| Course | NUR-7631 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Child and Adolescent Populations, Part A |
|---|---|
| Module | Module 5 |
| Paper type | Case analysis: eating disorders |
| Length | About 1,024 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7631 Module 5
A Resting Pulse of 46 Is Not Fitness: Medical Risk, Level of Care and Family-Based Treatment for a 15-Year-Old Runner With Anorexia Nervosa
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7631: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Child and Adolescent Populations, Part A
Mentor Name
Month Day, Year
A Resting Pulse of 46 Is Not Fitness: Medical Risk, Level of Care and Family-Based Treatment for a 15-Year-Old Runner With Anorexia Nervosa
A Runner Who Kept Running
Leah, an invented patient, is 15 and runs varsity cross-country in Princeton. Over eight months she has lost 9 kilograms, cut out fats and desserts, run extra miles before school and stopped menstruating five months ago. Her coach noticed she looked gaunt. Her parents thought her slow pulse showed fitness. She says she is "not that thin" and fears gaining weight. Her body mass index is 15.8, about 78 percent of the median for her age and sex. Her resting heart rate is 46 lying down and rises by 35 beats on standing, and her blood pressure falls on standing. Her potassium and phosphorus are normal. The picture fits restricting-type anorexia nervosa.
An electrocardiogram shows a slow but regular rhythm with a normal QT interval, and her bone density has not yet been measured. Her mother mentions that Leah weighs herself several times a day and has started wearing baggy clothes, and that she leaves the table early to go for walks. These details, gathered from family, fill in what Leah herself minimizes.
How Dangerous Is This?
Treasure et al. (2020) place anorexia nervosa among the deadliest psychiatric illnesses, through both starvation's effects on the body and suicide, and note that it most often begins in the teenage years. Starvation slows the heart, weakens heart muscle, depletes electrolytes and thins bone.
A position paper on restrictive eating disorders lists criteria for hospital admission in adolescents (Society for Adolescent Health and Medicine, 2015). Among them are weight at three quarters or less of the expected median, a waking pulse under 50, pressure under 90/45, a pulse jump of more than 20 or a pressure fall of more than 10 on standing, abnormal salts in the blood and refusal to eat. Leah meets the heart rate and orthostatic criteria even though her weight is just above the threshold.
| Criterion | Threshold | Leah |
|---|---|---|
| Percent of median BMI | 75 percent or less | 78 percent |
| Daytime heart rate | Below 50 | 46 |
| Orthostatic pulse rise | More than 20 | 35 |
| Electrolytes | Abnormal | Normal |
Medical Stabilization
Leah is admitted to the adolescent medicine unit for a few days of monitoring while nutrition is restored. Refeeding syndrome, a dangerous shift of electrolytes when a starved body begins to receive food, is the main risk in the first days, so phosphorus, potassium and magnesium are checked daily and replaced as needed while calories are increased. Her heart rate is monitored continuously. Once her vital signs stabilize and she is eating reliably, she can be discharged to outpatient treatment.
During the admission Leah is frightened and angry, insisting she is fine. The nursing staff and nurse practitioner respond calmly and consistently, explaining each step and separating her from the illness in their language: the eating disorder wants her to skip the snack, while Leah's body needs it. That framing, used from the first day, prepares the family for the outpatient work to come.
Her parents are taught during the admission how meals will run at home: three meals and three snacks, plated by a parent, eaten together, with no talk of calories or weight at the table. Nurses model calm firmness at each meal so that her parents can see it done before they try it themselves.
Why Family-Based Treatment
Lock et al. (2010) randomized 121 adolescents with anorexia nervosa to family-based treatment or adolescent-focused individual therapy. At the end of treatment, full remission rates were similar, but at six and twelve months of follow-up, family-based treatment produced significantly more full remission. Family-based treatment also produced faster weight gain. Treasure et al. (2020) note that family-based treatment is the best-supported approach for adolescents.
Family-based treatment does not blame parents. It treats them as the most important resource for recovery, temporarily placing them in charge of refeeding at home because the illness has taken over the adolescent's decisions about food.
The Phases of Treatment
In the first phase, lasting several months, Leah's parents take charge of all meals and snacks, deciding what and how much she eats and supervising every meal, while the therapist helps them stay firm and calm. Running is suspended until her heart rate and weight recover. The therapist separates the illness from Leah, so that the family fights the eating disorder, not her. In the second phase, as weight approaches a healthy level and eating becomes less of a battle, control over eating is gradually returned to Leah. In the third phase, the focus shifts to normal adolescent development, her identity beyond running and preventing relapse.
The PMHNP's Role
The psychiatric nurse practitioner coordinates with the pediatrician, who monitors weight and vital signs weekly, and with a dietitian. No medication is approved for anorexia nervosa, and antidepressants do not help weight restoration in underweight patients; low mood and anxiety often improve with refeeding and are reassessed then. Suicide risk is asked about at every visit, given the illness's mortality.
Her coach and school nurse are included with her consent. The coach agrees that she will not run with the team until her physician clears her in writing, which removes the pressure from her parents to argue about it each week, and the school nurse supervises a lunchtime snack during the first months.
Measuring Progress
Weight and vital signs are checked weekly, with a target weight based on her growth curve before the illness. Return of menstruation is a later marker of recovery. Her return to running is tied to medical stability and agreed in writing.
