Feeding Disorders Case Paper

Feeding Disorders Case Paper
Ryan Transcript
Ryan Edwards is a 30-year-old man reporting regurgitations without retching or gagging preceded by a sensation of pressure in his esophagus and abdomen.

Feeding Disorders Case Paper
Hello, I sure hope you can help me. For the last eight months, I’ve been upchucking between 7 and 60 times every day. It typically begins within 30 minutes of eating and last between an hour and a half, and 3 hours. It’s kind of gross to talk about, but here goes. An episode at first included my throwing up recognizable food material, but what’s coming up has gotten more acidic—it burns more—as the episodes progressed. They started after I’d had a bout of bronchitis. I’ve seen a bunch of docs and been diagnosed with gastroesophageal reflux and with General Anxiety Disorder. That hasn’t seemed to help me.

My main doc prescribed Fluoxetine and Buspirone but I’ve seen no change in the frequency of these episodes or my anxiety. She also gave me this handout about diagram… diaphragm… something or other breathing. Whatever… I didn’t really understand it and couldn’t figure out how to do it.
I’m here because I’m really concerned about the medical consequences of all this throwing up. I’ve lost close to 50 pounds, so I’m concerned about weight loss and nutritional deficiencies. At the beginning, it was okay; I could stand to lose a bit. But if I keep dropping weight, I know it’s not going to be good.
There are also some social issues I’m struggling with. I’m not going out much because I’m trying to avoid throwing up in public. I’m frustrated with my inability to increase my physical activity without puking. And I’m having trouble at work because of having to avoid a lot of situations.

I’ve tried several strategies to stop this. Let’s see… I’ve tried to just fight it off by forcing the puke down before it reaches my mouth. Ugh. Hasn’t worked. I avoid foods that increase the frequency of my need to vomit, like pasta, chicken, and most breakfast foods. Like I said, I’ve been avoiding physical activity because even small amounts of physical exertion, such as walking up the stairs at work, make bring up whatever I ate last.
My goals? I want to reduce the number of times I have to throw up every day to once or none. I no longer want to have to avoid foods. And I want to increase my physical activity. Can you help me?

In Ryan’s chart, you see that his doctor prescribed Fluoxetine 40 mg po daily and buspirone 15 mg po TID.

From your perspective as their psychiatric nurse practitioner, answer the following questions in a four-page double-spaced paper (not including the reference page) in APA format. Include at least three peer-reviewed, evidence-based references.

1. Write a summary statement about the case presentation, including potential DSM-5 diagnoses.
2. Is there a screening tool for this diagnosis? Would it be appropriate for this patient? If available online, include a link to the tool.
3. What assessment questions would you ask the patient to identify their eating disorders, triggers, and current coping skills?
4. What medication changes would you recommend, including doses and administration times? What precautions and interactions would you educate the patient about when prescribing your recommended medications or changes in medication?
5. Explain any other health professional referrals that would be significant in your patient’s treatment plan.

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