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Adime Note Allison 2

The patient has a history of disordered eating behaviors including binge eating large amounts of food followed by purging 4-7 times per day. She has experienced weight fluctuations between 105-130 pounds and reports feelings of loss of control around food. A diagnosis of disordered eating related to harmful beliefs about food and body image was made. The intervention plan focuses on nutrition education, collaboration with other providers, skill development to eliminate purging, nutrition counseling using motivational interviewing, and self-monitoring through food journaling with a goal of stopping binge/purging behaviors. Progress will be monitored by reviewing the patient's food journal for purging episodes.

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896 views3 pages

Adime Note Allison 2

The patient has a history of disordered eating behaviors including binge eating large amounts of food followed by purging 4-7 times per day. She has experienced weight fluctuations between 105-130 pounds and reports feelings of loss of control around food. A diagnosis of disordered eating related to harmful beliefs about food and body image was made. The intervention plan focuses on nutrition education, collaboration with other providers, skill development to eliminate purging, nutrition counseling using motivational interviewing, and self-monitoring through food journaling with a goal of stopping binge/purging behaviors. Progress will be monitored by reviewing the patient's food journal for purging episodes.

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ADIME Note: Case Study 4 Allison

ASSESSMENT

Food/Nutrition Food Recall​:


Related Hx Breakfast: Cinnamon Toast Crunch (purged)
Lunch: 2 sliders, 6 boneless wings, bowl of soup (purged)
Dinner: 4 slices of pizza (purged)
Snacks 1: peppermint bark (purged)
Snack 2: bag of chips (purged)
Snack 3: 3 granola bar (purged)
Fluids: water and Sprite throughout the day

The patient stated when she eats meals she will eat a lot and then purge
(4-7X/day). Her safe foods are smoothies, fruits and drinks in general. The patient
only drinks Deer Park water and Vitamin Water brands. The patient stated that she
feels a total loss of control when eating, purchases her own food and stores it in her
room. The patient has a history of restricting and counting calories.

Medications​:
Rx birth control, ethinyl estradiol-norgestimate and medroxyprogesterone.
Hx amphetamines abuse for weight loss.
Physical activity​:
Low intensity cheerleading 2 hr. 2x/week.

Anthropometric Ht: 155.9 cm


Measures Wt: 1.4 kg
BMI: 21.1
IBW: 48.5 kg
Weight fluctuations: 47.7-59 kg (105-130lb)

Caloric needs​: TEE = 1250 kcals x 1.3 AF = 1650 kcals

Biochemical No labs were provided at this time.


NFPF The patient experiences frequent constipation, nausea, and vomiting. She has
thinning of hair, cold intolerance, dizziness, bruising, fatigue, reflux, and difficulty
falling and staying asleep. The patient feels out of control of her emotions and has
an intolerable mood.

Client Hx The patient is a sophomore in college studying biochemistry. She lives with her
maternal grandparents, mother and brother. The patient has a family history of
bipolar, anxiety, and maternal grandparents with suspected eating disorders. The
patient has a past medical history of GERD and depression. She has a history of
cutting and some obsessive tendencies. The patient has a history of physical abuse
in elementary school by her stepfather. She reported a suicide attempt in 2013, and
has no suicidal ideation currently. The patient stated that she struggles with body
image and does body checking, body comparisons, and weighs self frequently.
DIAGNOSIS
Disordered eating pattern​ related to harmful beliefs about food and/or body image as evidenced by weight fluctuations (105 – 130lb), fatigue,
dizziness, cold intolerance, hair thinning, easy bruising and a stated feeling of loss of control when eating.
INTERVENTION
1. Nutrition Education
● Review the effect of purging on general health and related health risks (dehydration, and electrolyte imbalance).
● Meal plan: educate on what and “item” is and what are the main food groups.
2. Collaboration of Care
● Collaborate with other providers (eating disorder therapists) to encourage behavior change.
● Encourage the patient to review a list of therapists that specialize in eating disorders.
3. Skill Development
● Recommend distraction techniques to develop skills to eliminate purging.
4. Nutrition Counseling
● Use motivational interviewing to determine patient-centered strategies to eliminate eating disorder behaviors.
● Encourage self-monitoring by recommending journaling most days of the week for accountability for purging episodes.
● Patient Goals
1. Stop binge/purging behaviors.
2. Keep a food journal.

MONITORING AND EVALUATION


1. Indicator
● Food record
2. Criteria
● Patient will have 0 purging episodes recorded in her journal.
Nutrition Prescription​: 1650 kcals with 3 meals and 1-3 snacks throughout the day.

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