Anorexia Clinical Reasoning Case Study Eating Disorder/Electrolyte Imbalances

Mandy White, 16 years old
Primary Concept
Fluid and Electrolyte Balance
Interrelated Concepts (In order of emphasis)
1. Acid-base
2. Nutrition
3. Perfusion
4. Coping
5. Mood and Affect
6. Clinical Judgment
RAPID Reasoning Case Study: STUDENT
Eating Disorder/Electrolyte Imbalances History
of Present Problem:
Mandy White is a 16-year-old adolescent who has struggled with anorexia nervosa since the age of 11. She admits to
drinking several large glasses of water daily. Mandy has also been recently engaging in self injurious behavior (SIB) of
cutting both forearms and thighs with broken glass, causing numerous lacerations and scars.
 Mandy presents to the emergency department (ED) with increasing weakness, lightheadedness and a near syncopal
episode this evening. She admits to inducing vomiting after meals the past three weeks. She is 5’ 5” and weighs 83
lbs/37.7 kg (BMI 13.8). Mandy is reluctantly brought in by her mother and does not want to be treated. As the primary
nurse responsible for the care of Mandy, you overhear her say to her mother, “I hate everything about me! I am so tired of
living, I wish I were dead!”
Personal/Social History:
Mandy was sexually abused by her stepfather from the age of six to twelve. She confided what was taking place to her
mother and lives with her mother, who is now divorced. Mandy is sexually active and promiscuous. She uses the Tinder
app to meet older men for anonymous sexual encounters when her mother is working.
What data from the histories are RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Drinks a lot of water
Injures herself
Low BMI
Complaints of increasing weakness,
lightheadedness, and syncopal episode
Inducing vomiting after meals
“I hate everything about me! I am so tired of
living. I wish I were dead!”
 Diluting her electrolytes since she is not replacing them back
Some teens find this as way of coping from anger and frustration and
can also cause infection. Nurse should seek psychiatrist for pt
Indication of anorexia and should understand how this disease affects
the pt emotionally and physically
This is probably due to dehydration, malnutrition deficient fluid volume,
electrolyte deficiency
Dangerous and she is depleting her electrolytes in the body
The pt is at risk for suicide and should be monitored carefully and free
from objects that she can use to harm herself
RELEVANT Data from Social History: Clinical Significance:
Has been sexually abused by stepfather from
age six to twelve
Pt is sexually active and promiscuous. Uses
tinder to meet older men for sexual
encounter when her mother is working
 This must have been a traumatic experience for her and may be a
reason for self-harm and inducing vomiting
 Pt is 16 years old and sleeping with multiple older men and this is risky
and can be a case