A Care Plan for Patients With Eating Disorders Paper Example

The care plan is developed form the American psychiatric association level of care guidelines for patients with eating disorders.

Medical status

Miriam can be treated as an outpatient, intensive outpatient or be partially hospitalized if she is medically stable to the extent that medical monitoring might not be required. She can undergo residential hospitalization if she is medically stable to the extent that does not require intravenous fluids and nasogastric tube feedings among others. She can be taken for inpatient treatment if her heart rate is close to 40 bmp with changes in orthostatic blood pressure, low potassium phosphate and magnesium levels.

Suicidality

Miriam can be treated as an outpatient, intensive outpatient, partial hospitalization or residential hospitalization if she possesses any suicidal ideations that would require treatment and monitoring depending on their estimated risk levels. She would however go for inpatient treatment in the event of suicidal attempts of aborted attempts.

Weight as a percentage of a healthy body's weight.

She can be taken as an intensive outpatient or undergo partial hospitalization if her weight is greater than 80% of a healthy body's weight. She can be an outpatient it her weight is greater than 85% and undergo residential hospitalization or inpatient treatment if her weight comprises of less than 85% of a healthy body's weight.

Motivation to recover and corporate

She would be treated as outpatient if her motivation ranges from fair-to-good; intensive outpatient if her motivation is fair; partial hospitalization if she has a partial motivation; residential hospitalization if her motivation is poor-to-fair and inpatient treatment if her motivation is extremely poor.

The structure required for eating and gaining weight

Miriam would be treated as an outpatient or intensive patient if the structure required to eat and gain weight is self-sufficient. She would be partially hospitalized if some additional structures are required to gain weight. She would be taken care of as in inpatient if the structures to gain weight require nasogastric feeding models.

Management strategies

Self-mutilation

Processes involved include:

• Release the energy or tension by engaging in activities such as football, gym etc.
• Be creative and create something that explains how you feel such as a painting, drawing, model etc.
• Miriam should talk about how she feels via a helpline, a friend or support networks.
• Engage in things that make you feel better such as taking a bath, having a massage etc.
• Start a task such as watching a TV or reading a book.

Eating disorder

The processes involved include:

• Physical health management
• Mental health management
• Nutritional counselling and advice
• Cognitive behavioural therapy
• Nutrition education

Depression

Processes involved include:

• Psychological treatments that include cognitive behaviour therapy, interpersonal therapy and mindfulness-based cognitive therapy.
• Antidepressant medication alongside psychological treatments
• Preferred laboratory tests

Testing

Comprehensive Metabolic Panel test

• Measures the blood sugar level at the time of testing. A sudden drop in glucose levels (<70 mg/dL) could result in serious medical complications.
• Measures the amount of calcium in blood at the time of testing. Abnormal calcium levels would result in serious cardiac complications.
• Measures the amount of sodium in blood at the time of testing. Extreme levels could also result in complex medical operations.
• Measures the potassium levels in blood since abnormally high levels result in serious cardiac issues.
• Measures bicarbonate levels in blood since abnormally high levels result in vomiting and metabolic alkalosis while abnormal low levels result in metabolic acidosis.
• Measures chloride levels since abnormal low levels would result in vomiting and diuretic use.

Serum magnesium test

Measures the amount of serum magnesium since abnormally high levels during refeeding would result in serious medical complications.

Serum phosphorus

Measures the amount of serum phosphorus in blood since abnormal low levels would result in malnutrition, diuretic use and chronic antacid use.

Medical prescriptions

I would prescribe Prozac (Fluoxetine capsules) for Miriam. The drug would be administered orally. I selected the drug because it was the first in the selective serotonin reuptake inhibitor (SSRI) class and works appropriately as an antidepressant (Llamas, 2018). It was approved by the FDA to treat depression in children, adolescents and adults. Fluoxetine is easily metabolized in the liver. The only identified active metabolite (norfluoxetine) is formed by demethylation of fluoxetine.

