Nursing Assignment on Emotionally Unstable Personality Disorder and Type II Diabetes
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This assignment discusses the case study of a girl suffering from emotionally unstable personality disorder and type II diabetes. It explores the effects of the illnesses on the patient physically, mentally, and psychologically, as well as the nursing models and care planning involved.
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Running head: NURSING ASSIGNMENT NURSING ASSIGNMENT Name of the Student Name of the University Author note
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2NURSING ASSIGNMENT Introduction This assignment deals with the case study of a girl suffering from emotionally unstable personality disorder and from type II diabetes. It discusses about how the patient is affected by the illness or the disorder physically, mentally and psychologically. The essay also discusses about the different nursing models and the how the nursing models effect the process of care giving to the patient. It also includes about the assessment of the patient and also about which aspects of the assessment needed more priority. The essay is going to discuss about the process of care planning given to the patient and while planning about the care planning it also discusses about the resources that are available and can be utilised for the care plan (Lawn and McMahon 2015). It also discussed about the how the care planning was implemented and about the evaluation of the effects of the care plan. In the given case study, the patient was admitted to the hospital because of the overdose of codeine 30gms of 4 to 6 tablets, diazepam 2mg of 2 tablets and citalopram tablets. She had taken the overdose of the tablets because of her relationship break down. Since the time the patient took admission in the hospital, the patient started self- harming herself. Section 1 The two diseases from which the patient is suffering are emotionally unstable personality disorderandtypeIIdiabetes.Theemotionallyunstablepersonalitydisorder,alsocalled borderline personality disorder, describes all the problems that a person experience when the person is emotionally not stable. This also happens when the person suffers from anxiety or is experiencingbehavioursofself-destructiveness(Sheehan,NieweglowskiandCorrigan 2016).Threedomainsofpathophysiologyhavebeenidentifiedinthisdisorder-affect
3NURSING ASSIGNMENT dysregulation, affect the behavioural dyscontrol and also the interpersonal hypersensitivity. The affect dysregulation comprise of the expression of the more intensive aversive emotions, very high tension and more rapidly rise in the moods. The dysfunction of the behaviour shoes the self- destructive nature of the patients. It also show the aggressive behaviour and also failing to exhibit a properly balanced problem solving behaviour as well as the orientation about the future of the life (Bodneret al.2015). Injuring own is the most important behavioural dysfunction of the patients suffering from this disease. The interpersonal hypersensitivity has become one of the major field of research of the disease borderline personality disorder. While talking about the pathophysiology of the disease the hormone oxytocin should be given the importance (Pillayet al. 2015). The neuropeptides play an important role in the pathophysiology of the disease. Many researches are done on the oxytocin related to healthy subjects but also in the field of the researches of this disease. Much evidences are there regarding the role of oxytocin on this disease (Linehanet al.2015). The hormone oxytocin have some effects on the different fundamental mechanisms of the changes in the behaviour which are very much related with this disease. The type II diabetes is caused by insulin resistance mainly caused by obesity and also different physical inactivity. This disease is comprised of a cluster of different risk factors all of which can be considered to be either the causes or the consequences of the resistance of the hormone insulin. The type II diabetes is completely heterogeneous disorder having different prevalence on different ethnic groups. The dysfunction in the beta cell can be characterised by the impairment in the first phase of the secretion of insulin. The initiation of insulin is dependent on the transport of the trans-membranous glucose and also the coupling of glucose to the sensor of glucose. In some patients, the early onset of the disease, there may be deficiency in the secretion of insulin or it can also be due to the autoimmune destruction of the beta cells, however
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4NURSING ASSIGNMENT in patients suffering from severe type II diabetes, the delay in the immediate response of insulin secretion happens along with secondary hypersecretory phase of insulin as a result of the inherited or acquired (Hunt 2015). In the decline of the beat cell mass sulfonylurea serve a diminishing role in the management of the long term of type II diabetes. Apart from physical illness, the diseases affect a person psychologically and socially. Because of this illness, the patients get isolated from other people and normally do not talk with other people (Sun and Zhao 2016) Section 2 The models of nursing help in providing the delivery of high quality care. However the nursing care models are sometimes seem to be very over theoretical and irrelevant to the modern ways of care giving to the patients. The nursing model provides a compact theory about the people, the environment in which they live, the health of the patients and obviously the role of the nurses. So many nursing models are there having their own approaches to the medical issues. Few nursing care model are there which involve the self-care of the patient while some models deal with the activities of the living that all people need to carry out (Warrender 2015)Most of the nurses are familier with the nursing practice ASPIRE (assessments, systematic nursing diagnosis, planning, implementation, Rechecking and finally evaluation). An experienced nurse use the previous nursing care planning models for the purpose of providing the best care planning to the patient. In the present case, the patient is suffering from emotionally unstable personality disorder and type II diabetes, so the nursing care plan of this patient should be such that it includes the care plan methods of both the diseases (Dickens, Lamont and Gray 2016)
