Running Head: MENTAL HEALTH CASE STUDY 1

Mental Health Case Study

Omar Amireh
Youngstown State University
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Abstract
Borderline personality disorder is one type of mental health problem that effects individuals.

This case study will focus on a patient who was admitted to the hospital and diagnosed with

borderline personality disorder and depression. This case study will discuss objective data

gathered on admission and during the day of care. The case study will discuss this patient’s

psychiatric diagnosis and the triggers that led the patient to be admitted to the hospital. The

patients’ family and personal history of mental illness will be discussed as well. This patients’

influences will also be discussed including ethnic, spiritual, and cultural influences that had an

impact on her behaviors and mental health. The case study will lastly focus on outcomes related

to care, plans for discharge, and nursing diagnosis that were created and individualized for this

patient.
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Objective Data

Patient MG is a twenty-three-year-old female who was admitted on October seventh and was

transported to the hospital by ambulance voluntarily. Upon entering the emergency room and

being evaluated by the nurse practitioner and physician, they have noticed several lacerations to

her left forearm which she did to hurt herself. The patient was emotionally labile presenting with

irritability and anxiousness. According to admission notes, she also appeared upset and angry.

The physician attending to this patient finds out that she was in an argument and fight with her

boyfriend. The argument escalated, and the patient eventually had possession of a kitchen knife.

Patient MG attempts to cut her boyfriend and succeeds without causing significant harm but then

turns the knife to herself and begins cutting herself. According to admission notes, patient MG

has a child which was sent to MGs’ grandmothers house where he can be taken care of. After

obtaining lab results, hospital staff concluded she was positive for tetrahydrocannabinol (THC),

there was no other pertinent lab values obtained that were abnormal or that were of concern.

Patient MG had no prior medical conditions or medical conditions diagnosed on admission.

Patient MG was transferred to the psychiatric unit for observation and treatment. The psychiatric

medications she was prescribed included Cogentin, Vistaril, Zyprexa, and Desyrel. Patient MG

was put on Cogentin to prevent drug induced extrapyramidal symptoms. The patient was put on

Vistaril to treat the anxiety she was experiencing and Zyprexa for agitation. Desyrel is given

nightly to help patient MG sleep.

During the initial visit on October tenth, patient MG was laying in her bed on the psychiatric

unit. I knocked and opened the door to the room she stayed in and I introduced myself and asked

her if I can sit down in the room with her. Patient MG greeted me with a smile and said “yes”.

Based on my observations, the patient appeared calm and opened to talking with me about her
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situation and problems she is facing. We eventually went into the milieu where we continued our

conversation. Despite appearing happy and calm during our conversation, I felt that the patient

was upset and angry about the problems she was going through. Patient MG seemed tense, upset,

and angry when talking about her boyfriend and how he cheated on her. One word that kept on

popping up in the conversation was loyalty. The patient believes that her boyfriend was not

devoted or faithful in their relationship together and values loyalty in the relationships she is in. I

asked if she would ever go back to him after he cheated. Patient MG digressed from the question

for a while until she gave me an answer. For example, she went on by saying that he has a good

paying job and that he pays for everything for she and her child. The patient says that he is good

with her child. After finding out that he cheated on her, she tells me that he says she is his

number one and the other girl was not important to him. Patient MG then goes on by saying she

will go back to him despite that he cheated on her. Patient MG also tells me that she did not

really want to commit suicide, she just wanted him to feel guilty for what he did to her.

Patient MG was put on self- harm precautions and unit restrictions to keep her safe and to

ensure treatment is effective during her stay at the hospital. The patients’ room was placed near

the nurses’ station so that way the nurses can monitor her closely if she were to harm herself.

