Clinical Case Study Assignment Sample

Nursing Interventions for a Patient with Borderline Personality Disorder, Bipolar Disorder, and Treatment-Resistant Depression

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Patient situation

Sam is a 21 years old male working in the student accommodation as a residential assistant. He had recently quit this job due to the challenging working environment and it was affecting his mood and disrupting his sleep cycle. He was studying nursing though he wanted to quit nursing and wanted to start a new course. Sam has been diagnosed with many types of disorders including BPD, ADHD, and Treatment-resistant depression BPAD type 2. Sam is currently diagnosed with depression and bipolar disorder. Sam is going through many emotionally heavy stressful situations such as Sam’s parents being separated recently, and with that, he also has academic stress, work stress, and relationship stress.

Collection of clues/information

Clinical history of the client

Sam is suffering from depression and Bipolar disorder. He is the residential assistant in the accommodation of his school. Sam was highly functioning in the previous years; however, recently he is suffering from some mental issues related to his work, his family issues, and academic stress. Because of those issues, He was suffering from “Borderline personality disorder”. It is a mental disorder that makes him think a lot about himself and others whom he was surrounded with (Miller, & Black, 2020). This situation is affecting his behaviour and daily lifestyle. On the other hand, it is also diagnosed that he had ADHD (López-Muñoz et al., 2018). ADHD is a neurodevelopment disorder, which is first diagnosed in his childhood. He had problems paying awareness and spending impulsive behaviour.

 He was also distracted easily and had an issue with a short attention span as well as making some careless mistakes in his schoolwork. Sam was treated in the past to reduce his problem of “Bipolar Affective Disorder '' which is also known as “Manic Depression”. In this situation, he has a mood swing issue (High and low mood in the same week) and the mood was changing frequently (López-Muñoz et al., 2018). Sometimes he suffered from psychosis, which means that he saw and listened to things that did not exist in his mind, and he just hallucinated everything.

Relevance of the history to the current mental state

Sam might convey delusional thoughts, such as an existing connection to a celebrity or famous person, the thought that he had dominion or talent, as he can read any other's mind or thoughts and he stated over thinking about this imaginary part and started believing in that anyone can influence his so easily (López-Muñoz et al., 2018). Because of these mental issues, he isolated himself and his work life became a hamper for this reason. This reduction in working is distinctive of the “prodromal stage” of the disorder called “schizophrenia” (Miller, & Black, 2020). This stage is distinguished by a reduction in working, and differences in mindset and demeanour, which foregoes the beginning of “psychosis”.

Sam has a family issue related to the separation of his parents. That’s why he has no mental support from his family and because his mental disorders cannot be reduced with the help of his family support (López-Muñoz et al., 2018). Several explanations exist for getting specified laboratory investigations in this patient with the disorder of “bipolar disorder”; vast pastureland of the physical tests is suggested, for the reason that bipolar disorder contains both unhappiness and obsession. Since a substantial number of medical reasons for each condition, exist.

Nursing assessments related to the situation

According to the nursing assessment related to the situation, Sam is a danger to himself and to the others with who he is surrounded (Nolen et al., 2018). On the other hand, he has homicidal or suicidal originality sometimes. Sam has some issues such as hypomania and psychosis. He cannot eat and sleep properly as a normal person can and his communication ability and procedure is not decent.

Result of the assessment

According to the assessment, the nurse has a responsibility to deliver a safe and secure ambience. Sam feels out of possession of his mental state that's why he deserves exterior control nonjudgmental and empathically (Nolen et al., 2018). On the other hand, he needs security from uninhabited behaviour.

Action plan

The recovery-focused nursing intervention for Sam has been chosen, that are psychotherapy and behavioural therapy.

Psychotherapy:

The first intervention is Psychotherapy. Psychotherapy is also known as talk therapy which is mainly used for the treatment of Borderline personality disorder. The main aim of this therapy is to focus on the current ability to function and learn the process of managing the emotions which feel uncomfortable. According to the view of Marceau et al. (2018), psychotherapy helps to reduce impulsiveness and start observing the feeling rather than acting on it. However, according to the insight of Woodbridge et al. (2022), this therapy improves the relationship with others because this therapy will help the person to understand the feelings of himself as well as other people.

Sam also has Borderline personality disorder. So, psychotherapy will be very effective for Sam. Sam recently goes through a lot of emotionally heavy stress like his parents got separated and there are also complications from the relationship and working stress.

This therapy will help him by giving him training for managing all the uncomfortable emotions. He is going through an emotionally critical phase. He needs to stop reacting whenever a negative reaction or uncomfortable emotion arises rather than he can start observing those emotions, start thinking about those emotions, collecting all his thoughts and emotions of himself, and trying to find a different perspective for those thoughts.

This intervention will give the patient Sam the willpower to fight all his emotions and negative thoughts and try to find a way of solution. Sam will be aware of self-knowledge and can know the process of managing the emotion and which can affect him and which emotions cannot bother him (Slotema et al. 2021). This recovery model will give him better days in the future and all these bad days will go past and these bad phases will teach him about life at most. And also, this reflective model will indulge the spirituality inside Sam which will give him the power to find the solution to problems himself in the future days.

