Case study - Personality disorder: Nursing

Nurse, Amyra works on an inpatient psychiatric unit and is caring for Yang, a 42 year old with a history of borderline personality disorder who was admitted a week ago for self harm ideation following a breakup with his partner.

In collaboration with the registered nurse, Ren Franci nurse, Amira goes through the steps of the clinical judgment measurement model to make clinical decisions about Yang's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nsima recognizes important cues including Yang's vital signs which are temperature 98.9 °F or 37.1 °C, heart rate, 70 BPM, R 16 breaths per minute and BP.

132/82 of me. She notes that Yangs breakfast tray is untouched on the bedside table.

Hi Yang. I noticed you haven't eaten your breakfast.

How are you doing today? Sorry.

No offense. But that food is disgusting.

I'm good actually. And I'm happy I don't have a sitter anymore.

I'm ready to pack up my stuff and go home. I'm glad you feel ready for discharge to make sure you're safe.

To leave nurse Franci and I need to gather some information and give you your medicine. I know.

I know. I'm still sad.

My boyfriend broke up with me but I'm able to talk about it. Now.

I have other people in my life that care about me. So I feel less alone.

Thats good to hear. Next.

Nurse Ayra analyzes these cues. She reviews the electronic health record or EHR and Notes Yang was diagnosed with borderline personality disorder or BPD five years ago and has been hospitalized for self harm ideation.

In the past, nurse Ayra reviews the progress notes and sees that following the breakup between Yang and his partner, Yang called his sister and told her he wanted to commit suicide.

His sister then called the emergency services and he was taken to the hospital. NRS Soya recognizes that BPD is a condition where individuals have unstable moods and relationships.

Those with BPD may also experience fear of abandonment which leads to threats of self harm to keep someone from leaving them.

NRS AYA recognizes that Yang needs continued mood stabilization to prevent self harm. Now using the information she's gathered along with Yang's medical history.

Nurse, Amira reports her findings to RN Franci and together they choose a priority hypothesis of risk for violence against self.

Then nurse Aya collaborates with RN Franci to generate solutions to address Yang's altered safety that will include pharmacologic and non pharmacologic interventions and they established the expected outcome that after intervening, Yang will continue to use coping strategies to remain safe and free from injury.

Nurse Amira then takes action to implement these solutions. First.

She confirms Yang's room remains free from items that he could use to harm himself. She also notes that Yang is scheduled for his prescribed mood stabilizer.

She gathers the supplies and enters Yang's room. Yang I have your medication lithium which will help keep your mood stabilized.

Ok. I think it's been helping me.

Great Nrs Soya then administers the lithium according to the principles of safe medication administration. Now, I understand that your breakup has been very painful and caused you to have thoughts about hurting yourself.

Yeah, I did have those thoughts but not anymore. I'm happy to hear that.

Can you tell me about the strategies you're using to keep from harming yourself after you go home during our sessions? The counselor taught me how to write down my thoughts in a journal and it has been helping a lot.

Journaling is a great way to express your feelings in a safe way and I hope you can continue this after you leave. I will.

My sister already bought me a new notebook for when I get home. Nurse Ayra updates RN Franci on Yangs progress who begins to compile his discharge paperwork at the end of her shift.

Nurse, Amyra enters Yang's room to evaluate the outcome of her actions. Yang's vital signs are temperature 98.9 °F or 37.1 °C heart rate, 65 BPM, respirations, 14 breaths per minute and BP.

122/80 millimeters of mercury Yang is sitting at a table with his notebook and appears relaxed nurse. Soya calls Yangs sister who plans to pick him up once hes discharged.

All right. As a quick recap, nurse, Amira recognized and analyzed cues related to Yang's risk for self harm.

And in collaboration with RN Franci prioritized hypotheses and generated solutions to address this problem. Nur Amyra and Arne Franci then implemented pharmacologic and non pharmacologic interventions and evaluated Yangs outcomes and compared them to the expected outcome since Yang used coping strategies and no longer had thoughts of self harm.

They determined the plan of care was successful.