NR 606 Week 6 Assignment; Case Study - Eating Disorders

Week 6: Case study Initial Post: Eating Disorders Dr. Morgan and Class, Case study Chief Complaint: Rebecca’s mother noticed some concerning symptoms, then ended up reading Rebecca’s diary which led to taking Rebecca to the Pediatrician. Rebecca was referred by her Pediatrician to the PMHNP. The symptoms are listed in the symptom section of the case study. Demographics: 14-year-old Caucasian Female Diagnosis: Bulimia Nervosa Symptoms: Symptoms have lasted 4 months Excessive eating in the evening for at least 2 hours 2-3 times a week, which includes hiding food in the room to eat Does not eat breakfast or lunch at school and home Excessive use of laxatives 2-3 times a week After excessively eating, Rebecca induces vomiting stating that she feels guilty for excessive eating. Rebecca has been jogging around the neighborhood twice a day since starting high school and three times a day on the weekend. Based on Rebecca’s diary, she binges and does inappropriate compensatory behaviors on average 2-3 times a week for the last 4 months. Medical History: Irregular menstrual cycles Poor dentition: discolored teeth, bleeding gums, and pain with eating extremely hot and cold food. Diarrhea initially, but now complains of constipation Complaints of frequent abdominal pain with no known precipitating factors The pediatrician obtained lab work showing electrolyte abnormalities and prescribed medications along with education about ways to prevent and correct electrolyte abnormalities. Educational History: Is currently in her first year of High school, which is the 9thgrade, and this is the first year that she must dress out for Physical Education in the locker room in front of other girls. Rebecca’s grades consist of A’s and B’s. Family History: No one in the home is noted to struggle with eating disorders, but the patient does have an adolescent cousin with binge-eating disorder. The patient has a close relationship with her cousin. The patient’s mother does have a history of substance use during pregnancy with the patient and Major Depressive Disorder. The mother reports that her depression has been stable for five years. Recommended Management Strategies Eating Disorder-Focused Family-Based Treatment: According to the American Psychiatric Association practice guidelines, if there is an adolescent with a caregiver who is involved in the patient’s care then the patient and caregiver can be treated with eating disorder-focused family- based treatment (Crone et al., 2023). This would be a recommended management strategy for Rebecca and her mother. Rebecca’s mother is willing to be actively involved in Rebecca’s care, and it is noted that Rebecca has a good relationship with her mom. Cognitive-Behavioral Therapy: It is ideal to use cognitive-behavioral therapy for bulimia nervosa (CBT-BN) specifically. CBT-BN is based on the cognitive- behavioral model of bulimia nervosa which essentially hypothesizes that the patient’s body shape and weight concerns along with the eating disorder behaviors create a continuous cycle which causes bulimia nervosa to maintain and difficult to treat (Hagan & Walsh, 2021). This is why the CBT- BN primarily focuses on cognitive restructuring for the body shape and weight perception,