Behavioural therapy:

The second intervention is Behavioural therapy. Behavioural therapy is used for the treatment of Borderline personality disorder and Attention Deficit Hyperactivity Disorder (ADHD). According to Wright et al. (2019), behavioural therapy helps to collect all the negative thoughts and change the patterns of those thoughts and increase the self-esteem of the patient. On the other hand, according to Ditrich et al. (2021), Behavioural therapy has multiple pieces of training for relaxation and stress management to reduce the anxiety and stress which was impacting the mental health of the patient. In behavioural training, the mentor gives advice and teaches the strategies for maintaining home and work activities. However, there is also training for improving the working relationship and it will boost the performance on the job and it will help in educating the patient to grow a good bonding with family members.

Sam has Borderline personality disorder and Attention Deficit Hyperactivity Disorder both. So this intervention for Sam will be much helpful and relevant.

Sam is going through a mentally critical phase. His parents got separated recently which is very emotional for him. He also quit his job and the nursing course he was doing wants to quit that course and with that, there is also work stress and relationship stress. The multiple training of this therapy will help him to manage work stress and relationship stress with that, it will also help him to make a good bonding with his parents and help him to go through this critical phase.

Stress management training behavioural training and working relationship improvement help him to grow the willpower to fight his negative thoughts. This therapy also makes him aware of his capability and identifies his emotional breaking down point. All this training will make Sam feel good about the current situation and give him hope for the best in the future. This training will help him to become a more spiritually active person and can always have the willpower to fight negative thoughts and always have self-believe and it will enhance Sam’s self-esteem.

Evaluation of outcomes

After implementing the psychotherapy it can be seen that Sam is a little better than in his previous state. He has made a little progress in his condition and that can be a decent hope for his medical and treatment history. He is now trying to manage his emotions and not throwing the substances that he used to do in the past. He is not using abusive language and trying to slowly cope with the others around him. He is also taking the medication as per the instruction of the doctor and sometimes he looks frustrated yet he is managing his way in this situation.

He is also positively responding to the care of the allocated nurse to him and with that aspect, he is also trying to manage his anger. Behavioural therapy has also been beneficial for him as the thought scrutinisation of the condition and the outcome has been done. In addition, the medications that have been given to Sam are currently not being altered. The medication is having a better effect on the patient and the situation with Sam seems to be under control. The future treatment plan will be based on further reaction and condition of Sam.

Reflection on the process and new learning

Sam has a mental disorder of Bipolar disorder and depression and he has a manic-depressive disorder. According to the “Gibbs Reflective cycle” I can describe the scenario that has happened to Sam and the actions that were taken on behalf of it. As a nurse, I observed his behaviour and explained that “Bipolar disorder” is reasonably characterised as a condition of the power of his brain. He experiences exceptional and extreme transitions in his mood and manners. Obsession is considerably more intense than a rash detonation of vitality or a fine mood. “Manic” attacks may be connected with heightened-risk manners including sense misuse, “sexual promiscuity”, exorbitant spending, and actual roughness (Scott et al., 2018). As a nurse “Bipolar disorder” is not much harder to diagnose (Pos et al., 2019). He had a “bipolar disorder” for a long time before the sickness is analysed. I need to take care of him because he is with issues "of bipolar disorder" by considering his personality and the harshness of his symptoms to decide, It has to do depending on clinical knowledge and judgement.

Figure 1: Gibb’s Reflective Cycle

(Source: Self-Developed)

 As I am taking care of a Bipolar Disorder patient so I have to empathize with his mental condition and the situation of his problem to support make them feel supported and taken (Severus et al., 2018). To reduce his mental pressure I can be much more interactive with him. Based on the Gibbs reflective cycle the evaluation of the situation has been done by me.

But he had the intention to harm me or abuse me. That is why this type of taking care is different and hard from other treatments. During the process of taking care, I have to be calm at my work, let him know and believe that he can share anything with me and that his beliefs are real to me. Through this process, I can achieve his trust. If possible, I have to face the challenges during the treatment and stating with him as a mental support. If I will do this thing then it will be easier to reduce his manic depression and anxieties and then he can feel real and stop over thinking. I should also discuss my feelings and story with him to achieve his trust and try to not be judgmental about his crisis whatever it is.

 Though there is a risk factor to taking care of him so I have given some warning signs to my family, friends and others. I have to talk to my friends about this case and slowly let my family know about his certain behaviour.

 In conclusion mentioned in Gibbs cycle, if the process of taking is proper and planned, he will recover soon and overcome his depression and Bipolar disorders. He can feel his real side and cannot harm himself or others. On the other hand, the chance of suicide is will be going to decrease.

References

• Brown, S., Rittenbach, K., Cheung, S., McKean, G., MacMaster, F. P., & Clement, F. (2019). Current and common definitions of treatment-resistant depression: findings from a systematic review and qualitative interviews. The Canadian Journal of Psychiatry, 64(6), 380-387.https://doi.org/10.1177/0706743719828965
• Ditrich, I., Philipsen, A., & Matthies, S. (2021). Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited–a review-update on common grounds and subtle distinctions. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 1-12. https://doi.org/1-12. 10.1186/s40479-021-00162-w
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• López-Muñoz, F., Shen, W. W., D'ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of a bipolar disorder. International journal of molecular sciences, 19(7), 2143. doi:10.3390/ijms19072143
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