You are a nurse caring for 16-year-old Jonathan Collins. He was admitted to the emergency department after passing out during gym class. During your admission assessment, he admits he has not been eating much and exercising more to lose
weight. Based on this information, your prior knowledge of this client (refer to medical card from
the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of anorexia and fluid and electrolyte imbalances, respond to the following prompts:
• Thoroughly explain the pathophysiology of anorexia. Use a scholarly or authoritative source to support your answer.
• Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
o cultural
o financial
o environmental implications
• Identify 3-5 priority nursing interventions for the client while in the emergency department.
• Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
• What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.

SOLUTION – 16-year-old Jonathan Collins admitted to the emergency department after passing out during gym class

Pathophysiology of Anorexia:

Anorexia nervosa is a complex psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and persistent restriction of energy intake leading to significantly low body weight. The pathophysiology of anorexia involves various biological, psychological, and sociocultural factors.

1. Biological Factors: Biological predispositions, such as genetic susceptibility, neurochemical imbalances (e.g., dysregulation of serotonin, dopamine, and norepinephrine), and alterations in hypothalamic-pituitary-adrenal (HPA) axis function, contribute to the development of anorexia nervosa (Kaye et al., 2013). Genetic studies have identified potential genetic variants associated with an increased risk of anorexia, implicating abnormalities in neural circuits involved in appetite regulation, reward processing, and emotional regulation (Frank et al., 2020).
2. Psychological Factors: Psychological factors, including low self-esteem, perfectionism, body dissatisfaction, anxiety, and mood disorders, play a crucial role in the development and maintenance of anorexia nervosa. Individuals with anorexia often exhibit obsessive-compulsive tendencies, rigid thinking patterns, and an excessive focus on food, weight, and body image, which perpetuate disordered eating behaviors (Treasure et al., 2015).
3. Sociocultural Factors: Sociocultural influences, such as societal pressures for thinness, media portrayal of idealized body images, and cultural norms valuing thinness and equating it with attractiveness and success, contribute to the development of anorexia nervosa, particularly in Western societies (Smolak & Levine, 2017). Cultural emphasis on dieting, weight control, and fitness ideals may exacerbate body dissatisfaction and drive disordered eating behaviors among vulnerable individuals.

Cultural Implications:

• Cultures that prioritize thinness as an ideal body image may increase the risk of developing anorexia nervosa, especially among adolescents and young adults (Pike & Dunne, 2015).
• Cultural factors influence help-seeking behaviors, treatment preferences, and attitudes toward mental health and eating disorders, which may affect access to care and treatment outcomes (Becker et al., 2010).

Financial Implications:

• The financial burden of anorexia nervosa includes expenses related to medical treatment, psychotherapy, nutritional counseling, and hospitalization, as well as indirect costs associated with reduced productivity, disability, and long-term healthcare needs (Mangweth-Matzek et al., 2016).
• Families may face financial strain due to out-of-pocket expenses for specialized treatment programs, medications, and supportive services, particularly in cases where insurance coverage is limited or inadequate (Wade et al., 2009).

Environmental Implications:

• Environmental factors, such as peer influences, family dynamics, and social stressors, can contribute to the onset and exacerbation of anorexia nervosa symptoms (Herpertz-Dahlmann et al., 2015).
• Societal emphasis on appearance, dieting trends, and weight-related stigma may create a toxic environment that reinforces disordered eating behaviors and perpetuates the cycle of anorexia nervosa (Holland & Tiggemann, 2016).

Priority Nursing Interventions:

1. Assessment and Monitoring: Conduct a comprehensive physical and psychological assessment, including vital signs, nutritional status, electrolyte levels, and mental health status, to identify medical complications and assess the severity of malnutrition and dehydration.
2. Fluid and Electrolyte Management: Administer intravenous fluids and electrolyte replacement therapy to correct dehydration, electrolyte imbalances (e.g., hypokalemia, hyponatremia), and metabolic disturbances associated with anorexia nervosa (Golden et al., 2015).
3. Nutritional Support: Collaborate with a registered dietitian to develop a tailored meal plan and provide nutritional counseling to gradually restore weight, address nutrient deficiencies, and promote healthy eating behaviors while respecting the client’s autonomy and preferences (Le Grange et al., 2016).
4. Psychosocial Support: Engage the client in supportive counseling, cognitive-behavioral therapy (CBT), and motivational interviewing to address underlying psychological issues, improve body image, enhance coping skills, and facilitate insight and motivation for treatment (Hay et al., 2018).
5. Safety Monitoring: Implement suicide precautions and closely monitor the client for suicidal ideation, self-harm behaviors, and medical complications (e.g., cardiac arrhythmias, electrolyte disturbances) that may necessitate emergent intervention or psychiatric hospitalization (Arcelus et al., 2011).

Labs and Diagnostic Testing:

• Complete Blood Count (CBC): To assess for anemia, leukopenia, and thrombocytopenia secondary to malnutrition and bone marrow suppression.
• Comprehensive Metabolic Panel (CMP): To evaluate electrolyte imbalances (e.g., hypokalemia, hyponatremia), liver function, renal function, and glucose levels.
• Electrocardiogram (ECG): To monitor for cardiac arrhythmias (e.g., bradycardia, prolonged QT interval) and other electrocardiographic abnormalities associated with anorexia nervosa (Nakazato et al., 2019).
• Bone Mineral Density (BMD) Testing: To assess for osteopenia or osteoporosis secondary to nutritional deficiencies and hormonal imbalances, which are common complications of anorexia nervosa (Fazeli et al., 2017).

Interdisciplinary Team Members:

1. Psychiatrist/Psychologist: Provides psychiatric evaluation, diagnosis, and psychotherapy for addressing underlying psychological issues and promoting mental health recovery (Zipfel et al., 2015).
2. Registered Dietitian/Nutritionist: Offers nutritional assessment, counseling, and meal planning to optimize nutritional intake, correct nutrient deficiencies, and restore weight in a safe and effective manner (Golden et al., 2015).
3. Primary Care Physician/Internal Medicine Specialist: Coordinates medical management, monitors physical health status, and addresses medical complications associated with anorexia nervosa, such as cardiac abnormalities, gastrointestinal dysfunction, and endocrine disturbances (American Psychiatric Association, 2013).
4. Social Worker/Clinical Case Manager: Provides social support, advocacy, and assistance with navigating healthcare systems, accessing community resources, and addressing psychosocial stressors that may