Professional Nursing Practice and Care for Patients With Acute, Chronic and Mental Health Issues: A Case Study of Jessica Jones, Diagnosed With Bulimia Nervosa

Patients with acute, chronic, and mental health issues require appropriate and efficient nursing. Nurses are tasked with ensuring the administration of the care needed regarding the administration of the appropriate medication and ensuring patient compliance after undertaking a comprehensive Pathophysiology. Knowledge of the biological and physical abnormalities occasioned by a certain disease on a patient is vital in establishing the appropriate care and medication. Jessica Jones is one such patient diagnosed with Bulimia Nervosa and has had several treatments including medication and therapy. In light of her current situation and prescribed medications, Jones requires additional care and professional monitoring and management to comply with her medication. The essay focuses on Jones’s current medical condition, previous medical situation, and medication and develops a more patient-based professional approach to the treatment and care of Bulimia Nervosa.

Jones´s scenario

Jones is a teenager, an 18-year-old female. She lives with her mother in a divorced family. Her two male siblings live abroad and she is the youngest in the family. Jones´s Bulimia Nervosa condition was diagnosed in her 16th year of birth. Over the two years, she has managed and shown positive recovery from her condition through her adherence to cognitive behavioral therapy (CBT) treatment. Even so, Jones has had to defer college and resorted to formal employment. Her recent medical examination as early as the last six months has seen her lose weight and undergo behavior change. She has become antisocial, secretive around food, and withdrawn. Additionally, Jones avoids people at mealtimes and prefers eating alone. She experiences frequent bathroom visits after meals. Her recent medical review has shown that she has hypokalaemia, hypernatraemia, and cardiac arrhythmias. Signs and symptoms related to the conditions including irregular pulse, dizziness, and low blood pressure were revealed from her medical screenings and testing. Currently, Jones weighs 50kgs and has a height of 170cm. She has been provided medication to manage her condition including treatment for her other developed medical issues. Among her latest medications considering her mental health and chronic condition included potassium supplements and cardiac monitoring. Bed rest and supervised meals including fluid balance charts and food charts and bathroom access within an hour before and after meals are among the treatment prescribed. Jones perceives the instituted medication as a rule and restrictions and does not wish to comply with it.

Pathophysiology regarding Bulimia Nervosa

Bulimia Nervosa commonly referred to as Bulimia is an eating disorder. It is a serious and possibly life-threatening condition depending on the level of the condition and seriousness accorded to its treatment. Individuals diagnosed with Bulimia eat a lot of food without control of their eating (Mitchell et al., 2007). They then purge to get rid of the excess food and maintain a certain individually established correct weight. Bulimia patients, normally self induce vomiting or apply the use of laxatives. Other inappropriate means of weight loss used by such patients include the use of weight loss supplements, enemas, and diuretics. Mentally, Bulimia patients struggle with self-image. The patients judge themselves based on their weight and body shape. Bulimia, therefore, is the incorporation of eating disorders and individual mental perception on self-image. As such Bulimia is a challenging condition to treat and manage even though possible through effective and appropriate medication and strict compliance to such treatment.

General symptoms of Bulimia include preoccupation with body shape and weight, abnormal excess eating per sitting, living in fear of weight gain, fasting and restricted meals, use of dietary supplements or herbal products, use of laxities, and diuretics. Bulimia symptoms may lead to other health complications regarding the forceful excretion and wasteful removal of otherwise important nutrients from the body (Mitchell et al., 2007). Removal and loss of minerals such as potassium may lead to other health complications and conditions such as hypokalaemia. Inducing bodily activities such as vomiting require energy, the use of weight loss supplements consumes energy and therefore interferes with the normal respiratory system. Eventually, the patient would suffer from cardiac-related complications and fluctuating blood pressure that requires careful monitoring and management.

Analysis and comparison of Jones´condition and medication

According to the biological and physical analysis of the symptoms encountered by Jones, her previous medical condition, and diagnosis, she is fighting chronic Bulimia. Antisocial and withdrawal behavior are characteristic symptoms of Bulimia. Additionally, Jones experiences uncontrolled eating and frequent bathroom visits thereafter. After her CBT administration, Jones showed positive signs of recovery. CBT aids channel an individual’s view and perception of a situation and condition. Emotional and mental issues such as obsession with self-image are well managed through CBT. Perhaps her compliance to the therapy and medication significantly aided her recovery.  

