Free Essay: Nursing Diagnosis of Anorexia Nervosa

• Nutritional imbalance depicted by low body mass index of about 17.5 compared to the normal adult BMI of 20-25 due to extensive use of laxatives and purging(Bhandari (2020)
• The disturbing appearance of the body due to being extremely underweight
• Inefficient coping that is associated with being unable to meet basic needs
• The health assessment priorities for anorexia nervosa are;
• Patient's history
• Mood and effect
• Self-concept
• Overall appearance as well as motor behavior

It is important to diagnose Anorexia nervosa at its earlier stages since it enhances the recovery process. The initial step in the diagnosis of anorexia is seeking an appointment with a doctor. When the patients present themselves to the physicians, they would want to rule out that the patient's weight loss is not a result of any other condition (Bhandari, 2020). When a physician supposes that a patient has anorexia nervosa, the patient is referred to a psychological health expert. The expert will evaluate the patient for anorexia by comparing the patient's condition to a set of criteria written in the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5) (Brazier, 2018). DSM-5 refers to a document that psychiatric experts use to enable them to diagnose psychological disorders (Brazier, 2018). The criteria for diagnosing anorexia include fear of weight gain and prohibited dieting. During the evaluation, the psychiatric expert would ask the patients their dieting behavior, feelings, and thoughts (Brazier, 2018). An anorexic has a distorted view of themselves and their condition. The psychiatric also checks for any other mental disorder. The mental health professional may also request the patient to fill a mental self-evaluation questionnaire. For individuals that do not meet the criteria of DMS-5, Other Specified Feeding and Eating Disorders might be used in diagnosis (Belleza, 2019). For Emily's case, she meets the criteria of DMS-5 as she starves herself, views herself as having a bad condition, and abhors adding weight.

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Evidence-based nursing intervention for anorexia nervosa would be dealing with the disturbing body image. The nurse may assist Emily to accept a much typical corporeal image. Such would include Emily accepting to weigh a bit more than she would want, to be well, and remain outside a health facility. The nurse could also assist Emily to recognize her personal strength that is non-food related since it will widen Emily's perception of herself. The other evidence-based intervention would be to identify emotions and develop a coping strategy (Belleza, 2019). The nurse can assist Emily to start recognizing emotions like anxiety or guilt by requesting them to explain their feelings while allowing enough time for response.

The laboratory work that would be used to give Emily medical diagnosis would be a complete blood count (CBC) and liver function test. In CBC the levels of hemoglobin are usually normal but are raised in cases of dehydration. The count of white blood cells is normally low because of high margination. Liver function test results are slightly high. The levels of proteins are usually high.

Nursing Diagnosis of Acute Abdomen

The nurse diagnosis for acute abdomen depends on the location and region of the pain, and include;

• Pain resulting from psychological, cultural, emotional, or spiritual distress
• Pain from medical challenges
• Resulting pain from invasive diagnostic procedures, and well as medical treatment and intervention
• Pain coming from trauma
• The health assessment priorities for acute abdomen include;
• Pain characteristics like quality, location, severity, onset, duration, initiating or relieving factors (Wayne, 2020)
• Symptoms and signs associated with the pain
• Cultural, interpersonal, environmental, or intrapsychic factors relating to the pain
• Patient's expectations of pain relief
• The willingness of the patient to explore different alternatives to relief pain
• Fitness of the patient to be PCA candidate

The evidence-based practice intervention for acute abdomen would be predicting the need for pain relievers. Any patient experiencing pain would prefer to relieve it first. Timely intervention for Mr. Sam would limit the overall amount of analgesics needed. Mr. Sam would then be allowed to get enough rest to stimulate relaxation, relief, and sleep. A person's experience of pain might be exacerbated by tiredness, and therefore, providing enough resting periods might help relieve it (Wayne, 2020). Mr. Sam should then be given nonopioid analgesics on time unless directed otherwise. Nonopioid analgesics work in peripheral tissues, and some inhibit the production of prostaglandins. Nonopioid analgesic is effective for mild to moderate pain. The other evidence-based based intervention is the administration of opioid analgesics that is effective for severe pain. This can be given either by the oral or intravenous route, systemically by the PCA system, and epidurally. The intermuscular injection is intermittently absorbed (Wayne, 2020).

The laboratory tests for acute abdomen would constitute both blood tests and imaging. The first laboratory tests would be a urine dipstick to check for signs of haematuria or infection. Routine blood tests then follow, and they include complete blood count, liver function, and amylase tests. Where pancreatitis is suspected, serum calcium is measured (Mayumi et al., 2016). Blood cultures are done when infections are considered a likely diagnosis. It worth noting that amylase found to be three times higher than the upper limit indicates a diagnosis for pancreatitis. An increased value smaller than this might be a result of a different condition like perforated bowel, diabetic ketoacidosis, or ectopic pregnancy.

Within any emergency environment, each patient presenting with abdominal pain is subjected to an electrocardiogram to disqualify myocardial infarction. When renal tract infection is suspected, an ultrasound is done on the kidney, bladder, and ureters. Additionally, an ultrasound is done on the biliary tree and liver if the doctor suspects gallstone illness. For tubo-ovarian infection, an ultrasound is performed on the uterus, fallopian tubes as well as ovaries. Erect chest X-ray (eCXR) is done when there is proof of bowel perforation (Mayumi et al., 2016). CT imaging is done under the guidance of a seasoned physician when underlying factors like an inter-abdominal abscess, acute appendicitis, and acute diverticulitis are suspected (TeachMe Surgery, 2019). Conversely, magnetic resonance imaging is sought when there is pain in the lower quadrants, suprapubic region, and pelvis region, and when the pain is not localized. A multislice CT scan would be more important for Mr. Sam since it is straightforward and wastes no time. The scan will show exactly the location of the intestines that have been blocked and the kind of material blocking that particular location.

References

Belleza, M. (2019, Dec 12). Eating Disorders: Anorexia & Bulimia Nervosa. https://nurseslabs.com/eating-disorders-anorexia-bulimia-nervosa/

Bhandari, S. (2020, Jul 20). Anorexia nervosa. WebMD. https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/mental-health-anorexia-nervosa

Brazier, Y. (2018, Jan 19). Anorexia nervosa: What you need to know. Medical News Today. https://www.medicalnewstoday.com/articles/267432#treatment-and-recovery

Mayumi, T., Yoshida, M., Tazuma, S., Furukawa, A., Nishii, O., Shigematsu, K. & Maeda, S. (2016). The practice guidelines for primary care of acute abdomen 2015. Japanese Journal of Radiology, 34(1), 80-115. doi: 10.1007/s11604-015-0489-z

TeachMe Surgery. (2019). The acute abdomen. https://teachmesurgery.com/general/presentations/acute-abdomen/

Wayne, G. (2020, Apr 30). Acute Pain. https://nurseslabs.com/acute-pain/