Nursing Mental Health: Personal Disorder, Eating Disorder, and Nursing Prevention - Case Study Example

Nursing Mental Health - Personal Disorder, Eating Disorder and Nursing Prevention Total Numberof Words: 1,629 Type of DSM-IV Cluster Seen in Cassandra’s Behavior Cassandra’s behaviour is indicative of cluster B: Dramatic-Emotional-Erretic particularly the borderline personality disorder. Based on the features of borderline, Cassandra was able to meet six (6) criteria presented under this type of personality disorder. Upon analyzing the case scenario, the patient showed the following signs of borderline disorder: (1) pervasive pattern of instability of interpersonal relationship with her live-in boyfriend; (2) unstable mood swings which fluctuates from crying, pleading, sometimes charming, joking, and physically fighting the police using foul language; (3) terrified of abandonment which was evident when the patient was in the state of tears when I went out for my tea break and told me that all other nurses are mean to her and that I am the only one who understands her; (4) chronic feeling of emptiness which was evident due to the fact that her older sister and mother lives in another state and that her boyfriend left her 2 days ago; (5) recurrent suicidal behaviour which explains why she had cut her forearms; and (6) disturbed self-image (Zanarini, Frankenburg and Hennen). Even though the patient was well dressed, she was thin, pale, has dark circles under her eyes, and continuously wrings her bandaged hands in her lap. Likewise, several studies revealed that people with borderline personality disorder may also have eating disorder and substance use disorder such as drinking too much alcohol (Zanarini, Frankenburg and Hennen). In Australia, roughly 2 – 5% of the total population in the country are affected by borderline personality disorder at some stages in their lives (Sane Australia). Between men and women, women are three times more likely to become diagnosed with this type of personality disorder as compared to men (ibid). Possible Psychodynamics or Causes behind the Development of Cassandra’s Borderline Personality Disorder Given the fact that there is no single factor that could effectively explain the cause of developing borderline personality disorder, several studies revealed that past traumatizing events and severe emotional abuse during childhood are among the possible causes of developing this type of personality disorder (Brown, Cardena and Nuenhuis; Buckley, Michels and Mackinnon). As explained by Paris, biological factors like inborn temperamental abnormalities, psychological factor like traumatic experiences during childhood days, and social aspect like broken family also plays a significant role in its etiology. In the case of Cassandra, she has a bad experience with her father given that he physically, emotionally, and sexually abused her when she was still a young child. Because of her memory and thoughts about her negative life experiences, Breuer and Freud explained that Cassandra’s personality disorder was part of her psychological defense (Brown, Cardena and Nuenhuis). Over the years, such psychological defense can be converted into physical symptoms such as personality disorder which has been observed in the case of the patient. Three Major Issues / Problems / Risks The three major issues identified in the given case scenario include the patient’s repetitive suicidal tendency, eating disorder, and substance abuse related to excessive alcohol consumption. Repetitive Suicidal Tendency At least one out of every six young adults had tried committing suicide at one point in their life. (Gaynes, West and Ford) Specifically the research study that was conducted by Gaynes, West and Ford revealed that “suicide is the 11th leading cause of death and 7th potential life lost in the United States” (p. 822). The problem with patients that has history of repetitive suicidal tendency is that the fact that the clinical management of patients with suicidal risk is complicated especially when the patient has deliberately inflict self-harm such as in the case of Cassandra. In line with this, it is not easy on the part of the health care professionals to be able to tell when exactly would the patient inflict self-harm within the hospital area. In case the patient with borderline personality disorder died within the hospital setting due to suicidal acts, the hospital and health care professionals who are in-charge in the provision of patient’s care can be legally sued for negligence. Eating Disorder Eating disorders alone could cause millions of people who are diagnosed with mental illness to suffer from physical deterioration which often leads to death. (Sullivan) Basically, eating disorders are considered as serious psychiatric and physical illnesses related to a person’s unusual eating habit or attitude and behavior on food consumption. Most of the people who have eating disorders are usually unsatisfied with their own body structure and weight. This often causes them to go through unhealthy weight management processes either by not eating at all or the extreme intake of food. Anorexia nervosa is considered as a serious eating disorder that is normally characterize by significantly decreasing the intake of calories and increasing the physical activity which often results to a sudden lost of body weight and mass. According to Lindsay, anorexia nervosa is very much associated with becoming hopeless and anguish towards one’s own body. Anorexic people in general have a very strong desire to become very thin. (American Psychiatric Association b) Such desire alters the person’s mentality about his or her own body image. Even though anorexic people have already lost so much weight, they would still see and think of themselves as fat. Because of low calorie intake and excessive exercise, almost all patients who are diagnosed with severe