Medical instability comes first in this MN665 Unit 4 assessment of a composite teenager with anorexia, followed by refeeding risk and self-harm, each with its own named response. Searches like "mn 665 unit 4 assignment example", "mn665 unit 4 sample" and "mn665 unit 4 example" land here.
Risk Assessment for a 15-Year-Old Violist With Restrictive Anorexia Nervosa: Cardiac, Refeeding, Self-Harm and Exercise Domains
[Student Name]
Purdue University Global
MN665: PMHNP Diagnosis and Management Across the Lifespan II
Unit 4 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Values are composite; nothing here is a treatment protocol.
Background
A composite 15-year-old high school sophomore plays viola in her city's youth orchestra. Over five months she has lost 9 kg by cutting her intake to about one meal a day and running every morning before school. Her mother noticed when she fainted briefly at a rehearsal and brought her to the clinic. She meets criteria for anorexia nervosa, restricting type. During the interview, when asked directly, she said she had cut her forearm twice about two months ago and had told no one.
Domains are ordered by how quickly each could harm her. That places cardiovascular instability first, not because it matters more than self-harm, but because it could end her life within days if missed.
Domain 1: Medical Instability
Factors. Bradycardia, low blood pressure, an orthostatic pulse rise and severe malnutrition.
Evidence. A 2022 position paper lists criteria that justify hospitalization for medical stabilization in adolescents with restrictive eating disorders (Society for Adolescent Health and Medicine, 2022). They include a daytime heart rate below 50 beats per minute, blood pressure below 90/45, a sustained standing rise in heart rate of more than 40 beats per minute in those under 19, and a weight at or below 75 percent of median BMI for age and sex. Her values sit beside them:
Heart rate while awake: 44 beats per minute, against a threshold of below 50. Met.
Blood pressure: 86/52, with systolic pressure below 90. Met on systolic pressure.
Standing rise in heart rate: 38 beats per minute, against a threshold of more than 40. Not met, but close.
Weight: 74 percent of median BMI, against a threshold of 75 percent or less. Met.
Her electrocardiogram shows sinus bradycardia with a normal QT interval. Her temperature is normal.
Response. Three of the listed criteria are met on their own, and any one is enough to justify admission for medical stabilization. She is referred for inpatient admission today, with cardiac monitoring.
Domain 2: Refeeding Risk
Factors. Rapid weight loss, very low intake and a phosphate level already at the low edge of normal.
Evidence. Refeeding syndrome arises from treatment itself: when nutrition is restored after starvation, insulin release drives phosphate, potassium and magnesium into cells, and blood levels can fall to dangerous lows, with effects on the heart, breathing and muscles. The ASPEN consensus lists risk criteria that include significant weight loss over recent months, very low energy intake and low electrolyte levels before feeding begins (da Silva et al., 2020). She has lost about 18 percent of her body weight in five months, has eaten about one meal a day for months and has a phosphate at the low edge of normal. She meets several risk criteria.
Response. The plan to restore intake is paired with monitoring: phosphate, potassium and magnesium checked at least daily for the first several days of feeding, with replacement as needed and a daily check of her heart rate and rhythm. The same position paper notes that inpatient refeeding can start with more calories and advance faster than older protocols advised (Society for Adolescent Health and Medicine, 2022), so monitoring is what makes a faster start safe.
Domain 3: Self-Harm
Factors. Two episodes of cutting, kept secret, and the distress that accompanies a restrictive eating disorder.
Evidence. She was screened with the Ask Suicide-Screening Questions, four questions developed for pediatric emergency settings (Horowitz et al., 2012). Her one positive answer was to the question about wishing she were dead in recent weeks; she said no to current thoughts of killing herself, to a plan and to a past attempt. A positive screen leads to a brief suicide safety assessment, which was done in the clinic: she describes the cutting as a way to "feel something other than hungry," denies any intent to die, and names her younger brother and the orchestra as reasons to keep going.
Response. The screen is positive and the brief assessment finds no imminent risk. She is not placed on constant observation, but a safety plan is written with her before admission, the unit is told about the cuts and the screen, and sharp objects are managed on the ward as for any patient with recent self-harm.
