh each morning after voiding, in hospital gown with the patient's back to the scale.

 The initial focus is on stabilizing her physical condition and immediately addressing any acute
psychiatric symptoms, such as suicidal ideations.
 Approach the patient calmly and in a matter-of-fact manner.
 Reward for weight gain.
 Discuss minimal weight gain weekly that is acceptable to the patient.
 Encourage patient to set realistic and attainable goals for weight.
 Go over laboratory values with patient and importance of normality.
 Discuss with patient the willingness to work on self-esteem and body distortion issues.
 Discuss the importance of physical activity but that limitations are necessary.
 Remain nonjudgmental.
 Work on assertiveness skills with the patient.
 Encourage patient to participate in the treatment plan.
 Encourage participation in group therapy.
 Provide individual therapy after discharge.
 Praise successes and give immediate positive feedback, focusing on health promotion and
wellness. Often, patient privileges are linked to weight gain and adherence to the treatment plan.
 Monitor all trips to the bathroom, especially after eating, to prevent self-induced vomiting.

The answer to question 2  None of her laboratory values is dangerously low. However, the low Hgb and Hct may reflect a
deficiency in protein and iron. The potassium level is slightly lower than normal and should be
watched carefully.

 Malnutrition has long-term implications for disease and poor health.
 ECG changes could be life-threatening.
 Electrolyte imbalances need to be corrected, especially decreased K, Na, Cl, and Mg.
 Fluid balance needs to be corrected, and the patient might need to be treated for kidney damage
or failure.

The answer to question 3   Restriction of energy intake relative to requirements leading to a significantly low body weight in
the context of age, sex, developmental trajectory, and physical health
 Intense fear of gaining weight or becoming fat, even though underweight
 Disturbance in the way in which one's body weight or shape is experienced, undue influence of
body weight or shape on self-evaluation, or denial of the seriousness of the current low body
weight

 Emaciated and malnourished appearance
 Hypotension (She has been blacking out, which can indicate hypotension. No vital signs were
provided, but students might star this item.)
 Dysrhythmias, bradycardia
 Pale conjunctivae and mucous membranes
 Poor skin turgor and muscle tone
 Peripheral edema
 Excessive hair loss and dryness
 Cold extremities
 Lanugo
 Yellow skin
 Amenorrhea
 Headaches, sore throat, vague physical complaints
 Chronic urinary tract infections
 Constipation
 Memory deficits
 Fatigue
 Insomnia
 Depressed immune system
 Obese or overweight person: electrolyte imbalance, hypothermia, weight loss of more than 2
pounds per week, perception of being obese despite weight loss

 Major depression
 Posttraumatic stress disorder (PTSD) or other anxiety disorders
 Bulimia nervosa
 Obsessive-compulsive disorder (OCD)
 Eating disorders not otherwise specified
 Binge-eating disorder
 Cardiac dysrhythmias

 Anorexia nervosa is refusal to maintain body weight at a minimum level for age and height or
failure to gain weight during a period of growth, resulting in body weight less than 85 of what
is expected. The person has an intense fear of gaining weight or becoming fat, even though the
person is underweight. The person may have a persistent inability to recognize the seriousness
of the very low body weight and extreme weight loss. Some types of anorexia nervosa involve
periods of binging and purging behaviors.
 Bulimia is characterized by recurrent periods of binge eating and recurrent, inappropriate
behaviors to prevent weight gain (such as self-induced vomiting; use of laxatives, enemas, and
diuretics to lose weight; fasting; or excessive exercise). This cycle occurs, on average, at least once a
week for 3 months.

 Excessive daily exercise
 Binging and purging
 Intense food rituals
 Use of diuretics
 Laxative or enema abuse
 Denial
 Wearing loose clothing
 Withdrawal from social activities

 Middle- or upper-class background
 Passive father and dominant mother
 Expectations of perfection
 Overly dependent child
 Vague personal boundaries
 People pleasers
 High academic standards
 Sexual abuse

The answer to question 4  He is having a hallucination. Hallucinations involve perceiving a sensory experience for which there
is no external stimulus (he sees a bird over his bed and hears it talking to him). A delusion is a false
belief that a person thinks is true even with evidence to the contrary. For example, a person sees a
bed and becomes fearful because he believes it is his coffin.

Answer: a, c, d
Keep a calm demeanor and stay with the patient. If you do not understand what R.B. is saying, you
need to let him know. It is important to be gentle but clear. Tell R.B. that you are not understanding
him, and that you would like to be able to understand him. It is important not to negate what R.B. is
experiencing, yet you need to offer what you perceive. Tell him, I do not see a bird over your bed,
but I can understand how that would be upsetting to you. Do not argue with the patient. Notify the
physician if his behavior becomes aggressive.

The answer to question 5  Answers: b, c, f
Common side effects include drowsiness, agitation, insomnia, headache, dry mouth, and
weight gain.

that's the expression my face made when I got the notification email

glad I put that smile on your face