Kasey Gaines iHuman Case Study Answers

The Kasey Gaines iHuman Case Study focuses on the comprehensive management of a patient diagnosed with anorexia nervosa. This case study focuses on the key aspects of the treatment plan, including determining the appropriate level of care, screening for medical comorbidities, implementing nutritional rehabilitation, monitoring for refeeding syndrome, and incorporating psychological therapies such as cognitive-behavioral therapy (CBT) and family therapy. Additionally, the plan addresses the role of pharmacotherapy in managing comorbid conditions like depression and anxiety, providing a holistic approach to the patient’s recovery.

Kasey Gaines iHuman Case Study Answers

History and Physical Exam

In the Kasey Gaines iHuman Case Study, we examine a 16-year-old female presenting with significant weight loss and other health concerns. The physical examination and patient history reveal critical insights into her condition. Here’s an overview of the key points gathered during the interaction with the patient:

• Primary Concerns (Patient):
  • 20-pound weight loss over six months.
  • Concerns about body image, with a distorted perception of being overweight.
  • Periods of food restriction, avoidance of carbohydrates, and binging followed by purging.
  • Excessive exercise, including late-night workouts.
• Additional Symptoms:
  • The patient reports secondary amenorrhea (absence of periods) and physical signs like dry skin, lanugo (fine body hair), and dental erosion, suggestive of nutritional deficiencies.
  • Emotional concerns such as mild dysphoria and tiredness.
  • Family-related stress, particularly stemming from parental divorce, and social anxiety about how others perceive her weight.

Patient Interview

• Questions Asked During the History and Physical:
  • Do you have any other symptoms or concerns we should discuss?
  • Have you self-induced vomiting, used laxatives, or diuretics to control your weight?
  • Can you tell me about your diet? What do you normally eat?
  • How do you feel about the way you look?
  • Are you having any problems with your periods?
  • Have you had any thoughts of hurting or killing yourself?
  • Tell me about daily exercise or sports that you play.

The patient confirms a pattern of restrictive eating interspersed with binge eating, followed by self-induced vomiting and laxative use. Additionally, she experiences significant preoccupation with her weight, feelings of inadequacy, and stress due to her family situation.

Key Findings and Problem Statement

The patient’s clinical picture suggests an eating disorder, with features of anorexia nervosa and bulimia nervosa based on her extreme preoccupation with food, weight loss, and compensatory behaviors such as purging and excessive exercise. Notable findings include:

• 20-pound weight loss over six months, with a BMI of 15.7, which is indicative of severe underweight status.
• Secondary amenorrhea, a common finding in cases of significant weight loss in females.
• Orthostatic hypotension and a history of syncopal episodes (fainting).
• Physical signs such as dry skin, lanugo, dental erosion, parotid gland enlargement, and calluses on the dorsum of the right hand (likely from inducing vomiting).

Problem Statement

The patient presents with a progressive 20-pound weight loss associated with food restriction, excessive exercise, and body-image distortions. She engages in binging and purging behaviors, uses laxatives, and has developed secondary amenorrhea. Psychosocial stressors include high academic pressure, a history of parental divorce, and significant concerns about her body image, which may contribute to her disorder.

Differential Diagnosis

Based on the clinical findings, several conditions could be considered in the differential diagnosis:

1. Anorexia Nervosa – The restrictive eating patterns, excessive exercise, and preoccupation with body image strongly point to anorexia.
2. Bulimia Nervosa – Episodes of binging and purging, combined with the use of laxatives, align with the characteristics of bulimia.
3. Avoidant/Restrictive Food Intake Disorder (ARFID) – Although less likely due to the binging and purging behavior, this could be a consideration if the food avoidance is related to sensory aversions rather than weight concerns.
4. Body Dysmorphic Disorder (BDD) – The patient’s significant distress about her perceived body image could also suggest a diagnosis of BDD.

Diagnostic and Treatment Plan

The initial workup for this patient would involve a comprehensive psychiatric evaluation to better understand her eating patterns, emotional state, and coping mechanisms. Physical assessments should include:

• CBC, BMP – To assess for electrolyte imbalances, anemia, or other nutritional deficiencies.
• Bone Density Test – Due to the stress fracture and possible osteopenia/osteoporosis from malnutrition.
• ECG – To check for arrhythmias or bradycardia, common in eating disorders.