5NURSING ASSIGNMENT Section 3 The symptoms of the disease emotionally unstable personality disorder are the result of the wrong adaption of the personality of the persons to the environment. The symptoms can be classified into four broad classes of cognitive perpetual, affective, inter-personal and control of the behaviour. The assessments of the disease may vary from person to person and also according to the extent of the disease. All of the assessments comprehensively cannot be applicable in all cases. The important areas of the assessments include psychiatric history and the examination of the mental state, the collateral information, a structured formal tool of assessment and the obviously the observations of the clinicians (McMain, Boritz and Leybman 2015). The detail of the psychiatric history and the examination of the mental state include the relationships with the family and the parents involving the patterns of the attachment of the patients with the family members, the reactions of the patients with the key developmental events. It also includes losses, separations, relocations and responses. It also includes the preliminary assessment of the history of trauma or any neglect. If the patient do not have adequate skills of self-regulation then the assessment task do not become productive and it will become dysregulating. The mental state examination also includes any peer relationships or any romantic relationship. The collateral information involves the post-traumatic conditions like relieving experiences, constriction or avoidance and hyperarousal (Stringeret al.2015). It also includes substance use and different other mental illness. It also includes the assessments of the physical health assessments. Assessments of the risks associated with the disease and the treatment should also be done. Assessments of the interpersonal and the behavioural changes should also be done. The collateral records involves the records of the healthcare and the information from family, friends and other professionals. The clinical observations include the interactions that the patient is making with
6NURSING ASSIGNMENT other people and also with other encounters. All of these assessments are important for the patient of the given case study (Keuroghlianet al.2016) Assessment of the patients suffering from diabetes mellitus involved so many steps. The first most important step is the education and self-management. This involves the way how the patient is coping with the self-care and self-management. It is needed to be considered that the patient is whether bothered about the self-care or not. The doctors need to make sure that whether the patients are having a healthy diet or not (Khosravan, Alami and Rahni 2015). The doctors need to consider that the whether the patient had been admitted to the hospital before also or not, whether the patient has other complications like cardiovascular complications, cerebrovascular complications and neurological complications whether the patient has any sexual dysfunction or not. Monitoring the level of the capillary glucose is another most important assessment of diabetes. The examination of weight, height, BMI, urinalysis for the presence of proteins, ketones, nitrites need to be assessed properly (Sapkotaet al.2015)The pulse rate and the blood pressure of the patients should be checked properly, whether they are normal or not. The neuropathy of the patients must also be checked, the reflexes of the ankles and the knee must be checked. The urine and the blood tests should also be done regularly. Apart from all these, the diet, the physical activities and the medications must be reviewed properly (Kang and Gu 2015). All of these factors are important in the present case study. Section 4 The care planning was done by keeping in mind the diseases from which the patient is suffering. The patient is suffering from two diseases emotionally unstable personality disorder and type II diabetes. So the care planning should be such that it involves the care planning methods of both the diseases. Regarding the mental diseases, the most important thing that the