The recovery of any patient especially the acute, chronic, and mentally ill patients require personal effort. A lot of the treatment plans in this category of patients require the personal will to comply with the treatment procedure and process and work from a strong personal mentality. According to the current medication that Jones was offered, her likening of the treatment as restrictions is a wrong and unhealthy starting point toward patient recovery. Strict measures such as timed bathroom visits and food charts can only work on some conditions and not others. Bulimia is a mentally connected disorder and therefore therapies that ease and aid in controlling a patient’s mental orientation are necessary. The feeling of regret and shame Jones on her attitude and character toward eating is a sign that appropriate and efficient treatment can be constituted to help her condition willingly.

Professional solution to the Scenario

Nursing practice is tasked with the provision of curative, supportive, formative, preventive, palliative, and restorative care to all patients regardless of their race, religion, gender, culture, physical ability, and any other distinguishable characteristics (Epstein & Turner, 2015). The provision of professional care relies on an individual’s ability to analyze a patient´s condition, the biological and physical symptoms they encounter and administer the appropriate and effective treatment. Pharmacotherapeutics aids to define and explain to the patient the reason for specific drug administration and the need to comply with the treatment (Hay et al., 2009). According to the administered medication, Jones is comfortable with the medication less the therapy including monitored meals and bathroom visits. The first step as a professional nurse would be to instill the need to comply with a given medication and treatment. I would explain to Jones why she has to take potassium supplements and undertake continuous cardiac monitoring. The potassium supplements are meant to stabilize her body’s potassium levels and ease her developed conditions of hypokalaemia, hypernatraemia, and cardiac arrhythmias. Regular cardiac monitoring would aid in stabilizing her increased blood pressure and therefore treat the developed complication.

Bulimia is more of a mental illness considering the patient’s actions, perceptions and behavior contribute significantly to the condition. As such, I would recommend CBT to the patient. CBT is vital in handling emotional and mental issues (Curtis et al., 2017). So, Jones had earlier recovered from her condition following her previous CBT treatments. The first mental point of concern would be to inform Jones that Women and girls especially teenagers are at risk of the disease and therefore she should not be so much worried and feel withdrawn. The knowledge of risk factors would aid Jones to find a group to relate to and do away with the loneliness and antisocial behavior she had developed. Based on her weight (50kg) and height(170cm), Jones is within the average weight. Considering the body mass index (BMI), a person with an 18-25 BMI is of average weight (Lorenzo-Luaces et al., 2016). Jones´s weight and height provide a BMI of approximately 17 therefore she is not overweight and should not be worried and be fighting to lose weight. The facts about body weight, risk factors for Bulimia, and her age consideration should be adequate to convince Jones to comply with the medication and treatment process. Rules and strict schedules are only intended for patients who are mentally ill and do not have the personal urge to recover from their condition. Jones, being a teenager and of normal mind would only require CBT to acknowledge the need to manage her emotions and mental concerns and work towards a positive recovery path.

Conclusion

The first step towards a patient´s recovery is the identification of the specific biological and physical symptoms and their relation to a specific disease and treatment. Acute, chronic, and mentally ill patients encounter a combination of conditions that would require a combination of medicinal and other therapies for treatment. Patients require a breakdown of their medication and treatment regarding the knowledge of why they are under a given medication and therapy and thereby their need to comply with the treatment. Prescribed medication and treatment without the patient´s involvement and knowledge would lead to their view of the treatment as punishment and ill-intended and therefore would not wish to comply as Jones had indicated in her scenario. Nurses and the profession establish person-centered and evidence-based criteria that are aimed at the professional care of all patients. Any specific patient would require specific treatment even though a generic medication and treatments for diseases are provided.

References

Mitchell, J. E., Agras, S., & Wonderlich, S. (2007). Treatment of bulimia nervosa: where are we and where are we going?. International Journal of Eating Disorders, 40(2), 95-101. https://doi.org/10.1002/eat.20343

Hay, P. P., Bacaltchuk, J., Stefano, S., & Kashyap, P. (2009). Psychological treatments for bulimia nervosa and binging. Cochrane database of systematic reviews, (4). https://doi.org/10.1002/14651858.CD000562.pub3

Lorenzo-Luaces, L., Keefe, J. R., & DeRubeis, R. J. (2016). Cognitive-Behavioral Therapy: Nature and relation to non-cognitive behavioral therapy. Behavior Therapy, 47(6), 785-803. DOI: 10.1016/j.beth.2016.02.012

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872. DOI: 10.1111/jocn.13586

Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2), 1-10. DOI: 10.3912/OJIN.Vol20No02Man04.