Case Scenario J.M., 23 years old, has

Case Scenario J.M., 23 years old, has been in the psychiatric unit for 1 week following her diagnosis of anorexia nervosa. J.M. presents with dry skin, is thin and pale, and complains of feeling cold. Height is 5’2″; Weight 86 pounds; Body Mass Index (BMI) 15.7; she recently is complaining of frequent headaches. Vital signs: T 36.4 C, P 122, R 17, BP 86/58 mmHg, SPo2 96 % on Room Air (RA) J.M. only drinks the juice and eats one quarter of her lunch or dinner tray. J.M. refuses to eat breakfast. J.M. has been involved in one-on-one counseling and psychotherapy with the initial goal of ‘creating a therapeutic relationship’ with her nurse counselor. J.M. continues to be highly defensive regarding questions about nutrition, weight, lifestyle, and her home situation. J.M. says: “Two years ago before my surgery I was about a hundred and thirty pounds, maybe a little more. I wasn’t happy then. When I lost the weight after the surgery, being thin was the only time I really got the sense that no one wanted to talk to me or even knew I existed. It’s not that being thin has made me happier, but at least people speak to me now. At least I am of some value.” J.M. reports that she lives with her father in a small two-bedroom apartment. The area they live in is considered a ‘lower-class community’. They have had to move about 4 or 5 times since she was a teenager because her dad has a hard time keeping a job and they often got evicted from their apartment. J.M. mentions that there were a few days where they would live in her father’s pick-up truck before they found a new place to stay. When you ask about friends, J.M. says that she isn’t really interested in having friends: “Making friends is a waste of time. Most of the time, girls treat you mean because you are not thin. Then when you become thin, different people like adults and co-workers or boys start to automatically try to boss you around and control you. You can’t win. No one is ever happy with anything. My dad is good though. I am lucky; He doesn’t bother me. He has an o.k. job now as a truck driver and is away a lot for many days. He works overtime to pay for my school.” Before blacking out at school, J.M. was in the medical office assistant program at a small community college run out of an office building near the shopping mall. “I am not a super student, but I was passing my courses. That’s the worst part of my situation right now, I am not even really sick and this whole ‘anorexia’ illness that everyone says I have, which is such a joke, is stopping me from going to school. If I don’t go back soon, my dad’s money on my school is wasted.” QUESTIONS::: A. With your knowledge of the nursing process, identify the key elements for J.M.’s care for: Assessment, Diagnosis, Planning, Implementation, Evaluation B. Use the RNAO BPG Summary: Strategies for Self-Management for Chronic Illness to help devise a plan and interventions for J.M. SCIENCE HEALTH SCIENCE NURSING NURSING 025

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