Domain 4: Compulsive Exercise
Factors. Daily running before school, which she hid from her parents by leaving before they woke, and walking the halls between classes.
Evidence. She runs about 5 miles each morning regardless of weather or fatigue and says she feels "panicked" if she misses a day. With a heart rate of 44 and orthostatic symptoms, strenuous exercise adds to her cardiac risk, and the calories spent add to her weight loss.
Response. Exercise is stopped during medical stabilization, the ward team is told that she may try to exercise in her room, and her treating team will plan a gradual, supervised return to activity once she is medically stable, since orchestra practice and walking to school must eventually resume.
Protective Factors
Her mother is closely involved, noticed the problem and brought her in. Her father has agreed to take leave to share visits. She wants to return to the orchestra for its spring concert, which gives her a reason to recover that is her own rather than her parents'. She has a close friend in the viola section who she says she would talk to if things got worse. These factors are real, but they do not lower the medical risk: a supportive family does not change a heart rate of 44.
Overall Level and Setting of Care
Overall risk: high, driven by medical instability, with moderate refeeding risk and self-harm risk that is present but not imminent. Setting: inpatient medical admission for stabilization and supervised refeeding, followed by family-based treatment as an outpatient once she is stable, since it is the first-line outpatient treatment for adolescents with anorexia nervosa (Society for Adolescent Health and Medicine, 2022). She and her mother were told the reasons in plain terms, beginning with her heart rate.
References
da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., Cober, M. P., Evans, D. C., Greaves, J. R., Gura, K. M., Michalski, A., Plogsted, S., Sacks, G. S., Tucker, A. M., Worthington, P., Walker, R. N., Ayers, P., & Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. (2020). ASPEN consensus recommendations for refeeding syndrome. Nutrition in Clinical Practice, 35(2), 178-195. https://doi.org/10.1002/ncp.10474
Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., Wharff, E. A., Ginnis, K., Cannon, E., Joshi, P., & Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170-1176. https://doi.org/10.1001/archpediatrics.2012.1276
Society for Adolescent Health and Medicine. (2022). Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 71(5), 648-654. https://doi.org/10.1016/j.jadohealth.2022.08.006
How this MN665 Unit 4 example is structured
Domains are ordered by how quickly each could harm her, which puts cardiovascular instability ahead of self-harm without ranking one as more serious. Within each domain the assessment moves from factor to evidence to response, so no risk is named without the finding that establishes it and the action it would prompt. Thresholds are quoted from their sources rather than paraphrased, and every value of hers is bracketed beside them. Refeeding risk gets its own domain because it arises from treatment itself: the nutrition she needs is what could drop her phosphate, so the assessment pairs any plan to restore intake with monitoring of electrolytes in the first days. The self-harm section follows the screening pathway its instrument belongs to, positive screen, brief assessment, then disposition. The overall level is stated once, with the reasoning, and translated into a setting of care.
Get an MN665 Unit 4 example written to your instructions
Vital signs, labs and screening results matter most here, so include every one the MN665 Unit 4 case gives, plus the rubric. A free first custom assessment comes back in 24-48h, working each risk domain from factor to evidence to response and closing on a level of care that follows from them. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN665 Unit 4 questions, answered
Why does a psychiatric risk assessment include medical findings?
Because in some disorders the most immediate danger is physical. Anorexia nervosa can destabilize heart rate, blood pressure and electrolytes, and those findings can decide the level of care before any psychiatric factor does. A risk assessment that stops at mood and self-harm leaves out the risk most likely to cause harm soonest in this presentation.
Which suicide screening tool suits an adolescent?
Choose one validated for this age group and setting, and say why. The Ask Suicide-Screening Questions were developed for young people in medical settings, and a positive screen leads to a brief safety assessment rather than a conclusion. Whatever tool you use, report the result, follow its pathway and state the response it produced.
How specific should the stated response be?
Specific enough that the next person knows what happens. Name the setting of care each level points to, the monitoring it requires and who is contacted. A response written as closer follow-up gives no instruction, while one naming medical admission for monitored refeeding, or a same-day safety assessment, shows the reasoning carried through to action.