A nurse is caring for a client who has anorexia nervosa.

The client was admitted for medical stabilization due to a deteriorating condition that requires supervised refeeding. The client's weight is currently at 73% of ideal body weight.

Exhibits

Select the three findings that require immediate follow-up:

: The correct answer/s is Choice/s.

Choice A rationale: Phosphate level is a crucial indicator of the body’s electrolyte balance. In patients with anorexia nervosa, phosphate levels can be significantly affected due to malnutrition and the body’s metabolic response to starvation. Low phosphate levels, known as hypophosphatemia, can lead to serious complications such as muscle weakness, neurological dysfunction, and potentially life-threatening cardiac issues.

Choice B rationale: Capillary refill is a quick test performed on a patient to assess the adequacy of peripheral circulation. The time taken for color to return to an external capillary bed after pressure has been applied to cause blanching signifies the status of the patient’s peripheral blood circulation. Delayed capillary refill time may indicate shock or dehydration, which could be a concern in a patient with anorexia nervosa who may be dehydrated or malnourished.

Choice C rationale: Sodium level is another important electrolyte that needs to be monitored. Patients with anorexia nervosa can have abnormal sodium levels due to various factors such as vomiting, use of diuretics, or not consuming enough dietary sodium. Both high sodium (hypernatremia) and low sodium (hyponatremia) levels can lead to severe neurological symptoms and are considered medical emergencies.

Choice D rationale: Magnesium level is also an important consideration in patients with anorexia nervosa. Low magnesium levels, or hypomagnesemia, can occur due to inadequate dietary intake or excessive loss from the gastrointestinal tract, which can be seen in conditions like anorexia nervosa. Hypomagnesemia can lead to symptoms such as muscle cramps, seizures, and even cardiac arrhythmias.

Choice E rationale: Glucose level is a key indicator of a person’s metabolic state and energy balance. In patients with anorexia nervosa, glucose levels can be low due to inadequate food intake. Hypoglycemia, or low blood sugar, can lead to symptoms such as weakness, tremors, confusion, and in severe cases, it can be life-threatening.

Choice A rationale:

It is not accurate to state that the provider is required to notify the client's family of their admission. While providers may often choose to involve family members in the care of a client with MDD, this is not a mandatory requirement for voluntary admission.

Disclosing a client's admission without their consent could breach confidentiality and potentially damage trust between the client and healthcare team.

It's essential to respect the client's privacy and autonomy, and to obtain their permission before sharing any information with family members.

Choice C rationale:

It is incorrect to state that a client gives up their right to refuse psychotropic medications upon voluntary admission. Informed consent remains a crucial principle even in an acute mental health setting.

Clients have the right to decline medications or other treatments, even if healthcare providers believe those interventions would be beneficial.

It's important to engage in a collaborative discussion with the client, provide education about treatment options, and respect their decisions.

Choice D rationale:

It is misleading to suggest that a client cannot leave the facility until the provider completes a discharge summary and authorizes discharge.

While providers play a significant role in discharge planning, clients ultimately have the right to request discharge from voluntary admission, even if the provider does not fully agree with the decision.

Providers may need to initiate involuntary commitment procedures if a client poses a serious risk to themselves or others, but this is a separate process with specific legal requirements.

Choice B is the most accurate statement because it emphasizes the importance of informed consent throughout the treatment process. Even in a voluntary admission, clients retain their right to make decisions about their care and to be fully informed about the risks and benefits of any proposed treatments.