#1

Anorexia nervosa is a psychological disorder in which a person significantly decreases their caloric intake, leading to low body weight. Anorexia is a complex disorder that has genetic correlations with education attainment, neuroticism, and schizophrenia (Moore & Bokor, 2023). Endocrine abnormalities in anorexia nervosa are common and include low levels of gonadal hormones, reduced levels of thyroxine (T4) and triiodothyronine (T3),  and increased cortisol secretion (Attia & Walsh, 2022).

Culture is believed to be a significant factor in the etiology of anorexia nervosa. Rates of anorexia nervosa are more prevalent in specific ethnic and racial groups and change as culture evolves. An increase in anorexia seems to arise in cultures that place a high value on physical aesthetics (Miller & Pumariega, 2001).

The financial implications of anorexia nervosa are substantial. Economic costs of eating disorders in 2018-2019 were estimated to be $64.7 billion, which equates to about $11,808 per affected person (Streatfeild et al., 2021).

Environmental implications of anorexia nervosa include a person family origin, social network, and perceptions of stressful life events (Mazzeo & Bulik, 2009).

Nursing interventions for a patient admitted to the emergency room for anorexia nervosa include rehydration, cardiac monitoring, fall risk identification, and a suicide assessment.

Lab work such as a complete blood count (CBC) must be done to determine if the patient is dehydrated, as indicated by an elevated number of high red blood cells. A CBC would also include the patient hemoglobin and hematocrit levels to determine if the patient is anemic from not eating. Other blood tests, such as a basic metabolic panel (BMP), should be drawn to evaluate the body organ functioning. The BMP includes a blood urea nitrogen (BUN) test showing dehydration and a creatinine test used to evaluate kidney function. The BMP also includes several electrolytes, such as potassium, sodium, chloride, and phosphorus, which are at risk of being imbalanced for a patient with anorexia nervosa. BMP also includes calcium and glucose levels in the blood (National Heart, Lung, and Blood Institute, 2022).  An EKG should also be completed, and the patients should be monitored in a telemetry unit for severe sinus bradycardia, marked prolongation of the corrected QT interval, or syncope (Sachs et al., 2016).

Treatment of anorexia nervosa needs to be treated holistically with various members of an interdisciplinary team. First, the overall care must be overseen by a Primary Care Physician (PCP). The role of the PCP is to monitor labs, vital signs and coordinate care between the interdisciplinary team (Lenton-Brym et al., 2019). The role of the psychiatrist in prescribing antidepressants for patients with anorexia has been proven helpful in treatment (Marquez et al., 2022). The role of a dietitian is also vital in treating anorexia nervosa. The dietitian establishes healthy eating habits and monitors the patient’s food intake (Heafala et al., 2021). Registered nurses (RNs) must administer medication and educate patients about the disorder, medications, and treatment plans while providing therapeutic communication (Ramjan, 2004). A  therapist is also vital to the patient’s success as they help the patient navigate the psychosocial factors involved with their disorder through family therapy (Grange et al., 2019).  Furthermore, a physical therapist can supervise physical therapy to improve body awareness and mental and physical .

#2

Anorexia nervosa, a complex eating disorder characterized by an intense fear of gaining weight and a distorted body image, involves multifaceted pathophysiological processes. The disorder is primarily associated with severe caloric restriction, leading to significant weight loss and malnutrition. This malnutrition impacts various physiological systems, including metabolic and endocrine functions. According to Kaye, Mddr, and Bulik (2020), metabolic disturbances include alterations in thyroid function, adrenal hormone levels, and sex steroid levels, which contribute to the clinical manifestations of anorexia. Specifically, individuals with anorexia often exhibit decreased levels of thyroid hormones and disruptions in cortisol and leptin, which are critical for maintaining metabolic balance and regulating appetite (Kaye, Mddr, & Bulik, 2020).

Moreover, anorexia nervosa affects the central nervous system, particularly the areas involved in hunger and satiety. The dysregulation of neurotransmitters such as serotonin and dopamine has been implicated in the perpetuation of restrictive eating behaviors and the distorted self-image characteristic of the disorder. Studies have shown that individuals with anorexia have altered brain structure and function, especially in regions like the hypothalamus and the orbitofrontal cortex, which are involved in appetite control and reward processing (Kaye, Mddr, & Bulik, 2020). These neurobiological changes, combined with psychological factors, contribute to the persistence and severity of the disorder. The intricate interplay between metabolic dysfunction, endocrine abnormalities, and neurobiological alterations underscores the complexity of anorexia nervosa and the necessity for a comprehensive approach to treatment.

Cultural factors significantly influence the prevalence, manifestation, and treatment of anorexia nervosa. Cultural norms and ideals related to body image and beauty play a crucial role in shaping individuals’ attitudes toward food and body weight. For instance, cultures that emphasize thinness as a standard of beauty are more likely to experience higher rates of anorexia nervosa. According to Levine and Murnen (2009), media portrayals of thinness and societal pressures related to body image contribute to the internalization of these ideals, leading to increased risk of developing eating disorders. The study highlights that exposure to thin-ideal images in Western media is associated with body dissatisfaction and disordered eating behaviors, illustrating how cultural factors can exacerbate the risk of anorexia nervosa. Thus, cultural contexts that valorize thinness and stigmatize obesity can significantly impact the onset and persistence of anorexic behaviors.

Financial factors can have a profound impact on the development and management of anorexia nervosa, influencing both the accessibility of treatment and the socioeconomic pressures that contribute to the disorder. Individuals from lower socioeconomic backgrounds may face financial barriers that limit their access to specialized care and nutritional support, exacerbating the severity of the condition (Streigel-Moore & Bulik, 2007). Economic stressors can also contribute to disordered eating behaviors, as financial insecurity may lead to increased preoccupation with body image and weight control as a means of exerting some sense of power in a challenging environment. Moreover, the cost of healthy food options can be prohibitive for some, leading individuals to engage in restrictive eating patterns that mimic anorexic behaviors (Streigel-Moore & Bulik, 2007). Thus, financial constraints and related stressors play a critical role in both the onset and the progression of anorexia nervosa.

Environmental factors significantly influence the development and progression of anorexia nervosa, mainly through exposure to societal and familial pressures that impact body image and eating behaviors. For example, living in an environment with high levels of social comparison and appearance-related pressure, such as through media or peer groups that emphasize thinness, can increase the risk of developing anorexia (Stice, 2002). Additionally, family dynamics and interpersonal relationships play a crucial role; environments characterized by high levels of familial conflict, criticism, or an overemphasis on appearance can contribute to the onset of disordered eating patterns. Stice (2002) emphasizes that environmental stressors, including societal and familial influences, interact with individual vulnerabilities to exacerbate the risk of eating disorders, highlighting the importance of considering these factors in both prevention and treatment strategies.

For a client with anorexia in the emergency department, priority nursing interventions should focus on immediate stabilization, safety, and addressing both physical and psychological needs.