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7NURSING ASSIGNMENT patient needs is the mental support apart from the medicines. Though the patient has been taking the medicines, the mental support from the family members and the nurses are the main medicines for the mental disease (Knaaket al.2015). Proper mental rehabilitation is needed for curing of personality disorder. The goals of the nurse for the care planning of the patients resides on the developing the establishment of trust, providing proper safety and comfort, teaching the patients the basic skills of living and promoting a behaviour of very responsibility. In order to develop the social interaction, the nursing intervention includes limiting arguing, clinging, limitingseekingtheattentionconstantly,frequentlydisregardingtherules,limitingthe engagement in power struggles, getting angry and demanding for proper behaviour. If the patient cannot cope with the conditions then, the nursing intervention includes approaching the client in a consistent manner from all directions, refraining from sharing the personal information with the client, being aware of the flattery. The nursing care plan for maintaining the self-esteem are increasing the strengths and weakness of the patient by working daily (Pansier and Schulz 2015) The nurse must maintain a calm and respectful manner in front of the patient, reviewing with the client, the types of the cognitive distortions that the patient is suffering from, teaching the patient the need to dispute the cognitive disorder. The nurse should teach the patient to control the feelings of self-esteem by discouraging the patient from self-blaming and negative marks (Lawn and McMahon 2015) The nursing care plan of diabetes mellitus includes preparing a proper diet plan so that the patients can control over their food habits. Those who are suffering from diabetes need to follow the diet which contains less amount of fats and carbohydrates and should include high amount of proteins and green leafy vegetables (Jutterströmet al.2016). The nurse of the patient must prepare the care plan in such a way that it includes starting from the exercise of the
8NURSING ASSIGNMENT morning till the dinner at night. The nurse should serve different meals in the breakfast, lunch and at the dinner (Chapmanet al. 2015). The nurse should check the health condition of the patient before asking the exercises to be done, this is because the patient may not be able to perform the exercises because of age or any other health issues. The nurse should provide the patients with proper medicines at proper time. It must be noted that the patient is able to tolerate the medicines and that the patients are not affecting negatively to the patients. Section 5 The care plan was implemented successfully as the patient improved a lot after the whole intervention is over. The patient was even cooperative with the treatments and she neither quarrelled with the nurses or with the doctors nor, she denied to have the medicines. The nurse was very polite with the patient throughout the whole intervention, and so the patient also never quarrelled with the nurse. In the whole intervention of the patient the compassion, respect and dignity was maintained (Sapkotaet al.2015). The nurse was very cooperative with the patient, both of them listened to each other. The patient recovered a lot after the whole intervention was over. The mental conditions of the patient improved a lot, she had been able to cope up with every conditions, her habit of forming obsessive relationship with the nurses and the doctors have reduced (Ng, Bourke and Grenyer 2016). The patient is able to talk with every person without facing any complexity. The suicidal tendency of the patient had also reduced a lot, now she do not say that she was not feeling worthless as she used to do. The suicidal tendency of the patient had faded away, the depression from which she was suffering because of the childhood traumas all faded away. She had started forgetting her future and believing in the present and in the future. The health issue of diabetes ad also reduced, the patient had started doing regular exercises for improving her health conditions. She had also started taking medicines on proper
9NURSING ASSIGNMENT time. The blood glucose level of the patient had also decrease a lot after the whole intervention was over. The patient cooperated with the nurses and the doctors, otherwise it would not be possible for the patient to get improved in such a small period of time. The success of the intervention mainly goes to the effective communication that the nurses maintained with the patient (Lepardet al. 2015). It is also mentioned that the patient was in severe alcohol abuse before the time of her admission in the hospital and after the treatment was over the drinking and substance abuse of the patient had deceased a lot (Valentineet al.2015). Section 6 The intervention had worked successfully as the patient had been found to improve her health conditions, both mental and physical health conditions, after the car giving policy is over. The physical tests of the patient after the intervention reveal that she had improved her health. Previously, the patient was suffering from chronic pain in the lower back but this was reduced after the intervention was over. The blood glucose level had decreased a lot, and even the vital signs of the patient had also improved. The patient was previously having low blood pressure but after the treatment it had improved. The food habits of the patient had improved and also the patient became much concerned about the requirements to take healthy foods. The patient would maintain these diet throughout her entire life and would thus be able to control over the disease without further concerning with the doctors (Sollbergeret al.2015). The nurse regularly recorded the improvements of the patient, she compared the vital signs of the patient before the intervention and after the intervention.The change in the vital signs show that the patient had improved a lot. The common physical and psychosocial health problems are solved by following the associated nursing interventions. The public health policy involving the different nursing models are very helpful in the following case for treating the disease. The nurse in the given case
