Dylan Angelo L.

Andres BSN IV
J. Personality Disorder:
Situation: S.T. has been admitted to the hospital four times within one year. She is 29 years old.
Typically, she is
admitted after threatening suicide and has been found to burn herself with cigarettes. On the
unit, she has
complimented one of the staff nurses and told the nurse that she is the best nurse and all the
staff is awful. This
nurse has defended K.T. during team meetings. Other staff members are now angry with this
nurse. During group
meetings, S.T. has convinced other clients that the staff is incompetent.

1. Describe the data that indicate that S.T. may have a Borderline Personality Disorder?

Answer: She attempt suicide and burn herself with cigarettes according to Borderline Personality
Disorder the symptoms Self-harm. Suicidal behavior and deliberate self-harm is common in
people with BPD. Suicidal behavior includes thinking about suicide, making suicidal gestures or
threats, or actually carrying out a suicide attempt. Self-harm encompasses all other attempts to
hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.

2. What risks are involved in caring for S.T.

Answer: The risks that involved in caring for S.T are her suicide attempts and self-injury.

3. What is your initial impression for S.T.’s effect on the staff and the unit as a whole?

Answer: My initial impression for S.T is that she has an unstable relationship towards the people
around her. Her unstable relationship with other people gave a great stress for the whole staff.

K. Childhood Disorder:

Situation: You are a school nurse in an elementary school. You receive a call from a mother who
wants to come in

and talk to you about her son who is 7 years old. When you meet with the mother, she tells you that
her son has

been put on Ritalin for Attention Deficit Hyperactivity Disorder. The mother is concerned about her
son’s behavior in

school and at home. Her primary care provider has given her little information about this type of
behavioral disorder

or the medication that has been prescribed. You tell her that there are other children in the school
with this problem

and that you will help her gain some understanding.

1. What symptoms would you expect this mother to describe?

Answer: the symptoms that she describes is Inattention and hyperactivity/impulsivity such as:
Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy
reading, not follow through on instructions and fail to finish schoolwork, chores, or duties in the
workplace or start tasks but quickly lose focus and get easily sidetracked, leave their seats in
situations when staying seated is expected, such as in the classroom or the office, Talk nonstop,
Interrupt or intrude on others, for example in conversations, games, or activities

2. How would you describe the purpose of Ritalin to the mother?

Answer: Ritalin is just one of many medicines doctors use to treat attention deficit hyperactivity
disorder (ADHD). Ritalin (also known as methylphenidate) helps kids with ADHD concentrate and
focus at school and at home. Ritalin is a stimulant, a type of medicine that increases alertness. As
with other medicines, each child can respond to it differently. Many kids using Ritalin have few, if
any, side effects. Others have side effects like stomachaches, insomnia, decreased appetite,
growth problems, irritability, and blood pressure problems.

3. Why would you suggest that the mother use behavioral contracts with her son?

Answer: So that the mother can easily manage her child’s behavior at home and even at school.
And also it could help her provide her son some support and intervention. It provides self-
responsibility and even improves home/school communication.

L. Substance Abuse Disorders:

Situation: You are the nurse admitting a new client to the mental health unit of your facility. Your
assessment reveals

a client with hand tremors, diaphoresis and agitation. The client reports long-standing relationship
problems,

depression, with thoughts of suicide and mentions concurrent use of alcohol, cocaine and nicotine.

1. Would you classify this as a Substance-Use Disorder? Why?

Answer: yes, according to the data he/she use of alcohol cocaine and nicotine. Because of Drug
addiction, also called substance use disorder, is a disease that affects a person's brain and
behavior and leads to an inability to control the use of a legal or illegal drug or medication.
Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're
addicted, you may continue using the drug despite the harm it causes.

2. Provide three examples of therapeutic interaction that you could offer this client to build trust
and rapport during the initial stages of the admission process.

Answer: the three examples of therapeutic interaction are:

Providing health teaching for client and family. Clients and family members need facts about the
substance, its effects, and recovery.
Addressing family issues. Without support and help to understand and cope, many family
members may develop substance abuse problems of their own, thus perpetuating the
dysfunctional circle; treatment and support groups are available to address issues of family
members.

