BPD CASE STUDY:

Janine is a 25 year old female who was recently admitted to an inpatient psychiatric unit after she superficially scratched her wrists with a paper clip in front of a triage nurse, threatening to “use something sharper as soon as I can find it!” She has a history of multiple hospitalizations, all with similar presentations. Her case manager is very concerned with her recent increase in self-injurious behavior. Most of the time, she uses cigarettes to burn herself or sharp objects to scratch or cut herself, but last month she ingested three batteries, requiring surgical intervention. When asked about her recent stressors, Janine states, “My boyfriend dumped me…again! My life is a total nightmare.”

On the inpatient unit, Janine is irritable and angry most of the time. She accuses staff of never listening and never caring, threatening to sue them all. When her assigned nurse starts to set limits on her verbally abusive behavior, Janine grabs a plastic knife off the dinner tray and runs to her room, barricading herself in the bathroom. She yells, “You don’t think I’ll actually kill myself, but you’re wrong. F*ck all of you!”

A. What data would you like to have that you don’t already have?

B. Formulate and prioritize the three most appropriate NANDAs.

C. List at least two measurable client outcome criteria for each NANDA.

D. List at least two individualized nursing interventions for each NANDA.

CASE STUDY: DOMESTIC VIOLENCE

Sharon is a 32-year-old woman who arrives at the emergency department with her three small children. She has multiple bruises around her face and neck. Her right eye is swollen shut. Sharon says to the nurse at the E.D., "I didn't want to come here. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The E.D. nurse begins interviewing Sharon while she inspects her wounds. "He's been getting more and more violent lately," Sharon says. "He's been under a lot of stress at work the past few weeks . . . He's been drinking a lot when he gets home . . . He always gets mean when he drinks . . . I was getting

scared. So I just finally told him I was going to take the kids and leave . . . He got furious when I said that and began beating me with his fists."

When Sharon’s oldest child, her 12 year old daughter, tells the E.D. nurse that her mother lost consciousness after her father hit her, the nurse decides to admit Sharon to your med/surg unit.

A. What data would you like to have that you don’t already have?Does she has an escape plan ,

B. Formulate and prioritize the three most appropriate NANDAs.Risk for injury , ineffective coping , powerlesness

C. List at least two measurable client outcome criteria for each NANDA.Patient will verbalized safety plan , pt will verbalized the cycle of violence and why its important to leave

D. List at least two individualized nursing interventions for each NANDA.Educating cycle of violence and everything you might need , make referrals , its goo dif we don’t rescue the patient then they are more likely to go back , acknolodeging their feelings you can tmake the decision for them , stressing the importance of safety its about keep you and your kids safe