Her bone health is checked with a scan after several months of weight restoration, since prolonged low weight and missed periods thin bone during the years when it should be strengthening.
Conclusion
Leah's anorexia nervosa looked like athletic fitness to those around her, but her heart rate and orthostatic changes meet criteria for admission. After brief medical stabilization with careful monitoring for refeeding syndrome, family-based treatment, which produced more full remission at follow-up than individual therapy, offers the best-supported route to recovery, with her parents as partners rather than causes.
References
Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025-1032. https://doi.org/10.1001/archgenpsychiatry.2010.128
Society for Adolescent Health and Medicine. (2015). Position paper of the Society for Adolescent Health and Medicine: Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 56(1), 121-125. https://doi.org/10.1016/j.jadohealth.2014.10.259
Treasure, J., Duarte, T. A., & Schmidt, U. (2020). Eating disorders. The Lancet, 395(10227), 899-911. https://doi.org/10.1016/S0140-6736(20)30059-3
Reading the NUR 7631 Module 5 assignment instructions
Mental health concerns common among young people are a theme of the NUR-7631 catalog description, and as the syllabus is not available outside the course, this fifth module takes up an eating disorder. Expect a case analysis that assesses medical risk against published criteria, decides the level of care, explains the treatment with the strongest adolescent evidence and coordinates the team. Some classrooms set bulimia nervosa or avoidant restrictive food intake disorder instead. Check what the prompt names. Compare the adolescent's vital signs and labs with the criteria one by one, and do not let a normal-looking weight hide medical danger. Gather details from family, since patients often minimize. Name the admission criteria and the monitoring for refeeding.
How this NUR 7631 Module 5 example is built
Leah's eight months of weight loss, extra running and absent periods open the case, with her parents mistaking a slow pulse for fitness. A review describes the illness's mortality and medical effects. The adolescent medicine position paper's admission criteria are applied in a four-row table, showing she qualifies through her vital signs. Brief stabilization with refeeding monitoring follows. A trial comparing family-based treatment with individual therapy supports the choice, and its three phases are described. The PMHNP's coordinating role, the absence of effective medication for weight restoration and the measures lead to the conclusion. The coach and school nurse are brought into the plan. Her parents watch nurses run meals before taking them over.
Reading the NUR 7631 Module 5 grading rubric
Eating disorder cases are graded on accurate medical risk assessment against published criteria, an appropriate level of care, recognition of refeeding risk, an evidence-based treatment for the age group and team coordination. Mentors look for vital signs and electrolytes, not weight alone, used to judge danger. Family-based treatment should be described by its phases and its nonblaming stance. Statements about medication should reflect the evidence. Suicide risk assessment is expected. APA references, including the group-authored position paper, complete the grade. Including the school and coach, and checking bone health, shows thoroughness. Daily phosphorus checks in the first week of refeeding should be stated.
Common NUR 7631 Module 5 mistakes, and how to avoid them
A common error is deciding level of care by weight alone; heart rate, orthostatic changes and electrolytes often matter more. Apply each criterion. Another frequent gap is omitting refeeding syndrome. Describe family-based treatment by its phases, and avoid language that blames parents. Do not prescribe antidepressants to restore weight. Coordinate with pediatric and nutrition colleagues. Ask about suicide. Address when sports may resume. For your own NUR-7631 eating disorder case, the desk will write a first draft without charge. Agree in writing when sport may resume, and check bone health. State the admission criteria with her actual heart rate and weight. Then show how the family takes over meals at home after discharge.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 7631 and M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner sample papers
- NUR 7631 Module 1: Adolescent Substance Use Case: CRAFFT Screening and Cannabis Use Disorder
- NUR 7631 Module 2: Adolescent Depression Case: Fluoxetine, CBT and the Suicidality Warning
- NUR 7631 Module 3: Autism Case: Irritability, Parent Training, Risperidone and Aripiprazole
- NUR 7631 Module 4: Childhood Trauma Case: Trauma-Focused CBT After Witnessing Violence
- NUR 7631 Module 6: Early-Onset Psychosis Case: Antipsychotic Choice and Metabolic Monitoring
- NUR 7642 Module 1: Panic Disorder Case: PDSS Rating, CBT, Medicine and the Combined Treatment Question
- NUR 7632 Module 1: Adult Depression Case: PHQ-9 Severity, First Antidepressant and STAR*D
- NUR 7610 Module 3: Practice Setting Paper: The PMHNP in Collaborative Care
- NUR 7641 Module 4: Pediatric OCD Case: CY-BOCS, Exposure Therapy and an SSRI
NUR 7631 Module 5 questions, answered
Where can I find a free NUR 7631 Module 5 sample paper?
Leah's case, from admission criteria to family-based treatment, is printed above.
When should an adolescent with anorexia be hospitalized?
Criteria include a weight no higher than three quarters of the median BMI for her age, daytime heart rate below 50, low blood pressure, significant orthostatic changes, electrolyte abnormalities and acute food refusal.
What is refeeding syndrome?
A dangerous shift of phosphorus, potassium and magnesium when a starved body begins to receive food, requiring daily electrolyte monitoring early in treatment.
What is family-based treatment for anorexia nervosa?
A treatment that temporarily puts parents in charge of refeeding at home, then gradually returns control to the adolescent, without blaming the family.
Is family-based treatment better than individual therapy for adolescents with anorexia?
In a randomized trial, it produced similar remission at the end of treatment but more full remission at six and twelve months.