Nursing: a Borderline Personality Disorder - Case Study Example

Case study, nursing Background Personality behaviors are lasting patterns of perceiving, connecting to, and reflecting about oneself and the environment. They are portrayed in an extensive range of vital individual and social backgrounds. When these behaviors are considerably maladaptive and lead to severe functional impairment or biased distress, they add up to a character disorder. The appearances of character disorders are frequently identified by teenage years and continue all through most of grown-up life. These disorders are not officially identified in patients less than eighteen due to the continuing growth changes. But, if the disorder is persistent and if the criteria are completely and constantly fulfilled and are not restricted to a growth phase, detecting borderline personality disorder in teenagers and kids is proper. Historically, BPD has been perceived to be lying on the margin between neurosis and psychosis. It is typified through marked unsteadiness in functioning, mood, affect, interpersonal links and sometimes reality test. This disorder was conceptualized in 1975 by Kernberg to describe a collection of patients with specific prehistoric defense systems and pathologic object associations that are internalized. Case study The client is a forty four year old woman with a borderline personality disorder (BPD). She has a history of frequent presentation to the hospital. In addition, she has accommodation issues; legal Avo on her by her daughter, her legal status is involuntary. She is well known to police, poor coping skills, has concrete thinking also deemed as OHS hazard, finances under the financial management order, her medications as listed sodium valproate 500mg BD, pantoprazole 20mg mane steraline 50 mg mane, PRN med TDS ibuprofen 400mg. She also has allied support issues. History of client’s diagnoses The client felt emotions often, more profoundly and for prolonged periods. In addition, she had a history of reinitiating and even lengthening her emotional responses for longer periods. As a result, this took her a long period to go back to a steady emotional baseline after going through a strong emotional experience. The client was exceptionally happy, idealistic, and affectionate. However, she at times felt besieged by negative feelings, going through deep anguish rather than sorrow, disgrace and humiliation rather gentle embarrassment, anger instead of displeasure, and fright instead of anxiety. The client was particularly responsive to emotions of isolation, rejection, and apparent failure (Boyd 459). The client as well demonstrated impulsive traits regularly. The diagnoses reported repeated threats of self-harm, where the client’s history revealed that she has attempted to commit suicide several times. She as well portrayed impulsive conduct especially excessive drinking of alcohol. The client has a history of getting involved in unsteady relations, which regularly resulted to emotional ruin. These included abuse of alcohol and having sexual relations with several partners, changing jobs regularly, shoplifting, quitting relationships and self-harm. Self-injury or suicidal conduct is among the basic diagnostic condition in the DSM IV-TR. Recovery and management of this behavior is difficult and demanding. The reasons reported by the client to self-harm and attempting suicide entails articulating anger, creating usual emotions, self-punishment and distracting herself from emotional anguish or hard situations. The client had problems of concentrating often. The strong feelings of individuals with borderline personality can render it hard for them to regulate the focus of their concentration. She demonstrated dissociation in reaction to a painful episode and in cases where she remembered a painful experience. This involved directing complete or partial concentration away from the episode. Though this helps in relieving painful feelings, it repressed the usual experience of feelings, and reduces the potential of patients with borderline personality to operate in their day to day activities. At times it is likely to detect when the client is dissociating since her vocal and facial expressions seem very distracted. Other times it may be hardly observable (Boyd 259). Client’s nursing care Living with BPD can be hard. The patient may wholly discover that their thoughts and traits are self-damaging but they lack the ability to regulate them. Treatment and care can aid in managing the patient’s condition and they can have improved feelings. This care will include helping the client to follow her treatment plan, attending treatment sessions as planned, helping the client to practice better ways of relieving painful feelings, instead of inflicting self-harm and helping the client learn the kind of objects that stimulate anger or impulsive conduct. Medical care Treatment for patients with BPD has improved recently as a result of adoption of methods particularly aimed at individuals with BPD. Treatment entails: drugs. However drugs cannot cure borderline personality but they can aid in related problems for instance anxiety, impulsivity and depression. Drugs might encompass antianxiety, antipsychotic and antidepressants (Boyd 259). The client may also undergo psychotherapy-the basic cure for borderline personality. A behavior known as dialectical therapy was intended to particularly treat BPD. This kind of treatment is commonly carried out through the phone, group and individual counseling and employs an approach that is based on skills to instruct the patients on the way to control their feelings endure distress and enhance relations. The next treatment which can be provided to the client is hospitalization. Occasionally, the client may require a powerful therapy in a psychiatric clinic or hospital. Hospitalization may help to secure the client from self-harm. Due to the fact that therapy may last for a long time and could be intense, it is recommendable for the client to look for psychological medical providers who have experience in treating borderline personality. Self-care Self care is as well recommended. The client should learn about the disorder so as to comprehend its origin and get an improved treatment. She should moreover get in touch with other patients suffering from borderline personality to share experiences and insights. The client should not blame herself for suffering from the disorder; however she should realize her role to get therapy. Psychological and drug therapy When a verdict has been arrived at to provide mental therapy to a client with BPD, medical care experts must provide one that offers treatment in two modalities (.e.g. Group or person), got a well- organized program and a logical hypothesis of practice. The structure of the service should encompass psychotherapist control. Short psychotherapeutic interventions must not be employed especially for BPD or for particular signs of the disorder. Medication therapy must not be employed especially for BPD or for personal signs or conduct related to the disorder (for instance, regular self-injury, the conduct of taking risks, as well as temporary psychotic signs). Temporary employment of sedative drugs might be considered carefully as a piece of the general therapy plan for the client in a crisis. The period of therapy must be approved by the client; however it should not extent a week (Boyd 89). When considering mental therapy for any reason for the client, and to guarantee that well informed consent can be provided, health experts must provide the client a written material concerning therapy model and the proof for its efficiency in the cure of borderline personality, and must provide a chance to discuss this. When considering this kind of treatment, medical experts should consider