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10NURSING ASSIGNMENT study, prepared the nursing care plan for the patient by following the different previous nursing models. This is evident after seeing the recovery of the patient. The nurse also took care of the patients safely and also the nursing practice followed by the nurse is very effective. The nursing intervention followed by the nurses effectively did the assessment of the diseases (Fischetti 2015). The planning for the care giving policy was done after the assessment of the diseases. The roles and responsibilities of the nurses are maximum at the time of delivering care to the patients. The nurses spend maximum time with the patients rather than the doctors spend time with the patients (Chrvala, Sherr and Lipman 2016). The nurses need to communicate effectively with the patients so that the patients are not afraid of telling about the health issues from which the patient is suffering. The nurses have to create a comfort zone for the patient so that the patient can tell about the problems without any hesitation. Specially, in the given case study where the patient was suffering from personality disorder and the chronic disease diabetes, she needed a much complex care involving the care approaches of both the diseases (Carolan-Olah 2016)The nurses were able to provide the patient with all the requirements of both the diseases. The necessary skills which are required specifically for providing the safe and effective nursing care plan are maintaining a good relationship with the patients. For maintaining a good relationship with the patient, the nurse need to develop an effective communication with the patient. The nurse also need to increase the knowledge about the diseases from which the patient is suffering in order to avoid any kind of wrong treatment of the patient (Koivusaloet al. 2016). Conclusion This assignment was about the care giving methods and nursing interventions of the two diseases borderline personality disorders and diabetes mellitus. Diabetes mellitus is one of the chronic diseases which is affecting many people throughout the world. The patient is suffering
11NURSING ASSIGNMENT fromborderlinepersonalitydisordersincechildhood,evenshewasalsohavingsuicidal tendencies and she was admitted to hospital for taking in too many drugs. She needed a nursing care plan involving both the diseases and the care plan was rather complex as at the one side the nurse had to treat the mental health conditions of the patient and on the other side, the nurse had to treat the chronic condition of diabetes mellitus. The intervention followed by the nurses were very effective in curing the diseases and at the end it is seen that the health condition of the patient had improved a lot. After the whole treatment procedure was over, the patient was able to cope up with all the mental issues she was suffering from and also the diabetic condition was also reduced.
12NURSING ASSIGNMENT References Bodner, E., Cohen-Fridel, S., Mashiah, M., Segal, M., Grinshpoon, A., Fischel, T. and Iancu, I., 2015. The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder.BMC psychiatry,15(1), p.2. Carolan-Olah, M.C., 2016. Educational and intervention programmes for gestational diabetes mellitus (GDM) management: An integrative review.Collegian,23(1), pp.103-114. Chapman, A., Liu, S., Merkouris, S., Enticott, J.C., Yang, H., Browning, C.J. and Thomas, S.A., 2015. Psychological interventions for the management of glycemic and psychological outcomes of type 2 diabetes mellitus in China: A systematic review and meta-analyses of randomized controlled trials.Frontiers in public health,3, p.252. Chrvala, C.A., Sherr, D. and Lipman, R.D., 2016. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control.Patient education and counseling,99(6), pp.926-943. Dickens, G.L., Lamont, E. and Gray, S., 2016. Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review.Journal of clinical nursing,25(13-14), pp.1848-1875. Fischetti, N., 2015. Correlates among perceived risk for type 2 diabetes mellitus, physical activity, and dietary intake in adolescents.Pediatric nursing,41(3), p.126. Hunt, C.W., 2015. Technology and diabetes self-management: an integrative review.World journal of diabetes,6(2), p.225.
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13NURSING ASSIGNMENT Jutterström, L., Hörnsten, Å., Sandström, H., Stenlund, H. and Isaksson, U., 2016. Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes—A randomized study.Patient education and counseling,99(11), pp.1821-1829. Kang, H.Y. and Gu, M.O., 2015. Development and effects of a motivational interviewing self- management program for elderly patients with diabetes mellitus.Journal of Korean Academy of Nursing,45(4), pp.533-543. Keuroghlian, A.S., Palmer, B.A., Choi-Kain, L.W., Borba, C.P., Links, P.S. and Gunderson, J.G., 2016. The effect of attending good psychiatric management (GPM) workshops on attitudes toward patients with borderline personality disorder.Journal of personality disorders,30(4), pp.567-576. Khosravan, S., Alami, A. and Rahni, S.G., 2015. Effects of continuous care model based non- pharmacological intervention on sleep quality in patients with type 2 diabetes mellitus: A randomized controlled clinical trial.International journal of community based nursing and midwifery,3(2), p.96. Knaak, S., Szeto, A.C., Fitch, K., Modgill, G. and Patten, S., 2015. Stigma towards borderline personality disorder: effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design.Borderline personality disorder and emotion dysregulation,2(1), p.9. Koivusalo, S.B., Rönö, K., Klemetti, M.M., Roine, R.P., Lindström, J., Erkkola, M., Kaaja, R.J., Pöyhönen-Alho, M., Tiitinen, A., Huvinen, E. and Andersson, S., 2016. Gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish Gestational Diabetes Prevention Study (RADIEL): a randomized controlled trial.Diabetes care,39(1), pp.24-30.
