Brian & Michelle Methamphetamine or Borderline Personality Disorder Case Study Along With Essay Writing - Nursing Assignment Help

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Case1:  Methamphetamine-type substance use disorder

Brian is a 35-year-old man who has collapsed in the middle of the street at 9:30 pm on a busy Saturday night.  His friend Simon* has called the Queensland Ambulance Service, and a Code 2 is called to attend. On arrival, the paramedics find Brian lying on the ground. He is conscious, although appears to be responding to visual stimulus unseen by others. He is confused, agitated, paranoid, and diaphoretic. According to witnesses, Brian had been screaming obscenities and making threatening gestures to passing motorists in the street with no discernible motivation before he suddenly collapsed. 

The paramedics examine Brian - his airway is patent, and he shows no signs of trauma. His breath sounds are clear bilaterally; he has palpable, strong peripheral pulses; and his pupils are equal and dilated to 6 to 7 mm bilaterally. He moves his extremities purposefully, though he exhibits some muscle rigidity. His skin is flushed, diaphoretic, and hot to touch. His abdomen is soft and non-tender to palpation. Brian’s vital signs are heart rate, 160 beats/minute; BP, 200/110 mm Hg; respirations, 44; temperature, 40.4 degrees (Celcius) rectally. He appears to be responding to visual stimuli unseen by others.

His friend Simon offers some personal history. For almost 10 years, Brian worked as a financial broker for a large Australian bank (the same bank where Simon is employed). He was married, however, an acrimonious divorce (with his ex-wife receiving the house and full custody of his two young children) has created severe financial stress.  Most of his income goes on child support, and as a result, Brian is essentially homeless, couch surfing with his very small group of friends. Simon has noticed that Brian’s mental health has been suffering and that he has been consuming large amounts of alcohol and using “all sorts of pills” to cope. He suspects that Brian may have been experimenting with speed. He tells the paramedics that it is likely that his job is in jeopardy, as Brian has required numerous sick days, and often comes to work looking disheveled and unwell. 

Case 2: Borderline Personality Disorder

Michelle is a 17?year?old female student, who lives at home with her adoptive parents and two younger siblings. She presented to the ED late tonight after taking an overdose of paracetamol tablets following an online fight with friends from school. They had accused her of trying to steal someone’s boyfriend and although she denied it, she felt the group was ostracising her and she had challenged them about this. Half an hour after taking the tablets she informed her parents, who then drove her to the Emergency Department (ED). 

Michelle reports that she feels hopeless and sad about her life. She spent her first few years in foster care and explains that she was sexually abused by one of her family members when she was 10 years of age. Alcohol and marijuana use began at age 12, although she says that she only drinks intermittently now. Moving around the foster care system meant it was difficult to make friends - she has no friends at all currently, and she cannot see the point in living. She reports that things were okay for her until she started secondary school. She describes increasing problems with her peers and says her friends often blame her for starting fights and causing trouble. She has always worried about whether she was being left out or not. She spends a lot of time online, checking what her friends were doing. Michelle describes her moods as intense and that she feels four different moods in a day.  She finds this overwhelming and exhausting. When feeling particularly upset, she self?harms. Michelle describes intermittently self?harming since the age of 14, although she has only taken one overdose prior to this referral. She is able to identify that feeling rejected by her friends often precipitates her harming herself. Over the past two months, Michelle had been staying in her room, only leaving for short periods of time, refusing to go to school or to come out and engage with her family. Michelle’s self?harm has increased, to the daily superficial cutting of inner arms with razors. 

She also describes frequently feeling angry about small issues, and states she had been suspended from school for assaulting a peer six months ago. Her parents reported she is often moody, had frequent angry tantrums and had always had a short fuse “like her father”. Despite these ongoing problems, Michelle says she was managing academically, and that she had been good at basketball until she gave it up two years ago. She is currently enrolled in year 11, but with the recent events, she is unlikely to finish the year.

Note/-She is medically cleared by the ED and 24 hours later, is transferred to the Adolescent Inpatient Unit for further assessment.

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