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vSIM for Nursing Describe Disease Process Affecting Patient (Include Pathophysiology of Disease Process) Borderline Personality Disorder (BPD) is marked by impaired functioning, unstable emotional regulation, alterations in behavior and unstable interpersonal relationships. There is a genetic risk factor associated with the disorder. Neurobiologically, these pts have altered serotonin transporters, which results in lower levels of serotonin and impulsive and aggressive behavior. There is also a dysfunction in the prefrontal cortex. This area of the brain is responsible for regulating emotions and it does not respond in the pt with BPD. This results in the extreme and intense emotions observed in these pts. In addition, the limbic system, the emotional regulatory center of the brain, is overstimulated. This contributes to alterations in mood (Halter, 2018). Diagnostic Tests (Reason for Test & Results) Patient Information Anticipated Physical Findings ●Semi structured interview ●Self report inventory: MMPI ●Liver function tests ➔To ensure patient is not receiving toxic levels of Ibuprofen and Acetaminophen ●Kidney function tests ➔To ensure patient is not receiving toxic levels of Ibuprofen and Acetaminophen Patient: Sandra Littlefield. 36y.o female DOB: 12/21/83 Hx of back pain. Rx Acetaminophen and Ibuprofen for it, but pt states her pain is unrelieved for it. Hx of sexual abuse, suicide attempts, back pain, and drug and alcohol abuse. Currently in the Blooming County Jail for prostitution. ●Emotional lability ●Impulsivity ●Self destructive behaviors ➔Ineffective and self soothing habits (cutting, promiscuous sexual behavior, numbing with substances) ●Chronic suicidal ideation ●Feelings of antagonism manifested in hostility, anger, and irritability ●Physical violence manifested in destructive behaviors ●Splitting: inability to view both positive and negative aspects of others as part of a whole (results in viewing someone as a wonderful or terrible person). (Halter, 2018). Anticipated Nursing Interventions ●Provide clear and consistent boundaries ●Administration of psychotropic medications ➔Antidepressants (SSRIs) ➔Anticonvulsants
➔Lithium ➔Naltrexone (found to reduce self-injurious behaviors) ●Encourage/refer to community meetings, coping skills groups, and socializing groups ●Calm and united patient-centered approach by staff (both of jail and healthcare team) ●Referral to psychotherapy vSIM ISBAR Activity Introduction (Your name, position (RN), unit you are working on) Hi Dr. Smiley my name is------------. I am a Nurse at the Blooming County Jail. Situation (Patient’s name, age, specific reason for visit) I am working with your patient Sandra Littlefield. She is an inmate of the jail. Background(Patient’s primary diagnosis, date of admission, current orders for patient) She suffers from BPD, has a Hx of suicide and depression R/T previous sex abuse. She also has a Hx of drug and alcohol problems. She is being treated for back pain with Acetaminophen and Ibuprofen.