Once the diagnosis is confirmed, the following treatment approach could be implemented:

• Nutritional Rehabilitation: A structured meal plan to gradually restore healthy eating habits.
• Cognitive Behavioral Therapy (CBT): Aimed at addressing the distorted body image and unhealthy behaviors.
• Family Therapy: To address family dynamics, particularly after the parental divorce.
• Pharmacotherapy: In severe cases, antidepressants or anxiolytics may be considered if coexisting mood disorders are diagnosed.

Kasey Gaines iHuman Case Study Answers – Management Plan

The management plan for Kasey Gaines, a patient diagnosed with anorexia nervosa, involves multiple components aimed at restoring health, addressing psychological concerns, and preventing future complications. Below is a detailed outline of the key elements of the management plan:

1. Determine the Appropriate Level of Care

The first step is assessing the appropriate level of care required for Kasey. Treatment for anorexia nervosa can range from outpatient care to partial hospitalization (day treatment) or inpatient hospitalization, depending on the severity. Inpatient care is recommended for patients with life-threatening medical issues, a body weight less than 75% of ideal, or rapid weight loss.

2. Screen for Medical Comorbidities

It is crucial to assess the patient for any underlying medical conditions contributing to the disorder or those arising as a result of starvation. Addressing medical complications such as electrolyte imbalances, dehydration, or organ dysfunction is a priority.

3. Institute Nutritional Rehabilitation

Nutritional rehabilitation is the foundation of treatment. Initial refeeding typically begins at 30-40 kcal/kg/day and is gradually increased based on weight gain progress. The goal is to achieve a weekly weight gain of 0.5-1 pound for outpatients and 2-3 pounds for inpatients. In severe cases, nasogastric tube feeding may be used, though parenteral nutrition is reserved for extreme cases of malnutrition.

4. Monitor for Refeeding Syndrome

A significant risk for malnourished individuals is refeeding syndrome, which can result in dangerous shifts in electrolytes, especially phosphate, magnesium, and potassium. These shifts can lead to cardiac failure, dehydration, fluid overload, and sudden death if not properly managed. Close monitoring during refeeding is necessary, especially within the first four days when the risk is highest.

5. Restrict Exercise Based on Medical Stability

Given Kasey’s history of excessive exercise, it is essential to limit physical activity to levels appropriate for her medical condition. Exercise should only resume as her weight and overall health improve.

6. Psychoeducation

Educating Kasey and her family about the condition, its potential complications, and the importance of treatment is essential. Psychoeducation helps increase awareness and adherence to the treatment plan.

7. Cognitive Behavioral Therapy (CBT)

CBT is a cornerstone of psychological treatment for anorexia nervosa. It focuses on addressing distorted body image, improving self-esteem, and reducing the psychological fixation on weight and appearance. CBT also helps the patient challenge rigid eating behaviors and encourages healthier food choices.

8. Family Therapy

Family therapy, such as the Maudsley approach, plays a crucial role in supporting recovery. Initially, the family is encouraged to take control of the patient’s weight restoration. As the patient shows improvement, control is gradually transferred back to the patient. Family therapy also helps address any family dynamics that may be contributing to the disorder and fosters a supportive home environment.

9. Pharmacological Therapy

While pharmacotherapy has a limited role in treating anorexia nervosa, selective serotonin reuptake inhibitors (SSRIs) may be used to treat comorbid conditions such as bulimia, depression, or anxiety. Atypical antipsychotics have been considered for their weight-gain side effects, but patient adherence can be a challenge due to concerns about excessive weight gain.

10. Address Comorbid Conditions

Many patients with anorexia nervosa also struggle with depression and anxiety. Kasey should be screened for these conditions, and if present, treated with a combination of psychotherapy and pharmacotherapy. SSRIs can be particularly useful in managing depressive symptoms and reducing binge-purge behaviors in comorbid bulimia.

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