LTC & ED & HD
Hi all! I need some insight/tips on a case I am struggling with at the moment.
Patient is a female in long term care and started a few months ago on hemodialysis 3x/week. She is cognitively intact, full code, and under 65 y/o. She previously had an order for “no weights” due to fear of being weighed/knowing her weight. She reports a history of eating disorder (not many details available as she has not received treatment for it while at the facility, though it sounds like anorexia/restriction from what she tells me). Current weight is clinically appropriate but she feels it is too high/desires loss.
So far I am in communication with the MD and dialysis dietitian and have a psych referral pending. Her diet is already liberalized and she does take nepro with no objection at the moment. I am struggling with the balance between the need for post-dialysis weight trending vs limiting her mental distress surrounding the scale and being weighed (asked MD if we could reduce weight frequency…). It is difficult to have a detailed discussion about her health and dialysis progress while avoiding triggering numerical data points/trends. Care plan reflects her feelings around being weighed and staff knows she does not want to know weight values.
I have been in LTC for <3 years so have limited exposure to eating disorders in this population to start with, but throw dialysis in the mix and I am even more out of my wheel house. What am I missing?? Any other referrals/interventions that have worked in your experience?
TY in advance for letting me pick your brains!