Kasey Gaines iHuman Case Study Answers

Kasey Gaines Ihuman History and Physical Exam

How can I help you today? (patient)

Do you have any other symptoms or concerns we should discuss? (patient)

Have you self-induced vomiting, used laxatives, diuretics, or enemas to control your weight? (patient)

Do you ever engage in binge eating? (patient)

Can you tell me about your diet? What do you normally eat? (patient)

Are you eating too little or too much? If so. how often are you doing this? (patient)

How do you feel about the way you look? (patient)

Are you having any problems with your periods? (patient)

Have you had any thoughts of hurting or killing yourself? (patient)

Tell me about daily exercise or sports that you play. (patient)

Do you have problems with dizziness, fainting, spinning room. seizures, weakness, numbness, tingling, or tremor? (patient)

Do you have problems with nausea, vomiting, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, or bloating? (patient)

Do you have any problems with nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices or see things that you know are not there? (patient)

Do you have any problems with headaches that don’t go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty with night vision, problems hearing, ear pain, sinus problems, chronic sore throats, or difficulty swallowing? (patient)

When did she first notice her change in weight? (witness) Kasey Gaines iHuman Case Study Answers

Do you feel like you are a failure or disappointing others? If so, how often do you feel this way? (patient)

Kasey Gaines-HUMAN CASE STUDY: NAVIGATING PEDIATRIC GASTROINTESTINAL CONDITIONS

Get ready to delve into the world of pediatric patients and their families in this i-Human Case Study Assignment. As you prepare, consider the various gastrointestinal conditions that may present themselves on the i-Human platform. Picture the virtual office where you’ll meet these young avatars, and think about specific GI issues you’d like to address.

Utilize the Learning Resources provided this week to enhance your knowledge of gastrointestinal conditions and understand how socio-cultural factors impact family needs. Take a moment to reflect on your previous i-Human case studies. Challenge yourself to explore a child of a different age, race, or ethnicity, expanding your experience and broadening your understanding.

To prepare:

Review this week’s Learning Resources, focusing on applying your knowledge to assess, diagnose, and treat pediatric patients with gastrointestinal conditions.
Access i-Human Patients and review the Kasey Gaines iHuman Case Study Answers. Consider the health history you’d need to collect from the patient.
Think about appropriate physical exams and diagnostic tests to gather information, reflecting on how the results contribute to making a diagnosis.
Identify 3–5 potential conditions for a differential diagnosis.
Consider clinical guidelines supporting the diagnosis and develop a treatment plan, incorporating health promotion and education for pediatric patients and their families.

Dive into the i-Human platform, interact with the patient, and complete the assigned case study. If you need guidance, refer to the i-Human Graduate Programs Help link within the i-Human platform.

BY DAY 7 OF WEEK 7 Complete your Assignment in i-Human, exploring the Kasey Gaines iHuman Case Study Answers.

Access i-Human through the link in the Start Here module. Let’s journey together into the realm of pediatric gastrointestinal health!

Kasey Gaines iHuman Key Findings and Problem Statement

Case: Key Findings

Key Finding

Weight Loss: Lost 20 pounds; BMI 15.7.
Food Habits: Restricts food, avoids carbohydrates.
Exercise Behavior: Excessive exercise, including midnight workouts.
Preoccupation: Constantly thinking about food.
Eating Patterns: Binging and purging.
Laxative Use: Uses laxatives for alleged constipation.
Body Image Distortions: Sees self as overweight despite severe underweight.
Behavioral Signs: Mirror gazing, anxiety about others perceiving her as fat.
Physical Effects: Secondary amenorrhea, orthostatic hypotension, one syncopal episode.
Other Indicators: Stress fracture, tiredness, mild loss of interest, mild dysphoria.
Academic Traits: High academic achievement, perfectionistic.
Physical Appearance: Rough, dry skin, dry thin scalp hair, lanugo body hair.
Skin Conditions: Abrasions, calluses on dorsum of the right hand, cracked lips, mild angular stomatitis.
Dental Impact: Dental erosion, bilaterally enlarged parotid glands.
Life Events: Parental divorce one year ago.

