Nursing Assignment on Emotionally Unstable Personality Disorder and Type II Diabetes

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.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the University
Author note

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Table of Contents
Introduction......................................................................................................................................2
Section 1..........................................................................................................................................2
Section 2..........................................................................................................................................4
Section 3..........................................................................................................................................4
Section 4..........................................................................................................................................6
Section 5..........................................................................................................................................8
Section 6..........................................................................................................................................9
Conclusion.....................................................................................................................................10
References......................................................................................................................................12

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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
disorder and type II diabetes. The emotionally unstable personality disorder, also called
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
experiencing behaviours of self-destructiveness (Sheehan, Nieweglowski and Corrigan
2016).Three domains of pathophysiology have been identified in this disorder- affect

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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 (Bodner et 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 (Pillay et
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 (Linehan et 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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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)

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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 (Stringer et 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

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other people and also with other encounters. All of these assessments are important for the
patient of the given case study (Keuroghlian et 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 (Sapkota et 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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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 (Knaak et 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,
limiting seeking the attention constantly, frequently disregarding the rules, limiting the
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 (Jutterström et 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

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morning till the dinner at night. The nurse should serve different meals in the breakfast, lunch
and at the dinner (Chapman et 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 (Sapkota et 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

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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 (Lepard et 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 (Valentine et 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 (Sollberger et 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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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 (Koivusalo et 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

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from borderline personality disorder since childhood, even she was also having suicidal
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.

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