A nurse in the emergency department is receiving report on a group of clients. Which of the following clients should the nurse assess first?

A. Acetaminophen is a suitable option for pain relief in clients with a history of peptic ulcer because it does not typically irritate the gastric mucosa or increase the risk of gastrointestinal bleeding.
B. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of gastric ulceration and bleeding, especially in clients with a history of peptic ulcer.
C. Aspirin is also an NSAID and can increase the risk of gastric ulceration and bleeding, particularly in individuals with a history of peptic ulcer.
D. Ketorolac is an NSAID with a high risk of gastrointestinal side effects, including peptic ulceration and bleeding, and should be avoided in clients with a history of peptic ulcer.

Condition Most Likely Experiencing:

The client's admission to the behavioral health unit for prolonged weight loss and refusal to eat suggests a significant disordered eating pattern. The client's weight of 37.2 kg (82 lb) and BMI of 15 fall significantly below the healthy range for their height, indicating severe underweight status characteristic of anorexia nervosa. The client's behaviors during meal times, such as pushing food around the plate, eating only a small percentage of meals and snacks, and expressing anxiety about eating in front of others, are consistent with the restrictive eating patterns and fear of weight gain seen in anorexia nervosa.

Physical signs such as dry and flaky skin, dry and chapped lips, thin and dull hair, dry buccal mucosa, diminished bowel sounds, swollen and bloated abdomen, and lanugo (fine, downy hair) are commonly associated with anorexia nervosa due to malnutrition and starvation. The client's reported feelings of depression, initiation of dieting due to feeling fat compared to others, and cessation of menstrual cycles for the past 3 months are all indicative of the psychological and emotional distress often seen in individuals with anorexia nervosa.

Actions to take:

Clients with anorexia nervosa often benefit from a structured meal plan to promote regular eating habits and prevent skipping meals.

Focusing on the client’s underlying feelings of dysphoria and lack of control can help the client develop a more positive self-image and cope with emotional stressors that may trigger their eating disorder.

Parameters to monitor:

Monitoring weight is essential in assessing nutritional status and tracking changes in body composition, especially in clients with anorexia nervosa who may experience rapid weight loss.

Cardiac function with ECG can help the nurse detect any signs of cardiac arrhythmias, bradycardia, hypotension, or electrolyte imbalances that may result from severe malnutrition and dehydration.