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RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

Scholarly Assignment: Concept map and Paper

Monday, March 16th, 2015
Enma Serrano Alvarado
810 043 372
NURS 252: Complex Issues and Patient Safety
Professor Wendy Chow
Humber College

RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

The scenario presented to me is of a 13 years old male with a diagnosis of Bulimia. Client
has been admitted to the pediatric unit with hypotension and bradycardia. The clients body mass
index is documented by the pediatrician as Moderate underweight. Also, client complains of
dizziness and fatigue when ambulating.
The assessment reveals the following findings: chest is clear with no adventitious sounds
present, bowel sounds are hyperactive in all four quadrants and bowel pattern reported to be once
every 4 to 5 days. Vital signs are 36.9, 64, 17, 84/64, 99%RA.
Chosen pathophysiological/psychosocial priority: Imbalanced nutrition; less than body
requirements
Based on the data from the scenario, I chose Imbalanced nutrition as my priority. The
client assessment reveals relevant data that indicates that his diagnosis of bulimia has affected his
well-being. The fact that the client presents with an altered bowel pattern indicates that he does
not have an appropriate diet. Bulimia nervosa is an eating disorder characterized by frequent
binge eating, self-induced vomiting associated with loss of control over eating, and a persistent
concern with body image (Lewis et al, 2014, p. 1070). For this reason, it is important to pay
close attention to both physiological and psychological effects that the clients bulimic behaviour
could have to his well-being.
Moreover, if we take a look at the clients vital signs, the blood pressure reading of
84/64mmHg is a major concern. Hypotension is considered present when the systolic blood
pressure decreases to 90 mmHg or lower (Potter et al., 2014, p. 523). In my opinion this
particular finding, must be my number one priority as a nurse. Hypotension could occur due to

RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

multiple factors. It is evident that due to the clients bulimic behaviour, has led to create an
imbalance in his system.
Clinical manifestation or complication
Establishing priorities or determining urgency of the identified health
problems is done on the basis of their severity or physiological importance.
Nursing diagnoses of conditions that, if untreated, result in harm to the client
or others have the highest priorities. For example, risk for other directed
violence, impaired gas exchange, and decreased cardiac output are typically
high-priority nursing diagnoses that raise issues of safety, adequate
oxygenation, and adequate circulation (Potter, 2014, p. 174). For this reason, I
would chose to focus on the clinical manifestation of decreased cardiac output as evidenced by
hypotension. Since Acute hypotension is the second leading cause of cardiac arrest and sudden
death, and is associated with tissue ischemia and progressive organ failure (Tuggle, 2010, p. 1),
I would focus my interventions towards preventing hypotension complications and correcting the
underlying cause of this issue.
As a nurse, I can assume that the clients hypotension might be due to an electrolyte
imbalance related to dehydration and/or malnutrition. Bulimia is a complex disorder. It is
generally considered that eating disorders, as with other psychological disorders and mental
illnesses, arise from a combination of factors, including biological/medical, psychological and
social or environmental factors (Burton, 2014, p. 606). Therefore, when formulating a plan of
care for a bulimic patient it is imperative for health care workers to look at the whole picture and

RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

try to not only correct the physiological effects of the disease, but also the underlying
psychological issues leading to this behavior.
However, given the circumstances of my client, I would primarily focus on correcting
and preventing the effects of hypotension. I do understand the importance of looking at the
psychosocial factors and issues; yet, once the clients pertinent physiological complications have
been stabilized, I can start exploring the underlying psychosocial issues that affect my clients
well-being.
Nursing Interventions
In order to address the issue of decreased cardiac output, I would assess the client for
possible signs of dehydration such as: low blood pressure, weak and thready pulses, decreased
body weight, temperature elevation, dry mucous membranes, decreased skin turgor, decreased
urine output, constipation and mental changes such as confusion, disorientation and
hallucinations (Ford and Roberts, 1995). In this scenario, dehydration could be caused by misuse
of laxatives and/or over-exercising as an effort to lose weight. In addition, misuse of laxatives is
associated with individuals with eating disorders (anorexia nervosa and bulimia nervosa). Their
primary function is for weight loss, as laxatives speed up the movement of feces through the
large intestine (Day, Wills & Coffey, 2014, p. 198). Moreover, if dehydration is evident, I would
correct it by administering IV fluids and this will also contribute to stabilizing clients low blood
pressure.
Another nursing intervention would be to assess the patients mental status. Low blood
pressure could be a sign of a hypovolemic shock. Hypovolemic shock, the most prevalent form
of hypo-perfusion, occurs when the vascular system loses blood or fluid either externally or

RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

internally, leading to a fall in perfusion pressure (Tuggle, 2010, p. 2). A hypovolemic shock is
an emergency; therefore, it is of extreme importance to assess for its signs such as low blood
pressure, cool, clammy skin and decreased level of consciousness (Lewis et al, 2014).
Also by monitoring the clients skin color, moisture, temperature and capillary reflex, I
can determine if the issue of decreased cardiac output has worsen or has compromised patients
airway. As mentioned before, client complains of dizziness and fatigue when ambulating;
therefore, I would assist patient during ambulation and ensure the environment is safe. By
finding the underlying cause of the decreased cardiac output, I would be able to take the
necessary steps to stabilize the client. Once client has been stabilized, I could focus on the
psychological issues leading to bulimic behaviours that have led to the physiological problems
presented. It is of extreme importance to educate the patient on the possible consequences of
bulimia and to seek appropriate collaborative care to treat the clients eating disorder.
Decreased cardiac output, should not be taken lightly because it could have devastating
consequences on clients. As a nurse, I would focus myself on determining the cause of decreased
cardiac output and I would also assess for possible complications that this issue can cause to the
client. Yet, most importantly my focus would be on correcting metabolic imbalances present in
order to prevent further fatal complications.

RUNNING HEAD: Scholarly Assignment: Concept Map and Paper

References
Burton, M. (2014). Understanding eating disorders in young people. Practice Nursing, 25(12),
606-610.
Day, M. R., Wills, T., & Coffey, A. (2014). Constipation and the pros and cons of laxatives for
older adults. Nursing & Residential Care, 16(4), 196-200.
Ford, D., & Roberts, B. (1995). Avoiding dehydration. Nursing, 25(8), [32CC].
Lewis et al,. (2014). Medical Surgical Nursing in Canada, 3rd Edition [VitalSource Bookshelf
version]. Retrieved from http://pageburstls.elsevier.com/books/978-1-926648-70-5
Potter, Perry, Ross-Kerr, al, e. (2014). Canadian Fundamentals of Nursing, 5th Edition
[VitalSource Bookshelf version]. Retrieved from
http://pageburstls.elsevier.com/books/978-1-926648-53-8
Tuggle, D. (2010). Hypotension and shock: the truth about blood pressure. ED Insider, 40, 1-5.
DOI: 10.1097/01