A patient with anorexia nervosa refuses meals and presents with hypotension, bradycardia, cold extremities, and extreme fatigue.
Which nursing action is the priority?

Question

BlackTom AI · Accepted Answer

Medical instability in anorexia nervosa is signaled by hypotension, bradycardia, cold extremities, and extreme fatigue; these findings require immediate clinical reassessment and provider notification.

1. Relevant knowledge points and concepts
- Medical instability criteria in eating disorders include significant bradycardia (often <40–50 bpm), hypotension (systolic BP <90 mm Hg), hypothermia (cold extremities, low core temperature), syncope, and severe fatigue.  
- These signs indicate risk for life-threatening complications: cardiac arrhythmias, circulatory collapse, electrolyte disturbances (e.g., hypokalemia), and organ dysfunction.  
- Nursing priorities follow the ABCs (airway, breathing, circulation) and rapid escalation when a patient is medically unstable.

2. Step-by-step reasoning process
- Step 1: Identify objective red flags in the vignette: hypotension and bradycardia are present along with poor perfusion (cold extremities) and extreme fatigue.  
- Step 2: Interpret these findings as markers of medical instability rather than routine psychiatric care needs.  
- Step 3: Prioritize immediate actions that address safety and medical stabilization: continuous monitoring (vitals, cardiac telemetry), obtain ECG and labs as ordered, place on fall precautions, and notify the provider/medical team for urgent assessment and likely admission or treatment changes.

3. Intermediate clinical considerations (no numeric calculations)
- Obtain baseline ECG because severe bradycardia and malnutrition increase arrhythmia risk.  
- Check electrolytes, especially potassium, magnesium, and phosphate.  
- Prepare for possible transfer to a higher level of care.

4. Why the correct answer is correct
- Notifying the provider is the highest-priority nursing action when objective signs indicate medical instability; it initiates immediate medical assessment and interventions that can prevent deterioration or death.

5. Why other options are incorrect
- Offering nutritional pamphlets and encouraging journaling are educational/therapeutic but nonurgent.  
- Providing privacy during meals may support long-term care but does not address imminent physiological danger. None of those address acute risk.

6. Conclusion
Given the patient’s hypotension, bradycardia, poor perfusion, and extreme fatigue—clear indicators of medical instability—the priority nursing action is to notify the provider due to clinical indicators of medical instability, which matches the provided correct answer.

A patient with anorexia nervosa refuses meals and presents with hypotension, bradycardia, cold extremities, and extreme fatigue. Which nursing action is the priority?单项选择题

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