Mechanism of action

Fluoxetine provides activating properties that make it an appropriate option for patients with retarded or atypical depression. Just like other SSRIs, fluoxetine prevents secretion of the serotonin transporter protein. It is also a weak inhibitor of the norepinephrine reuptake with this effect increasing with rises in its dosage. It has been approved for the treatment of major depressive disorders and bipolar depression hence making it vital in this case. Fluoxetine possesses unique pharmacokinetic properties that make it stand out from the other SSRIs with the main one being its long half-life. Most SSRIs have an estimated half-life of 1 day while fluoxetine has a half-life of 2 to 4 days while its active metabolite (norfluoxetine) has a half-life of 7 to 15 days making it beneficial regarding treatment adherence (Guzman, 2017). Critical side effects associated with the drug include suicidal thoughts, sexual dysfunction and anorexia. Others include serotonin syndrome, allergic reactions and rash, seizures, altered appetite and weight and hyponatremia among others.

Dosage range

In the event of depression resulting from sexual assault, the victim should take 20-60 mg per day. Anxiety disorders would commence with a lower starting dose i.e. 10 mg per day then advance to 20-60 mg per day with time. Miriam suffering from Bulimia sleeping disorder would use 60 mg per day.

Case conceptualization

Eating disorder

I sought to clarify the patient's view on hypotheses regarding her problems alongside her concepts about life, happiness and how to achieve her goals and others through maladaptive thought patterns. She showed intense cognitive diffusion and identified every mental event as a reality with strong cognitive rigidity. In line with the cognitive, behavioural and theoretical model, we focused on three areas of her life that involved application of therapeutic goals and adoption of unrestricted eating patterns.

Self-mutilation

Concept formulation involved conducting an initial assessment to obtain information from the client including their age, occupation, family history and living situations. Behavioural analysis to establish a comprehensive problem list indicates noncompliance, dangerous behaviours and behaviours that interfere with the quality of life. An analysis of the client's strengths when dealing with self-mutilation and the associated urges to self-injure attributes the causal factors to relationship issues and psychiatric disorders among others.

I would recommend a family-based therapy as a psychotherapy strategy for Miriam. This is one of the main evidence-based treatment strategies for teenagers with anorexia. Since the teenager is not able to make proper choices on health and eating while in such a critical condition (with anorexia), this therapy would enable the parents to help the child with the appropriate re-feeding and weight restoration processes until the affected child can make proper choices about health.

Sexual assault

The client in this case experiences physical touching or physical force, attempted sexual acts, abusive sexual touching as well as other noncontact assaults that include threats, harassment and forced exposure to sexual content.

In all the above cases, the parents are also in total denial of the problems experienced by Miriam. Joel and Sarah fail to recognize that they have a vital role to play to help control Miriam's eating disorder and the effects of self-mutilation and sexual assault.

The two vital levels that can be employed by therapists to determine the most ethical course of action that facilitates moral decision making involves the critical-evaluation level and the intuitive level. The intuitive level includes knowledge on the professional codes of conduct while the critical-evaluative level guides ethical practices based on reasoned judgements and evaluations. In this case, the ethical principles of that guide ethical decision making processes include autonomy, justice, no maleficence fidelity, beneficiaries and self-interest. I would proceed by implementing the ethical principles stipulated in the Kitchener model.

References

Bouvier, P. (2014). Sexual violence, health and humanitarian ethics: Towards a holistic, person-centred approach Paul [Ebook] (p. 20). International Review of the Red Cross. Retrieved from http://file:///C:/Users/ADMIN/Downloads/irrc-894-bouvier.pdf

Michelle, L. (2018). Prozac Side Effects, Dosage, Uses, & Drug Interactions - Drugwatch.com. Drugwatch.com. Retrieved 9 August 2018, from https://www.drugwatch.com/ssri/prozac/

Flavio, G. (2017). The Psychopharmacology of Fluoxetine: Mechanism of Action, Indications, Pharmacokinetics and Dosing. Psychopharmacology Institute. Retrieved 9 August 2018, from https://psychopharmacologyinstitute.com/antidepressants/ssris/psychopharmacology-fluoxetine-illustrated-review-prescribers/