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
© 2016 Keith Rischer/www.KeithRN.com
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:
1. Admits to several large glasses of H20
2. Engaging in SIB
3. Increasing weakness, lightheadedness,
syncope
4. Admits to vomiting after meals
5. BMI of 13.8
6. Reluctantly brough to ER by mother
7. “I hate everything about me! I am so
tired of living, I wish I were dead!”
Clinical Significance:
1. Risk for fluid overload
2. Unhealthy/harmful coping mechanisms
3. Signs and symptoms of illness or malnutrition
4. Sign of eating disorder
5. Normal BMI is 18-24, another sign of an eating disorder
6. At risk for leaking or signing out AMA
7. At risk for suicidal behavior