Promoting coping skills. Nurses can encourage clients to identify problem areas in their lives and
to explore the ways that substance use may have intensified those problems.

3. What discharge needs do you anticipate for this client?

Answer: I would expect the client to have established eating nutritious food, getting a balance
rest, sleep and activity. Also the patient should be abstaining from alcohol and drugs and try to
join to group support meetings.

M. Abuse and Violence:

Situation: At 1 am., a father and mother rush into the emergency department with their daughter,
who is 4-years old.

She is screaming. The mother is yelling for help saying her daughter fell and hurt her arm. When the
father tries to

touch the child, the child cries more. The child is taken into the examining room and you attempt to
talk with the

parents.

1. What data do you need to know about the child?

Answer: I need to ask the parents what exactly happened to child and how did she got injured.
After that, I need to interview the child to see if there are some signs and symptoms of abuse and
to ask her personally what really happened to her that night.

2. Who must you contact if you suspect that the child has been physically abused?

Answer: First, I need to report it to a physician, nurse practitioner, or physical assistant. I could
also notify my supervisor.

4. What might be the significance of the child’s response to the father?

Answer: the child’s response or behavior towards her parents is a good indication to see if there is
a physical abuse happening within the family.

A 51-year old female with a history of bipolar disorder presented to the ER claiming she was feeling
suicidal. She
had jumped from a second story window and is experiencing pain in her back and both ankles. She
was alert and
oriented, but combative on admission. With cervical collar in place, she was handcuffed to a
stretcher. “I was on the
floor, my husband was trying to hurt me, so I jumped.” “I wanted to hurt myself and I wanted to
hurt my husband.”
The police reported that the patient was aggressive towards husband with scissors, attempted to cut
self on
wrists. Patient’s husband has a restraining order against her. “She reported that her husband had
been abusive to
her through the years and he recently threatened to kill her. Her ex-husband reported she has been
deteriorating for
five weeks, belligerent, aggressive, not sleeping and drinking wine.
On admission, the patient reported she was depressed, suicidal and scared. She reported a recent
decreased
need for sleep, euphoric mood and racing thoughts. Mental status: appearance- poor hygiene,
disheveled

appearance; motor activity- restless; affect-agitated; mood- depressed and anxious; speech- soft;
thought process-
circumstantial; judgment-poor impulse control, maladaptive; Insight- poor. Intelligence is below
average;

concentration-distracted.
Patient suffered multiple comminuted fractures on her left ankle and in her L5 spine. These injuries
resulted from
her jumping out of the second story window. Surgical intervention was not needed but the patient
was admitted to the
medical-surgical unit.
Psychiatric history- she reported past history of manic symptoms along with psychotic symptoms. A
decreased
need for sleep, euphoria, bizarre behavior, racing thoughts and increased goal-oriented activity has
led to
hospitalizations in the past along with paranoia. She has 12 psych admissions most recent admission
was 2 years
ago. Reports 1 past suicide attempt 6 years ago when she left her husband and was in a shelter. She
was
discovered by staff and brought to the hospital. She then divorced her husband. She reports to have
had consumed the occasional beer or wine, no street drugs or abused prescribed
medications. However, her blood alcohol level was negative and her urine toxicology screen was
also negative.
Family psych history- mother had schizophrenia and alcohol dependence and one of her nieces
committed
suicide.
Hospital course- on admission, patient was depressed and reported feelings of helplessness,
hopelessness,
suicidal ideation and paranoia. Patient was started on Risperidal, discontinued from Wellbutrin as it
was thought to
induce the symptoms of depression and mania to the patient. She was also placed on Zoloft for her
depressed mood
and continued Depakote. With an improved mood, her affect is stabilized and her paranoia
symptoms were starting
to diminish. The patient remained on the medical-surgical floor for 13 days. She was managed well
on the unit and
did not have any behavioral problems. She was followed-up by the psyche Nurse Practitioner, nurses
and her
attending physician. The nurses reported not understanding her condition and they were wary of
caring for her.

Concept Map of Bipolar Disorder in the lower page