Every item that enters the patients’ room is monitored closely to make sure the item can not be

used for self -harm. Rounds are performed more frequently to make sure the patient is calm and

not planning to harm herself and to make sure nursing staff is aware of her location. Vital signs

and assessments are performed more frequently to make sure the patient is physiologically stable

and not having adverse effects from medications. Medications are administered much more

carefully to make sure the patient takes the medications at scheduled times and to make sure the
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patient does not save medications to overdose later. Cigarette smoking is not tolerated at the

hospital, so a nicotine patch may be used if the patient has the urge to smoke.

Summarize the Psychiatric diagnoses

Patient MG was diagnosed with both bipolar 1 disorder and major depressive disorder without

psychotic features. According to psychiatric and mental health clinical nurse specialist Mary

Townsend (2017), “Borderline personality disorder is characterized by a pattern of intense and

chaotic relationships, with affective instability and fluctuating attitudes toward other people.

These individuals are impulsive, are directly and indirectly self-destructive, and lack a clear

sense of identity” (p.596). People with BPD fear abandonment and attempt to avoid it as much as

possible. According to author Lisa Philips (2018), “When people with BPD love, they love hard,

idealizing partners and friends and forming obsessive relationships. When loved ones disappoint,

BPD sufferers go to the opposite extreme, their terror of abandonment drives them to anxiety,

rage, or paranoia” (para.9). Patient MG became upset and angry when her boyfriend cheated on

her and ended up cutting him and herself, this is a behavior manifested in BPD.

Patient MG was also diagnosed with major depressive disorder. According to Townsend

(2017), “MDD is characterized by depressed mood or loss of interest or pleasure in usual

activities, evidence will show impaired social and occupational functioning that has existed for at

least two weeks, no history of manic behavior, and symptoms that cannot be attributed to use of

substances or a general medical condition” (p.380). There are many factors that could have

influenced the patients MDD. Charlotte Davis, a surgical intensive care unit nurse (2017) says,

“recent or traumatic stressful events, such as the death of a loved one, sexual or physical abuse,

and financial hardship can increase the risk for MDD” (p.28). Patient MG talked to me about the

loss of her mother to cancer when she was just starting high-school. The patient said during that
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time her mother was starting to homeschool her, her mom discontinued homeschooling because

she became ill. The mother eventually died and patient MG never continued with her education.

Patient MG talked to me about her father and said she and her father never get along and always

argue. The patient said that she has half siblings and they are not very close. Patient MG feels as

if her father gives more attention to her half siblings and not enough attention to her. The patient

mentioned to me that once she got into an argument with her younger half -brother and she felt

as if he took her brothers side. Patient MG then said that she and her dad started arguing and it

became physical. The patient then mentioned that her brother said, “Get off my daddy”! as if

they were not related or had the same dad and felt excluded from the family. Patient MG also

mentioned that her father had a heroin addiction at one point in his life but eventually went to

rehab and became better. Other common behaviors in MDD include significant weight loss or

gain, fatigue or loss of energy, insomnia, feelings of worthlessness and guilt, inability to

concentrate or indecisiveness, and suicidal ideations or attempts.

Patient MG did attempt to commit suicide with a kitchen knife. The patient also has difficulty

sleeping, which was why she was prescribed Desyrel. The patient also told me that she stays in

her apartment for most of the time. Patient MGs boyfriend pays for everything including rent,

bills, and food. The patient’s boyfriend even bought her a car and pays for gas and insurance on

it as well. The patient told me she does not work and never really had a job. The patient says that

her boyfriend’s job requires him to travel the whole country, so he is only home twice a month.

The patient also mentions that her car has been broken for several months now and he sent the

car to a mechanic to get fixed. However, the patient tells me that he has been upset with her

lately, so he decided not to get the car fixed for her, therefore she cannot go anywhere. The

patient told me that she became a dancer at a club for about a week which she got his approval
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for before getting the job. However, she said he eventually became upset about her becoming a

dancer, so he told her to quit immediately. I asked the patient if she was interested in going back

to school or getting another job that maybe her boyfriend would approve of. The patient goes on

by saying things like “I don’t know if I am good at anything” and “I don’t even know about how

to go about going back to school or who to call to get me situated in a school”. This type of

behavior mimics feelings of worthlessness which is indicative of depression.