anorexia have protruding bones, deny the feeling of hunger, feels fat despite being underweight, and has the tendency to withdraw from social activities. Anorexic patients may also starve themselves by eating lesser food as compared with their body requirements or even nothing at all. (American Psychiatric Assocation a) These individuals may sometimes practice self-induced vomiting which may lead to significant physical and psychological changes related to constipation, abdominal pain, cold intolerance, lethargy, excess energy, emaciation and dryness of the skin. (ibid) The problem with a sudden reduction of body weight is the danger towards one’s health since people with anorexia may experience dehydration, malnutrition, heart, kidney, immune system, and liver problems, infertility, osteoporosis, personality disorder, and permanent health damage which could eventually lead to death. (Kushi and Glovannucci; Shikany and White) Likewise, the lack of nutrients could lead to a lot of biological changes that may cause disturbances in the normal functioning of the brain. Substance Abuse Related to Excessive Consumption of Alcohol With regards to substance abuse related to excessive alcohol consumption, this particular habitual practice could increase the patient’s risk of developing not only with health related problems like liver cirrhosis (DeGottardi, Spahr and Gelez) but also their social relationship with friends, family, and other people including their psychosocial and cognitive development. The research study of Barnow, Schuckit and Lucht revealed that people with drinking problem is associated with parental and peer rejection. Such behavioral problem often leads to excessive alcohol use which may cause them to end up not being able to develop a good relationship with other people. With regards to mental development, drinking too much alcohol could negatively affect the brain’s neurological and cognitive functioning. (Connelly) Nursing Interventions in Managing Borderline Personality Disorder Repetitive Suicidal Tendency To prevent the incidence of suicidal attempt within the healthcare institution, nurses should carefully monitor signs of self-harm and suicidal tendency of the patient in order to ensure the patient’s safety (Livesey). As part of keeping the patient feel safe and calm, nurses should constantly communicate with patients with suicidal tendency to allow them to unload some of their emotional burdens and teach them ways on how to cope with their problems (ibid). Aside from administering prescribed medication to control the patient’s mood swings and anxiety among others (Haw and Stubbs), nurses should keep the environment free from objects that could make them harm themselves. Likwise, nurses should also give patients some Vitamin B12 in order to reduce the patient’s depression (Tesar). Other useful nursing intervention includes: cognitive behavioral therapy and alternative therapy like providing the patient with chamomile tea to help reduce anxiety (Tarrier, Taylor and Gooding). Eating Disorder To treat anorexia, nurses should provide the patient with health care teachings regarding the negative health impact of not eating properly in order to correct the patient’s eating habit (Warin; Whitney, Murray and Gavan). Since there are quite a lot of young adults who are experiencing eating problems, nurses should encourage the patient to participate in group therapy and psychotherapy to enable them to gradually change their personal beliefs about good health and physical appearance (Whitney, Murray and Gavan). While at the hospital, nurses may provide nasogastric tube feeding upon the order of the physician to ensure that the patient will receive proper nutrition (Rigaud, Verges and Colas-Linhart). Substance Abuse Related to Excessive Consumption of Alcohol Nursing should teach the patient with regards to the adverse health consequences of alcoholism. (Ernst, Pettinati and Weiss) By letting the patient know the negative effects of excessive alcohol in the human body, the patient would be able to think twice before she decides to open another bottle of beer. Nurses should also use behavioral treatment like motivational interview to determine the main reason why the client has engaged herself in heavy drinking. Together with the patient’s participation, nurses should develop a nursing care plan which aims at gradually reducing the patient’s intake of alcohol (Ernst, Pettinati and Weiss). Recommended Strategy on How to Respond to Cassandra’s Statement The nurse should not give the patient false hope about her presence at the hospital since it could only increase the patient’s mistrust and depression. Instead, the nurse should explain that she will be back the next day to provide her with necessary care and treatment. Likewise, the nurse should help the patient realize that other nurses also meant good in terms of providing her with necessary care and treatment while she is still at the hospital. *** End *** References "American Psychiatric Association." 2000a. Associated Physical Examination Findings and General Medical Conditions - Anorexia. 10 September 2009 . "American Psyciatric Association." 2000b. Diagnostic Criteria for 307.1 Anorexia Nervosa. 10 September 2009 . Barnow, S., M. Schuckit and M. Lucht. "The Importance of a Positive Family History of Alcoholism, Parental Rejection and Emotional Warmth, Behavioral Problems and Peer Substance use for Alcohol Problems in Teenagers: A Path Analysis." Journal of Studies of Alcohol (2002): Vol. 63, pp. 305 - 312. Brown, R.J., et al. "Should Conversion Disorder Be Reclassified as a Dissociative Disorder in DSM–V?" (Psychosomatics (2007): Vol. 48, No. 5, pp. 369–378. Buckley, P.J., R. Michels and R.A. Mackinnon. "Changes in the Psychiatric Landscape." 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American Journal of Psychiatry (2004): Vol. 161, No. 11, pp. 2108–2114. Read More