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Kasey Gaines iHuman Case Study Answers

Kasey Gaines iHuman Case Study Answers

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)

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)

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)



Think ahead to the pediatric patients and families you may meet in this i-Human Case Study Assignment and, based on the Learning Resources, the types of gastrointestinal conditions that may be waiting for you in your virtual office on the i-Human platform. Have in mind GI conditions that you would particularly like to address in the avatar setting. Also reflect on your previous i-Human case studies and consider a child of an age, race, or ethnicity that you have not yet examined and would expand your experience to do so this week.



Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

To prepare:

Review this week’s Learning Resources. Consider how to apply knowledge of gastrointestinal conditions and understanding of socio-cultural family needs to assessing, diagnosing, and treating pediatric patients. 
Access i-Human Patients from this week’s Learning Resources and review the Kasey Gaines iHuman Case Study Answers. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis. 
Identify 3–5 possible conditions that may be considered in a differential diagnosis for the patient. 
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis. 
Develop a treatment plan for the patient that includes health promotion and patient education strategies for pediatric patients with gastrointestinal conditions and their families. 

The Assignment:
As you interact with the i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.


Complete your Assignment in i-Human, Kasey Gaines iHuman Case Study Answers.
You will access i-Human from the Access i-Human link located in the Start Here module.

Key Findings and Problem Statement
Case: Key Findings
Key Finding

20lb weight loss; BMI 15.7
Restricting food
Avoidance of carbohydrates
Excessive exercise; including middle of the night exercise
Preoccupation with food
Use of laxatives to lose weight (alleged constipation)
Body-image distortions
Mirror gazing
Anxiety regarding other people perceiving her as fat
Secondary amenorrhea
Orthostatic hypotension; one syncopal episode
Stress fracture three months ago
Mild loss of interest
Mild dysphoria
High academic achievement, with perfectionistic traits
Rough, dry skin, dry, thin scalp hair
Lanugo body hair
Abrasions and calluses on dorsum of right hand
Cracked lips, mild angular stomatitis
Dental erosion
Bilaterally enlarged parotid glands
Parental divorce one year ago

Case: Problem Statement 
The patient is a 16-year-old female with a progressive 20-pound weight loss over the last 6 months associated with food restricting, food preoccupation, excessive exercise, and subjective feelings of being overweight despite being severely underweight (BMI 15.7). Periods of restriction are interspersed with episodes of binging-eating and self-induced vomiting (two times per week on the average), as well as the use of laxatives for “constipation.” Other general health concerns include secondary amenorrhea and a recent metatarsal stress fracture. She reports tiredness, as well as a mild loss of interest in usual activities. Psychosocial stressors include striving for straight A’s; splitting of her family following parental divorce one year ago; and, social anxieties/phobias surrounding others perceptions of her weight. She is interested in entering the fashion industry. Physical findings are significant for orthostatic hypotension, dry skin and scalp hair, lanugo body hair, calluses of the dorsal aspect of the right hand, mild angular stomatitis, bilateral parotid enlargement, and secondary sexual development consistent with Tanner stage 4.

Kasey Gaines iHuman Case Study Answers – Management Plan
Case: Management Plan
Key elements of the management plan for the patient will include the following;

 Determine appropriate level of care
 Screen for medical comorbidities.
 Institute nutritional rehabilitation
 Monitor for refeeding syndrome.
 Restrict exercise to level appropriate for medical status
 Provide psychoeducation.
 Initiate cognitive-behavioral therapy.
Promote family therapy.
 Discuss pros and cons of pharmacological therapy for anorexia nervosa
 Screen for and treat comorbid depressive and anxiety features

A decision needs to be made regarding the level of care warranted in treating this specific patient. Treatment of anorexia spans outpatient, partial hospitalization (day hospitalization), and inpatient hospitalization. Inpatient hospitalization should be considered in those individuals with life-threatening medical complications, those weighing less than 75% of ideal body weight, and those losing weight at a rapid rate.
Any patient with anorexia nervosa should be screened for any medical conditions contributing to the presentation and/or any medical complications of starvation. Any and all medical concerns should be actively addressed.
Nutritional rehabilitation is the mainstay of initial management of anorexia nervosa. Refeeding is usually started at 30-40 kcal/kg/day and advanced gradually based on the patient’s weight gain. The goal is usually a 0.5- to 1-pound weight gain per week in outpatients, and a 2- to 3-pound gain per week in inpatients. In some patients nasogastric tube feeding is utilized, parenteral nutrition, however, is reserved for cases of extreme malnutrition.
Patients undergoing nutritional replenishment should be monitored closely for manifestations of refeeding syndrome. Upon refeeding, a malnourished individual undergoes a shift from fat to carbohydrate metabolism with a corresponding increase insulin secretion and anabolism. There is a resulting increase in phosphate uptake at the cellular level In addition to potentially severe hypophosphatemia and fluid and glucose disturbances, other electrolyte abnormalities may include hypomagnesemia, and hypokalemia. Complications, as described below, may occur with any route of caloric intake and typically manifests within four days of refeeding.
The metabolic abnormalities, principally electrolyte and fluid disturbances, resulting from the refeeding syndrome can influence many body functions. The fluid intolerance can result in cardiac failure, dehydration or fluid overload, hypotension, prerenal failure, and sudden death. Refeeding with carbohydrates can reduce water and sodium excretion, resulting in expansion of the extracellular-fluid compartment and weight gain, particularly if sodium intake is increased. Refeeding with predominately protein or lipid can result in weight loss and urinary sodium excretion, leading to negative sodium balance. High protein feeding also can result in hypernatremia associated with hypertonic dehydration, azotemia, and metabolic acidosis.
From: Crook MA, Hally V, Panteli JV. The importance of refeeding_syndrome. Nutrition. 2001; 17(7, 8) 632-637. Patients who are severely undemourished are at a higher risk for refeeding syndrome. Nutritional replenishment should be done in a more gradual manner, starting low and increasing gradually.
Exercise should be permitted basing on medical stability and improvement made by the patient.
Along with weight restoration, treatment includes psychoeducation, family therapy, and cognitive behavioral therapy (CBT directed toward weight gain. These treatment modalities are preceded by a careful assessment of the patient’s body-image perception, self-assessment of target weight, and history of previous weight reduction attempts

 CBT focuses on improving self-esteem, reducing psychological emphasis on weight and shape, addressing rigid eating-related rules, improving food choices, and reducing weight-restriction measures.
•Another popular psychotherapy modality is the Maudsley approach whereby parents are encouraged to take control of the patient’s weight restoration initially and with the patient’s increasing weight gain, control is gradually delegated to the patient
Family therapy has utility in addressing family dynamics that contribute to the patient’s eating disorder and in helping the family provide appropriate emotional support. Relapse-prevention strategies are usually formulated in these sessions.

Pharmacotherapy has a limited role in the treatment of anorexia nervosa. There is current debate regarding the use of atypical antipsychotics for their weight-gain side effect. When this class of drugs is used for anorexia alone, patient fear of excessive weight gain and medication adherence are often problems.
Patients with anorexia nervosa should be screened for comorbid depressive disorders and anxiety disorders. When present these comorbidities should be treated with either psychotherapy, pharmacotherapy, or the two modalities in combination. Selective serotonin reuptake inhibitors (SSRIs) have utility in treating comorbid bulimia nervosa, depressive disorders. Kasey Gaines iHuman Case Study Answers

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