Health Screening

APA format, paraphrase text using medical terminology.

What are some initial areas for concern? What screening tools can help lead you closer to your diagnosis?

Anorexia typically have low body weight, intense fear of gaining weight, and a body image disturbance. While more often detected in women, cases in young men may be underrepresented. Diagnosis requires a thorough history from the patient, and from family members and friends. Treatment is most successful if anorexia is caught early. Patients may represent with fatigue and weakness, which are specifically related to weight loss as is poor concentration. Fainting if often related to orthostatic hypotension and bradycardia. Initial areas for concern for a 16 year old patient with these complaints is lack of nutrients due to poor diet, self-esteem issues. Abnormal heart rate, low blood pressure due to lack of essential nutrients, reduction of bone density, muscle loss and weakness among other concerns. Screening tools that help the clinician lead closer to a diagnosis include eating disorder screening tool which is a short screening appropriate for patients older than 13 and can help determine if it’s time to seek professional help.

Diagnosis is clinical, though CBC, serum chemistry, thyroid function test, EKG and LFTs are typically ordered to assess severity and need for admittance to hospital. A CBC may show leukopenia, and serum chemistry may show hypokalemia, hypochloremia, elevated serum bicarb levels, or elevated BUN levels. Elevated BUN levels may indicate dehydration or can be an indication of kidney abnormalities.

Describe 1 health promotion strategy you can discuss with the patient.

Dietary assessment and guidance by a nutritionist is helpful to identify specific deficiencies and to create a healthy diet plan. Psychotherapy in conjunction to pharmacological therapy is also recommended. During acute refeeding and while weight gain is occurring it is beneficial to provide patients with individual psychotherapeutic management that is psychodynamically informed and provides empathic understanding, explanations, praise for positive efforts, coaching, support, encouragement and other positive behavioral reinforcement. For children and adolescents, evidence suggests that family treatment is an effective intervention. In most situations family therapy should be considered. SSRI initiation should also be part of the care plan, medications such as Prozac 20mg PO QD could help with symptoms of depression. The most common comorbidity in patients with anorexia nervosa is depression. Dietary potassium repletion is also recommended. Potassium chloride 40 mg PO QD should be ordered because hypokalemia is often the result of purging and or laxative abuse. As an outpatient, weekly weights should be gathered until safe weight is reached. Additionally serum CBC, liver and thyroid function test may be repeated if weight not improving and patient’s condition deteriorating. Monthly follow up visits should be considered. Referral to nutritionists and psychiatrist in addition to family practitioner to monitor physical and emotional progress.

Reference:

Jennings, K. M., & Phillips, K. E. (2017). Original Article: Eating Disorder Examination–Questionnaire (EDE–Q): Norms for Clinical Sample of Female Adolescents with Anorexia Nervosa. Archives Of Psychiatric Nursing, 31578-581. doi:10.1016/j.apnu.2017.08.002

Zaitsoff, S., Pullmer, R., Menna, R., & Geller, J. (2016). A qualitative analysis of aspects of treatment that adolescents with anorexia identify as helpful. Psychiatry Research, 238251-256. doi:10.1016/j.psychres.2016.02.045