Republic of the Philippines

Catanduanes State University

Virac, Catanduanes

Ma. Nikka C. Ramirez

Bachelor of Science in Nursing
3rd Year, Block A – Group 4

NCM 117- PSYCHIATRIC NURSING

Case Study:

Daisy Mae, a 19-year-old college student, has been admitted to the mental health
ward of the acute psychiatric unit. Prior to being admitted, she had slit her wrists in an effort
to commit suicide while receiving treatment for depression. To assist her, the facility set up a
care plan.

Daisy Mae started crying and acting distressed as she continued to describe the
circumstances that led to her suicide attempt. She also started insisting on being seen by a
doctor. Daisy Mae grew irate when she was informed that the doctor would be in around 10
minutes and would need medication to calm her down. She then ran towards the ward's doors
while yelling that she wanted to go home. As soon as the doctor entered the ward, Daisy Mae
also started to feel better.

Daisy Mae acknowledged during the assessment process that she frequently became
irate when she did not get her way. She also emphasized how dreadful she felt after these
angry outbursts. She claimed that she was a "bad person who was out of control" and that all
she wanted to do was pass away. The nurse evaluated Daisy Mae and then began to develop a
treatment strategy.

1. What kinds of psychiatric treatments would the nurse be willing to try?

The nurse may try to involve in the therapy is the psychotherapy or

counseling also called talk therapy, it involves talking about your problems
with a mental health professional that is often done one-on-on and or by
group. Psychotherapy explores thought, feelings and behaviors of the client.
The nurse may also try prescription of medicine, medicines for mental
disorders alters chemicals in the brain that are involved in emotions and
thought patterns.
 Republic of the Philippines
Catanduanes State University
Virac, Catanduanes

2. Daisy Mae has currently been formally admitted to the ward. Daisy Mae's
issues with impulse control may cause this to change. What information is
necessary for the nurse to manage Daisy Mae's legal status based on this?
Acquiring patient’s consent to care as well as the guardian’s affidavit about
Daisy Mae’s admission to the ward. The nurse may also obtain the doctor’s
diagnosis about Daisy Mae’s condition supporting the need of admission in
the institution and the agreement about the treatment concerning the client’s
situation are all under consent. Any procedure given or may give under
various circumstances involving the patient is all understood and have an
accord to the institution policies. The nurse will assist in the education about
the hospital policies to the guardian including the procedures given to patient’s
under conditions.

3. A "borderline personality disorder" is later determined to be Daisy Mae's

condition. Which personality disorders are there in addition to these?
Borderline personality disorder can occur with other mental illness such as
post-traumatic disorder (PTSD) and other symptoms of major depression,
bipolar disorder, anxiety disorders substance abuse or eating disorders.

4. What particular psychiatric treatments would the nurse offer?

Psychotherapy of talk therapy is considered the first-line treatment.
Medications are also recommended particularly for mood swings or
depression.

5. What may the nurse take away from their interactions with Daisy Mae?
Offer emotional support, understanding, patience and encouragement to
patient. It can be difficult because of the circumstances with over emotion
emphasis for both good and bad feelings. Take vigilant assessment and
security to Daisy Mae because of her history of self-harming. Take away
possible objects that can be used to harm self and or others in the environment.
 Republic of the Philippines
Catanduanes State University
Virac, Catanduanes

Daisy Mae has now spent more than six months on the ward. Dais Mae threatens
suicide or self-harms each time discharge is scheduled. Daisy Mae has since accepted the
offer to move into a therapeutic community, a room has been reserved, and she is currently
working on preparation for therapy.

1. What other therapies are suggested for people with borderline personality
disorder besides therapeutic communities?
Dialectal Behavior Therapy (DBT) – developed particularly for individuals
with borderline personality disorder, this involves concepts of mindfulness or
awareness of one’s present situation and emotional state. Therapy also
includes education about control of intense emotions, reduction of self-
destructive behaviors and improve relationships.
Cognitive Behavioral Therapy (CBT) – this therapy involves identifying and
changing core beliefs and behaviors that come from inaccurate perceptions of
themselves and others and problems interacting with others. This therapy may
help to lessen patient’s mood swings and anxiety symptoms and the chances
of self-harming behaviors.

2. The primary nurse has found the relationship with Daisy Mae to be rather
stressful at times while working with her. What symptoms of stress are there?
 Over-burdened or overwhelmed
 Anxious
 Worried or tense
 Fatigue
 Muscle aches and headaches
 Sweating
 Unable to concentrate
 Memory feel slower than usual
 Republic of the Philippines
Catanduanes State University
Virac, Catanduanes

3. What methods of stress management could the nurse employ?

 Practice moving your body, exercising or even going on for a walks.
 Try relaxation activities.
 Eat healthy.
 Avoid multitasking and minimize conflict.
 Have enough time to rest/sleep.
 Set limits appropriately and say no to requests that would create
stressful situations.
4. What procedure should be used to assist the primary nurse in developing their
skills?
Taking emergency procedure training particularly in self-harm situations.
Improving their communication techniques to help reduce anxiety of patients.