Case: Problem Statement

Kasey Gaines iHuman Problem Statement

The patient, a 16-year-old female, has experienced a significant 20-pound weight loss over the past 6 months. This is associated with food restricting, excessive exercise, and a constant belief of being overweight, despite having a severely low BMI of 15.7. Her eating patterns involve cycles of restriction, binge-eating, self-induced vomiting, and laxative use. Additional concerns include secondary amenorrhea and a recent metatarsal stress fracture. She reports tiredness, a mild loss of interest in activities, and faces psychosocial stressors such as academic pressures and family split due to parental divorce. The patient aspires to join the fashion industry. Physical findings include orthostatic hypotension, dry skin, lanugo body hair, calluses on the hand, mild angular stomatitis, bilateral parotid enlargement, and Tanner stage 4 sexual development.

Kasey Gaines iHuman Case Study Answers – Management Plan

Case: Management Plan

Key components of the management plan:

Determine Appropriate Care Level
Screen for Medical Issues
Initiate Nutritional Rehabilitation
Monitor for Refeeding Syndrome
Control Exercise to Medical Status
Provide Psychoeducation
Start Cognitive-Behavioral Therapy
Encourage Family Therapy
Discuss Pros and Cons of Medication
Screen and Treat Depressive and Anxiety Features

Treatment Decision for Anorexia Nervosa

The treatment approach for anorexia nervosa involves critical decisions about the level of care, considering outpatient, partial hospitalization, or inpatient hospitalization. Inpatient care is reserved for cases with life-threatening complications, individuals weighing less than 75% of ideal body weight, and those experiencing rapid weight loss.

Medical Screening for Comprehensive Care

Screening for medical conditions contributing to the presentation or complications of starvation is essential for an all-encompassing approach. Addressing any identified medical concerns actively contributes to a holistic treatment strategy.

Nutritional Rehabilitation as the Mainstay

The primary focus in the initial management of anorexia nervosa is nutritional rehabilitation. Refeeding is initiated at 30-40 kcal/kg/day and adjusted based on the patient’s weight gain goals. The aim is to achieve a 0.5-1 pound per week gain for outpatients and a more substantial 2-3 pounds per week for inpatients. In severe cases, nasogastric tube feeding may be employed, while parenteral nutrition is reserved for extreme malnutrition.

Navigating Refeeding Syndrome

Close monitoring during nutritional replenishment is imperative to identify and manage manifestations of refeeding syndrome. This metabolic phenomenon, marked by electrolyte imbalances, can impact multiple bodily functions, leading to complications such as cardiac failure, dehydration, fluid overload, hypotension, renal failure, and even sudden death.

Gradual Nutritional Replenishment for High-risk Cases

For patients at a heightened risk, particularly those severely malnourished, a more gradual nutritional replenishment is recommended. Starting at lower caloric levels and gradually increasing helps mitigate the risks associated with refeeding syndrome.

Strategic Consideration of Exercise

The decision to permit exercise is contingent upon the patient’s medical stability and progress in treatment. Balancing physical activity with overall health is crucial for an effective and safe recovery.

Holistic Approach Including Psychotherapy

Treatment extends beyond physical aspects to encompass psychoeducation, family therapy, and cognitive-behavioral therapy (CBT) geared towards weight gain. CBT is instrumental in addressing psychological facets, including self-esteem improvement, challenging rigid eating rules, and diminishing the emphasis on weight and shape.

Maudsley Approach and Family Dynamics

The Maudsley approach involves a strategic inclusion of parents in the initial phase of weight restoration, gradually transitioning control to the patient. Family therapy is integral to addressing dynamics contributing to the eating disorder and fostering a supportive environment. Collaboratively, relapse-prevention strategies are formulated.

Pharmacotherapy: A Limited Role

Pharmacotherapy plays a limited role in anorexia nervosa treatment. Atypical antipsychotics, though debated, may be considered due to their weight-gain side effect. However, patient concerns related to excessive weight gain and medication adherence are common challenges.

Comprehensive Screening for Comorbidities

Patients with anorexia nervosa should undergo thorough screening for comorbid depressive and anxiety disorders. When present, these comorbidities should be addressed through psychotherapy, pharmacotherapy, or a combination of both. Selective serotonin reuptake inhibitors (SSRIs) show utility in treating comorbid bulimia nervosa and depressive disorders.

In summary, the multifaceted treatment plan encompasses medical, nutritional, psychological, and family-oriented components. Individualized care and ongoing assessment are paramount for the successful management of anorexia nervosa.

Source

Crook MA, Hally V, Panteli JV. The importance of refeeding_syndrome. Nutrition. 2001; 17(7, 8) 632-637.

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