Make an treatment plan and recommendation about the information below:
Tiffany Dale , a 15 year old girl, was seen with her mother for an initial family interview in an eating disorder program for children and adolescents. The first meeting was conducted on out patient basis. Mrs. Dale expresses concern about her daughter’s physical status. Tiffany is 5 4″ tall and weighs 80 lb. from the original weight of 120 lb. over the last 8 months and she experienced amenorrhea for the last 4 months.
Tiffany admitted to eating very little food , consisting of raw green vegetables. She drinks only water and diet soda on a restricted basis. she admitted to using vomiting only when her mother forces her to eat. she denied any use of diuretics, laxatives ,or ipecac, although she did complain of constipation. Tiffany has exercised very day for 2 hours but can no longer do this because she is too exhausted. Lanugo hair was evident on both her for arms , and her lips were dry and cracked. Tiffany wore layers of clothing and complained of constantly being cold. She kept her coat on throughout the interview. Her affect was flat , and she said little . She maintained minimal eye contact on interview. She was tearful at times. Answers given by Tiffany were slow and laborious in coming.
Family history revealed the Mr. and Mrs. Dale had a divorced when Tiffany was 3 year old. She has 2 older sisters. Mrs. Dale stated that Mr. Dale had been physically abusive of her and their girls. She also the questioned the possibility of sexual abuse of Tiffany by her father. Tiffany has always denied this. The family history was positive for depressive disorder and alcoholism on the paternal side. Tiffany admitted to long standing insomnia, decreased concentration and suicidal ideation. Tiffany continuous to attend high school, where she maintains a 4.0 grade point average. Tiffany used to be active in school clubs, cheerleading and dance. How ever she has withdrawn from all the exta-curricular activities and stays home, isolated in her room . She rarely spends times with friends.
Because of the findings revealed in the interview. Tiffany was hospitalized immediately in Children's hospital in adolescent medical unit. Her primary care physician was a pediatrician who consulted the eating disorder team, including the team's child psychiatrist. A complete physical examination was done and appropriate laboratory test were ordered. These showed sever metabolic acidosis, hypophosphatemia, elevated cholesterol and low serum zinc levels and anemia. there was brady cardia in the range of 45-49 beats per minute. An ECG was done and Tiffany was placed on strict bed rest with cardio respiratory monitor. She was started on IV fluids , and nasogastric tube was placed for feedings, which she resisted. The team dietician began to work on food related issues. The APRN on the team was designated as primary therapist. The team psychiatrist recommended a trial dose of Fluoxetine. A behavioral plan was instituted. The team Psychologist later conducted a full psychological profile . The primary plea nurse worked closely to the eating disorders team and constructed a plan of care for tiffany.