Josephine is a 20 year old female who is present for an eating disorder not otherwise specified. She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, but as soon as puberty hit, she has struggled to maintain her weight and since she is a salsa instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers. She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided you a 24 hour meal record:

Question

Josephine is a 20 year old female who is present for an eating disorder not otherwise specified. She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, but as soon as puberty hit, she has struggled to maintain her weight and since she is a salsa instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers. She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided you a 24 hour meal record: 
Breakfast: 
1-6” corn tortilla 
½ cup fried beans cooked with peppers, onions and oil 
½ cup rice 
1 cup no sugar added orange juice 
Lunch: 
1 slice of whole wheat bread 
2 slices turkey 
1 small apple 
Dinner: 
2- 6” tortillas 
Beef with onions, peppers cooked in oil 
Tomato, onion, pepper salad (made with oil and lime juice) 
2 cups of rice 
Height: 5’2” Weight: 117 pounds (based on your scale in the office) 
Labs: 
Test 	Result 	Reference Units 
Albumin (visceral protein stores) 	3.3 g/dL 	3.5-4.8 g/dL 
Sodium 	133 mEq/L 	136-145 mEq/L 
Potassium 	3.8 mEq/L 	3.5-5.2 mEq/L 
Iron 	0.4 mg/dL 	0.6-1.1 mg/dL 
Vitamin B12	185 pg/mL 	200-835 pg/mL

Questions for Unit 3: 
1.	What stage of change do you believe Josephine is in? In the above paragraph, what makes you determine she is in that stage of change? 
2.	For this situation, how would you establish a rapport with the client? 
3.	What personal boundaries would you establish for this seminar session? 
4.	What cultural considerations do you have to keep in mind? 
5.	What other physical or psychosocial questions would you ask this client?

bobpursley · Answer

If I were her doctor, I would declare an emergency: 1200 calories a day, and she is a dance instructor? Iron deficiency, protein deficiencey, caloric deficiency, vitamin deficiency, and she blames her Mom's cooking?

She needs to get ahold of her life: Turnip Greens every day. Stop the fried foods. Drink 2-3 glasses of milk every day.

And, as a doctor, I would look at her zinc levels, calcium, and folic acid levels.

I would discuss protein, iron, calcium reserves and the female body needs.

Now for you: The questions are obviously tied to your text material, I suspect the answers are in that material.

SraJMcGin · Answer

Although I will not attempt to answer your questions, here are some things that she might do:

1. If she MUST eat that way, she cuts the portions way down. (portion control) If she has a much smaller plate, she only eats what arranges on there.

2. Eating only 1 meal day is a PERFECT way to put on weight. If she had 6-7 small meals during the day it would help rev up her metabolism.

3. There are certain foods she can eat that are catabolic - that means they take more calories than they provide. No junk food snacks but fresh fruit and fresh veggies. (Even if she doesn't like them, if she's hungry enough and consumes them, she may learn to like them!)

Sra