NUR 4386Care Plan (S. Littlefield)
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 Patient Information Anticipated Physical
(Reason for Test & Results) Findings
● Semi structured interview Patient: Sandra ● Emotional lability
● Self report inventory: MMPI Littlefield. 36y.o ● Impulsivity
● Self destructive behaviors
● Liver function tests female ➔ Ineffective and
➔ To ensure patient is not self soothing habits
receiving toxic levels DOB: 12/21/83 (cutting, promiscuous
of Ibuprofen and sexual behavior,
Acetaminophen Hx of back pain. Rx numbing with
● Kidney function tests substances)
Acetaminophen and ● Chronic suicidal ideation
➔ To ensure patient is not Ibuprofen for it, but ● Feelings of antagonism
receiving toxic levels pt states her pain is manifested in hostility,
of Ibuprofen and unrelieved for it. Hx anger, and irritability
Acetaminophen of sexual abuse, ● Physical violence
manifested in destructive
suicide attempts,
behaviors
back pain, and drug ● Splitting: inability to view
and alcohol abuse. both positive and negative
aspects of others as part of
Currently in the a whole (results in viewing
someone as a wonderful or
Blooming County
terrible person).
Jail for prostitution. (Halter, 2018).
Anticipated Nursing Interventions
● Provide clear and consistent boundaries
● Administration of psychotropic medications
➔ Antidepressants (SSRIs)
➔ Anticonvulsants
, NUR 4386Care Plan (S. Littlefield)
➔ 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 Hi Dr. Smiley my name is-----------. I am a Nurse at the
(Your name, position (RN), unit Blooming County Jail.
you are working on)
Situation I am working with your patient Sandra Littlefield. She is
(Patient’s name, age, specific an inmate of the jail.
reason for visit)
Background She suffers from BPD, has a Hx of suicide and
(Patient’s primary diagnosis, date depression R/T previous sex abuse. She also has a Hx of
of admission, current orders for drug and alcohol problems. She is being treated for back
patient) pain with Acetaminophen and Ibuprofen.
Assessment Her VS, CBC, BMP, and Urinalysis were all within
(Current pertinent assessment data normal limits. Upon mental assessment it was found that
using head to toe approach, she has feelings of hopelessness, has suicidal ideation
pertinent diagnostics, vital signs) w/o plans of doing it, and intense feelings of
abandonment. During her assessment S.L became angry,
used increased sarcasm, and became bitter.
She ℅ 10/10 pain in her back.
Recommendation I would recommend referring her to pain management
(Any orders or recommendations and a psychologist for further evaluation and plan of
you may have for this patient) treatment with pharmacological assistance. Is there
anything else you would suggest?
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 Patient Information Anticipated Physical
(Reason for Test & Results) Findings
● Semi structured interview Patient: Sandra ● Emotional lability
● Self report inventory: MMPI Littlefield. 36y.o ● Impulsivity
● Self destructive behaviors
● Liver function tests female ➔ Ineffective and
➔ To ensure patient is not self soothing habits
receiving toxic levels DOB: 12/21/83 (cutting, promiscuous
of Ibuprofen and sexual behavior,
Acetaminophen Hx of back pain. Rx numbing with
● Kidney function tests substances)
Acetaminophen and ● Chronic suicidal ideation
➔ To ensure patient is not Ibuprofen for it, but ● Feelings of antagonism
receiving toxic levels pt states her pain is manifested in hostility,
of Ibuprofen and unrelieved for it. Hx anger, and irritability
Acetaminophen of sexual abuse, ● Physical violence
manifested in destructive
suicide attempts,
behaviors
back pain, and drug ● Splitting: inability to view
and alcohol abuse. both positive and negative
aspects of others as part of
Currently in the a whole (results in viewing
someone as a wonderful or
Blooming County
terrible person).
Jail for prostitution. (Halter, 2018).
Anticipated Nursing Interventions
● Provide clear and consistent boundaries
● Administration of psychotropic medications
➔ Antidepressants (SSRIs)
➔ Anticonvulsants
, NUR 4386Care Plan (S. Littlefield)
➔ 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 Hi Dr. Smiley my name is-----------. I am a Nurse at the
(Your name, position (RN), unit Blooming County Jail.
you are working on)
Situation I am working with your patient Sandra Littlefield. She is
(Patient’s name, age, specific an inmate of the jail.
reason for visit)
Background She suffers from BPD, has a Hx of suicide and
(Patient’s primary diagnosis, date depression R/T previous sex abuse. She also has a Hx of
of admission, current orders for drug and alcohol problems. She is being treated for back
patient) pain with Acetaminophen and Ibuprofen.
Assessment Her VS, CBC, BMP, and Urinalysis were all within
(Current pertinent assessment data normal limits. Upon mental assessment it was found that
using head to toe approach, she has feelings of hopelessness, has suicidal ideation
pertinent diagnostics, vital signs) w/o plans of doing it, and intense feelings of
abandonment. During her assessment S.L became angry,
used increased sarcasm, and became bitter.
She ℅ 10/10 pain in her back.
Recommendation I would recommend referring her to pain management
(Any orders or recommendations and a psychologist for further evaluation and plan of
you may have for this patient) treatment with pharmacological assistance. Is there
anything else you would suggest?