the below factors: Client preference and choice The extent of harm and harshness of the disorder Individual and expert support The client’s desire to engage in the treatment and her drive to transform The frequency and the degree to which the client employs the service Case management Case management is a joint procedure of evaluation, planning, support and facilitation for choices and services to meet a person’s holistic wants through accessible resources and communication to encourage quality gainful results. The description of case management pays attention on meeting the health requirements of a client. The values that support case management are personalized delivery of service based on inclusive evaluation employed to create a service or case plan. The plan is created in partnership with the client and mirrors their preferences and choices for the service preparations being created. The objective is to authorize the client and guarantee that she is involved in all facets of the planning and preparation of services in a dynamic method. The person in charge of case management coordinates the procedure, discussing with casual care takers and major service suppliers to guarantee that the plan is created properly, clearly contracted and monitored for efficient and financially liable service delivery grounded on desired and specified results. Assessing the client’s care The community psychological medical services must be accountable for the regular evaluation, cure and management of individual’s with BPD. When the client pays the first visit to the community health experts an appointment is provided to carry out an assessment of the disorder. During the assessment, medical experts must clearly describe the procedure. They should also clearly explain the significance of having BPD. They will enquire about the client’s conduct, emotions and thoughts and the way she handles any difficulties in diverse areas of her living, entailing any additional psychological health hitches. They will as well discuss with the client if she requires mental therapy, social support and care in obtaining proper education, work or training. They must develop a care plan for the client (Schultz and Videbeck 304). The client’s therapy and care should consider her private wants and preferences, and she has the right to get complete information as well as to reach at decisions in association with medical care team. To assist with this, her medical care team must provide her with the data that she can comprehend and that is appropriate to her condition. Every healthcare expert ought to treat her with respect, understanding and sensitivity. The healthcare experts should as well clearly and simply explain the disorder and the therapy to the client. The data the client obtains from her medical care should entail facts of the likely dangers and benefits of specific therapy. The client is free to make inquiries and can regularly change her decisions as the treatment continues or her status transform. Her personal choice for a specific treatment is crucial and her team of medical experts must support her choice of therapy where applicable. The clients therapy and care, and the data she is provided with, must consider any ethnic, religious or cultural wants she might have. It must as well put into consideration any other factors for instance learning or bodily disabilities, hearing or sight difficulties, or problems with speaking or reading English. The client’s medical care team must be capable of organizing for an interpreter or an activist if required (Boyd 459). In case the client agrees to the involvement of caretakers and relatives, they ought to be engaged in reaching decisions concerning her care. Relatives and care providers posses the right to support and data they require in their responsibilities as caregivers. In case the client is not able to comprehend a given concern or she lacks capacity to arrive at her personal decisions health experts must follow the advice provided by the health department. The client’s health care experts must as well follow the code of practice for the psychological health capacity regulation. Diagnoses Personality disorders are detected on the basis of symptoms and signs through a psychological assessment. For the client to be diagnosed with this disorder, she must meet the conditions stated in the DSM. The guidebook is employed by experts in psychological health to diagnose psychological status and by indemnity organizations to reimburse for therapy (Boyd 459). The DSM-IV-TR explains the major aspects of BPD as impulsive traits and unsteadiness of feelings, interpersonal connections, self-appearance, and states a criteria to portray the presence of these aspects. Since several mental health experts found it challenging to detect borderline personality in the client by the use of conditions in DSM-IV-TR, they addressed this concern by grouping the signs of the disorder that were evident in the client under five major states of dysregulation: behavior, emotions, self sense, interpersonal links and cognition. The diagnosis was based on clinical examination by a qualified psychological health expert. The examination included the client’s personal reported experiences in addition to the medical practitioner’s observations. With the client’s permission, the examination included interrogating friends and relatives. An individual diagnosed with BPD will exhibit most of these signs which considerably influences her life. The signs include: hardships in creating and keeping relations, self-harm and undertaking activities without reflecting on the outcomes, unsteady emotions, having delusions and hallucinations and substance abuse among others. Individuals suffering from BPD come from diverse settings; however most of them have suffered from neglect in childhood or trauma (Schultz and Videbeck 304). A care plan The client should get most of her therapy from community psychological medical service. Groups working with individuals with borderline personality must create an inclusive multidisciplinary care plan in partnership with service consumers and their caretakers, and where possible the client. The plan of care ought to: Clearly establish the functions and duties of all medical and social care experts. Establish long-term objectives that the individual would like to accomplish, which must emphasize on the general therapy policy; these objectives must be reasonable, and related to the short-term therapy aims. Find out controllable short-term cure objectives and specify measures that the client may take so that to attain them. Create a crisis plan that spells out potential activators that may result to a crisis, establishes self-management policies likely to be efficient and identifies an approved plan for getting services when self-management policies only are not adequate. All medical care experts working with the borderline personality client must guarantee that therapy and delivery of service are well integrated. The care plan and treatment should be executed and when the client’s community psychological medical service thinks that the client is well enough to depart the service, client’s care will be shifted to a primary care expert for instance a GP for constant support. This should be discussed with both the client and her relatives or carers. The client and the family should also consent a plan that provides guidelines which she can take to manage crises and how to get in touch with the community psychological health service another time if required. Works Cited Boyd, Morris. Psychiatric Nursing. Philadelphia, Pa: Lippincott Williams & Wilkins, 2007. Print. Schultz, Judith M, & Sheila L. Videbeck. Lippincott's Manual of Psychiatric Nursing Care Plans. Philadelphia: Lippincott Williams and Wilkins, 2009. Print. Read More