It appears that she is very dependent on her boyfriend despite their unstable relationship. The

patient had many relationships and fears abandonment from her current boyfriend despite the

fact he cheated on her. Patient MG says she still loves him and would not know what to do

without him because she has been with him for a few years and it was her longest relationship

yet. This case seems relevant to and associated with her psychiatric diagnosis of BPD.

Identify the stressors and behaviors

As discussed previously, patient MG and her boyfriend got into argument and fight because

he cheated on her for another girl. The patient obtained a kitchen knife and cut him and then

turned the knife onto her self and started cutting her wrist. The patient found out that her

boyfriend was cheating on her through social media. This other girl and the patient went back

and forth on social media and were arguing and were very vulgar on social media according to

the patient. When the patient’s boyfriend came home she said she was very upset and angry at

him. According to the patient, her boyfriend said that this other girl was not important to him and

that the patient will always be his number one. After the altercation and harm done to her

boyfriend and to herself, her boyfriend was able to call the police and they sent an ambulance to

the residence where they picked the patient up and sent her to the hospital. The patients son was

sent to her grandma and aunts home.

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Discuss patient and family history of mental illness

The patient was diagnosed with borderline personality disorder and major depressive

disorder. Prior to that, the only behavioral problem she had was attention deficit hyperactivity

disorder. Patient MG was diagnosed with ADHD when she was fifteen years old and went to a

psychiatrist for it, according to admission notes. According to the patient, she said her father had

a substance abuse disorder. Patient MG said her fathers’ drug of choice was heroin. The patient

said her father eventually went to rehab and got the treatment he needed. The patient admits to

smoking marijuana occasionally and smoking cigarettes daily, however, she does not have a

substance abuse disorder.

Describe the psychiatric evidence-based nursing care provided

Patient MG was at an increased risk for harming herself and others. The patient is to be

observed more frequently to make sure she and others around her are safe. However, I tried not

to be watchful or appear suspicious when with this patient. I made sure there were no dangerous

items that can potentially cause harm to the patient or other around her. I stayed relaxed and had

a normal conversation with this patient like I would with any other person that is a patient or not

so that she was more open to talking. I allowed the patient to express her feeling about herself

and the problems that she was facing. This included good and bad feeling that patient MG was

feeling or did feel before hospitalization. I also gave her my empathy when she told me her

mother died to cancer. The patient attended the group therapy session and participated even

though she was not a drug abuser or an alcoholic. Patient MG read a handout aloud so that the

group can hear and shared with the group that she does not abuse drugs or alcohol. However, the

patient did share that she smokes cigarettes and smokes marijuana occasionally. Established a
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good rapport, being honest, and having an accepting attitude with this patient allowed her to be

more comfortable with talking and expressing her feelings more openly.

Analyze ethnic, spiritual, and cultural influences

Patient MG says she is a Christian but that she is not very religious. The patient says she is

not a person that goes to church often. However, the patient does look to God or Jesus when

referring to someone or something. For example, the patient says, “Jesus is watching” when

referring to her boyfriend cheating on her and being loyal to her. The patient does not know if

her boyfriend cheated on her prior to the time she caught him so that is why she makes that

comment. When patient MG started talking to me about her mom and her battle with cancer and

eventually her death, she said the last thing her mother wanted her to do was to finish school and

become educated. Patient MG made a comment about her mom being able to rest in peace and

that she is with God now and that she was going to fulfill her moms wish by going back to get

her education. So, the patient seems to look at God and Jesus for guidance whenever she has a

problem or is going through rough times. Growing up, patient MG said she stayed around the

type of people who consumed alcohol and smoked cigarettes and marijuana. The patient also

says that many people in her family including her mother are smokers or do drugs. The patient

believes she started smoking and drinking alcohol because of the people she would hang out with

and that she grew up with that type of lifestyle.

