Module 07 Case Study
Read the case study below about Borderline Personality Disorder and answer the following questions .
How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and an appropriate nursing intervention.
What interdisciplinary referrals might be appropriate?
MODULE 07 CASE STUDY
S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part time in a nursing home and also works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that her supervisor at the nursing home “is a bitch”; although she really liked her supervisor at first, she says “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get fulltime jobs five times in the last four years, was hired for three, but only lasted one or two weeks at each one.
S. reports that she is currently not talking to her daughter because “she is horribly mean to me and she needs to apologize or I won’t talk to her again”. She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that say “I still love you! Grandma”, but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her.
S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband, and has a pattern of meeting and dating men who eventually abuse her. She states that her last relationship was very good, however; the man was not abusive and “I loved him very much”. The relationship ended for reasons that S. doesn’t understand, although she does report many arguments that ended in “scenes” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more and I showed it”. She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong on a regular basis. When the boyfriend asked to break up, S. reports sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about 4 months ago.
S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her individual psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.
Expert Solution Preview
Introduction: Borderline Personality Disorder (BPD) is a complex mental health condition that affects a person’s emotions, thoughts, and behavior. As a medical professor, I would approach the case study of S., a 48-year-old woman with BPD, by focusing on therapeutic communication and principles of cognitive behavioral therapy, conducting a thorough assessment process, and collaborating with an interdisciplinary team to develop a comprehensive care plan.
1. How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
Therapeutic communication is essential in engaging individuals with BPD in the treatment process. As a medical professor, I would use active listening, empathetic responses, and non-judgmental communication to foster a therapeutic relationship with S. Cognitive-behavioral therapy (CBT) is an effective treatment approach for BPD that focuses on identifying and modifying negative thought patterns and behaviors. I would use CBT principles by helping S. recognize her negative thought patterns, challenging them, and developing coping skills to manage her emotions and behavior.
2. Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and an appropriate nursing intervention.
The assessment process for individuals with BPD involves a comprehensive evaluation of their medical, psychiatric, and social history. I would conduct a clinical interview to evaluate S.’s symptoms, behaviors, and functioning. Co-morbid conditions commonly associated with BPD include depression, anxiety disorders, substance abuse, and eating disorders. One nursing diagnosis for S. could be impaired social interaction related to interpersonal conflicts and emotional dysregulation. An appropriate nursing intervention could be to encourage S. to participate in group therapy to improve her social skills and develop positive relationships.
3. What interdisciplinary referrals might be appropriate?
Individuals with BPD often require interdisciplinary care to address their complex needs. Referrals for mental health counseling, medication management, and psychiatric consultation may be appropriate for S. Additionally, referrals for occupational therapy, vocational rehabilitation, and financial counseling may also be beneficial in addressing S.’s social and economic needs. Collaboration with a multidisciplinary team is crucial in developing a comprehensive care plan for individuals with BPD.