Michelle, a 21-year-old female, has been admitted informally to an acute mental health unit this is her first admission. ?MENTALHEALTH_DISCUSION.docx

Michelle, a 21-year-old female, has been admitted informally to an acute mental health unit this is her first admission. Michelle is currently under treatment with her GP for depression and prior to her admission Michelle attempted suicide by cutting her wrists. Subsequently a short admission was arranged with the aim of devising a comprehensive care plan.

After discussing the circumstances leading up to her suicide attempt Michelle became increasingly tearful and distressed, she started demanding to see a MD/NP. After being told that the NP was on their way and would arrive in about 10 minutes, Michelle became angry demanding medication to calm her down; she then proceeded to run towards the unit doors shouting that she wanted to go home. At that moment the NP arrived on the unit and Michelle immediately calmed down.

During the assessment process Michelle disclosed her emotions of anger if she did not get her way was not unusual for her. She also mentioned that she often had regrets about her behavior and these bouts of anger later. She described herself as a "terrible person who was out of control" and she "just wanted to die". Following this assessment, the NP initiated a plan of care.

1. What type of psychological interventions would the nurse practitioner consider implementing?

2. Currently Michelle has been admitted informally to the Behavioral Health (BH) unit. Due to Michelle's difficulties with impulse control, this admission decision may change. Based on this possibility, what does the nurse practitioner professionally need to know when managing Michelle's legal status?

3. Michelle is subsequently diagnosed with a "borderline personality disorder". What other types of personality disorders present similarly to this behavior?

Michelle has now been on the BH Unit for over 6 months. Each time discharge had been arranged Michelle was noted with suicide attempts or was found having harmed herself. Michelle has agreed for transfer to a therapeutic community and is now engaging in pre-therapy work.

4. What other treatments besides a therapeutic community are recommended for individuals diagnosed with a borderline personality disorder?

5. While working with Michelle the primary nurse practitioner has found the relationship at times to be quite stressful. What are the signs of caregiver stress?

6. What strategies could the NP use to manage this type of stress?

7. What process should be utilized as a way to support the primary NP to improve their practice?

List your (3) credible PEER-REVIEW resources/references within 5 years and in  APA format. Please use reliable medical references such as your Goroll text, your Current Medical Diagnosis and Treatment book, or UpToDate.  Do NOT use WebMD, Wikipedia etc. as these are not advance practice references.  

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