Evaluate the patient’s outcomes r/t care

After the fact that the patient cut her wrist, to her, it seems now that an argument with her

boyfriend was not worth cutting herself. The patient said she will not attempt hurting herself

anymore when she is upset. Patient MG and I were thinking of coping strategies that she can use
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whenever she feels angry or wants to hurt herself. The patient said she wants to better express

her anger other than by physical violence. Patient MG says she wants to start walking around her

block for thirty minutes a day or perform other physical activities for thirty minutes a day to

relieve that stress and anger she is dealing with. The patient also wants to take more control over

herself and her life problems and become more independent. Patient MG said she was thinking

about getting a job at a nail salon because she likes getting her nails done or applying for a job at

Walmart so that she is not that reliant on her boyfriend’s income.

Summarize the plans for discharge

Patient MG is to follow up with psychiatrist two weeks upon discharge. The patient is to

comply with the medication regimen and to take medications as directed. Patient MG is ordered

Cogentin 2mg by mouth daily, Vistaril 50mg three times per day by mouth, Zyprexa 5mg twice a

day by mouth, and Desyrel 50mg nightly. The patient is to report to her physician if she has any

severe symptoms such as hallucinations, confusion, dizziness upon standing, palpitations, or

muscle spasms or rigidity and seek help immediately. If suicidal ideations or suicidal attempts

persist, patient MG will seek help immediately.

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Prioritized list of all actual diagnoses

1. Self-directed/ other directed violence r/t ineffective relationship as manifested by cutting

left wrist, bruises on arms, cutting boyfriend, and arguing with boyfriend

2. Low self- esteem r/t psychiatric disorder (depression, BPD) as manifested by being

dependent on boyfriend, hesitant to go back to school or to get a job, and underestimating

ability to deal with her relationship with boyfriend

3. Ineffective coping r/t inability to deal with situation and insufficient social support as

manifested by cutting self because of argument, loosing mom to cancer, not close or in

terms with father, living alone with son and boyfriend only around twice a month

List of Potential Nursing Diagnosis

1. Risk for loneliness r/t affectional deprivation, emotional deprevation, physical isolation,

and social isolation

2. Risk for constipation r/t pharmaceutical measures; taking Trazadone

3. Risk for impaired parenting r/t mental illnesses, history of substance abuse, young

parental age, insufficient social support, unemployment

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Conclusion

Borderline Personality Disorder and major depressive disorder are two common

mental health illnesses that can affect individuals. These mental illnesses can be

influenced and caused by many factors. As for patient MG, it seems to me that childhood

trauma could have been a factor for her mental illnesses. Everyone perceives trauma

differently and trauma for one person might be different for others. There are no cures for

these mental illnesses but effective treatment options and therapies can allow patients to

accept their past history and learn how to effectively cope with the problems they are

facing during the present day.

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References

Davis, C. (2017, September). Not Just Feeling Blue: Major Depressive Disorder. Retrieved from

http://eps.cc.ysu.edu:3735/sp4.02.1a/ovidweb.cgi?&S=PCNIFPBNJBEBGFHAJPCKCG

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7c0015225820170900000007%7cyrovft%7covftdb%7cyrovfts&Counter5Data=0015225

8-201709000-00007%7cyrovft%7covftdb%7cyrovfts

Philips, L. (2018, November). Tangled In Turmoil. Retrieved from

https://eps.cc.ysu.edu:3778/ps/retrieve.do?tabID=T003&resultListType=RESULT_LIST

&searchResultsType=SingleTab&searchType=AdvancedSearchForm&currentPosition=1

&docId=GALE%7CA561343818&docType=Article&sort=Relevance&contentSegment=

ZNUP&prodId=PPNU&contentSet=GALE%7CA561343818&searchId=R1&userGroup

Name=ohlink104&inPS=true

Townsend, M. (2017). Essentials of Psychiatric Mental Health Nursing. Philadelphia, PA: F.A.

Davis Company