14NURSING ASSIGNMENT Lawn, S. and McMahon, J., 2015. Experiences of care by A ustralians with a diagnosis of borderlinepersonalitydisorder.JournalofPsychiatricandMentalHealthNursing,22(7), pp.510-521. Lawn, S. and McMahon, J., 2015. Experiences of family carers of people diagnosed with borderline personality disorder.Journal of psychiatric and mental health nursing,22(4), pp.234- 243. Lepard, M.G., Joseph, A.L., Agne, A.A. and Cherrington, A.L., 2015. Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.Current diabetes reports,15(6), p.37. Linehan,M.M.,Korslund,K.E.,Harned,M.S.,Gallop,R.J.,Lungu,A.,Neacsiu,A.D., McDavid, J., Comtois, K.A. and Murray-Gregory, A.M., 2015. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.JAMA psychiatry,72(5), pp.475-482. McMain, S.F., Boritz, T.Z. and Leybman, M.J., 2015. Common strategies for cultivating a positive therapy relationship in the treatment of borderline personality disorder.Journal of Psychotherapy Integration,25(1), p.20. Ng, F.Y., Bourke, M.E. and Grenyer, B.F., 2016. Recovery from borderline personality disorder: a systematic review of the perspectives of consumers, clinicians, family and carers.PloS one,11(8), p.e0160515. Pansier, B. and Schulz, P.J., 2015. School-based diabetes interventions and their outcomes: a systematic literature review.Journal of public health research,4(1).
15NURSING ASSIGNMENT Pillay, J., Armstrong, M.J., Butalia, S., Donovan, L.E., Sigal, R.J., Vandermeer, B., Chordiya, P., Dhakal, S., Hartling, L., Nuspl, M. and Featherstone, R., 2015. Behavioral programs for type 2 diabetesmellitus:asystematicreviewandnetworkmeta-analysis.Annalsofinternal medicine,163(11), pp.848-860. Sapkota, S., Brien, J.A., Greenfield, J. and Aslani, P., 2015. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes—impact on adherence.PloS one,10(2), p.e0118296. Sapkota, S., Jo-anne, E.B., Greenfield, J.R. and Aslani, P., 2015. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes —components of interventions.PLoS One,10(6), p.e0128581. Sheehan,L.,Nieweglowski,K.andCorrigan,P.,2016.Thestigmaofpersonality disorders.Current Psychiatry Reports,18(1), p.11. Sollberger, D., Gremaud‐Heitz, D., Riemenschneider, A., Agarwalla, P., Benecke, C., Schwald, O., Küchenhoff, J., Walter, M. and Dammann, G., 2015. Change in identity diffusion and psychopathology in a specialized inpatient treatment for borderline personality disorder.Clinical psychology & psychotherapy,22(6), pp.559-569. Stringer, B., Karman, P., Koekkoek, B., Hoogendoorn, A.W., Kerkhof, A.J. and Beekman, A.T., 2015. Collaborative Care for Patients With Severe Personality Disorders: Preliminary Results and Active Ingredients From a Pilot Study (Part I).Perspectives in psychiatric care,51(3), pp.180-189.
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16NURSING ASSIGNMENT Sun, Y. and Zhao, H., 2016. The effectiveness of lifestyle intervention in early pregnancy to prevent gestationaldiabetesmellitusin Chinese overweight and obese women:A quasi- experimental study.Applied Nursing Research,30, pp.125-130. Valentine, S.E., Bankoff, S.M., Poulin, R.M., Reidler, E.B. and Pantalone, D.W., 2015. The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature.Journal of Clinical Psychology,71(1), pp.1-20. Warrender, D., 2015. Staff nurse perceptions of the impact of mentalization‐based therapy skills training when working with borderline personality disorder in acute mental health: a qualitative study.Journal of psychiatric and mental health nursing,22(8), pp.623-633.