Anxiety Disorder/Obsessive Compulsive Diso

Case Study – anxiety disorder/obsessive compulsive disorder

Course Competency

Assemble nursing care interventions for clients with behavioral or cognitive disorders.

Scenario

Lauren has been diagnosed with Social Anxiety Disorder and experiences obsessive thoughts that result in compulsive behaviors. This has a major impact on her life and day to day functioning.

Instructions

View the videos segments 1, 2, and 3 for Lauren.

Notice how the nurse continues to gather information to assess the extent of Lauren’s illness. The content relates to the objective that you will be able to describe the symptoms of anxiety and OCD.

Segment 1

Segment 2

Segment 3

Create a document which contains this information:

· Describe at least three clinical signs of Anxiety observed in the videos.

· Describe at least three Obsessive-Compulsive behaviors observed in the videos.

· Explain at least three therapeutic communication techniques used by the nurse in the videos.

· Discuss at least two nursing interventions appropriate for Lauren. Support your choices with rationales.

· Support your ideas with at least two credible resources.

,

Segment1

KAREN Hi, Lauren. Glad that you’re here and umm… I’d like us to continue talking about some of the difficulties that have been going on recently. And getting a little bit more specific about what happens if, if that’s okay with you. And where I would like to start is to ask you if you could describe what happens, when let’s say at school uh… and you frequently have stomach aches, nausea and that discomfort that arises, can you talk a little bit more about those situations that occur?

01:15LAUREN Umm… I just, I get nervous. Uh… That all, you… you know, embarrass myself.

01:25KAREN How could you embarrass yourself?

01:30LAUREN I can trip over gravity, I can knock into someone, I can… I can hit locker I can say the wrong thing.

01:40KAREN Are you clumsy and general, or you kinda somebody that stumbles and falls over your own feet?

01:50LAUREN No.

KAREN But you worry that, that could happen?

LAUREN Yeah.

01:55KAREN And you worry, you could sit. What you say, say the wrong thing?

LAUREN Yeah.

02:00UNKNOWN How might that happen?

02:05LAUREN If someone, I don’t know if someone talks to me and I… I’m not really listening to them and that I just blurt something out. And they get offended or…

02:15KAREN Has that ever happened?

02:20LAUREN No.

02:25KAREN But you worry that you could blurt out something that would offend the other person?

02:30LAUREN Yeah.

02:35KAREN Well, you know, that, that’s kind of interesting in the sense that what you have previously described is feeling that other people are judging you or other people are doing things that umm… is hurtful to you, and yet, you say, your worry is that you would blurt out something that would be hurtful to someone else. What do you do when you have those thoughts that you could stumble or you could blurt? How do you cope with that feeling or impulse?

03:25LAUREN I do what I always do.

03:30KAREN Lauren, what do you always do?

LAUREN I think of something in my head.

03:35KAREN Something?

03:40[sil.]

03:45LAUREN Umm… And I think about it a lot and I, actually all the time actually, throughout the day.

03:55KAREN And thinking about this something helps you to cope with the worry that you could stumble or you could blurt out something?

04:10LAUREN Yeah.

KAREN It takes away the worry?

LAUREN Yeah.

04:15KAREN Is it the same something all the time?

04:20LAUREN Yeah.

04:25[sil.]

04:30KAREN It’s hard to talk about?

04:35[sil.]

04:40LAUREN Did I say was the same something?

KAREN You said, it’s the same something that you think about.

04:45LAUREN Oh, yeah. I, I repeated over and over in my mind.

04:50KAREN And what is that?

04:55LAUREN It’s a book.

05:00KAREN You repeat the name of the book over and over or you repeat the story?

05:05LAUREN The story of the book.

KAREN What book is that?

05:10LAUREN Goodnight Moon.

05:15KAREN This Goodnight Moon have a particular significance for you? Something special about it?

05:25LAUREN It’s my favorite child.

05:30KAREN So it calms down your worry? At least enough, so that you could stay umm… where you are in the environment you’re in. Not enough where you can then interact and talk. Okay. So it’s been there for comfort. But it doesn’t quite do enough.

06:00LAUREN Yeah.

Segment 2

KAREN Hi, Lauren. Glad that you’re here and umm… I’d like us to continue talking about some of the difficulties that have been going on recently. And getting a little bit more specific about what happens if, if that’s okay with you. And where I would like to start is to ask you if you could describe what happens, when let’s say at school uh… and you frequently have stomach aches, nausea and that discomfort that arises, can you talk a little bit more about those situations that occur?

01:15LAUREN Umm… I just, I get nervous. Uh… That all, you… you know, embarrass myself.

01:25KAREN How could you embarrass yourself?

01:30LAUREN I can trip over gravity, I can knock into someone, I can… I can hit locker I can say the wrong thing.

01:40KAREN Are you clumsy and general, or you kinda somebody that stumbles and falls over your own feet?

01:50LAUREN No.

KAREN But you worry that, that could happen?

LAUREN Yeah.

01:55KAREN And you worry, you could sit. What you say, say the wrong thing?

LAUREN Yeah.

02:00UNKNOWN How might that happen?

02:05LAUREN If someone, I don’t know if someone talks to me and I… I’m not really listening to them and that I just blurt something out. And they get offended or…

02:15KAREN Has that ever happened?

02:20LAUREN No.

02:25KAREN But you worry that you could blurt out something that would offend the other person?

02:30LAUREN Yeah.

02:35KAREN Well, you know, that, that’s kind of interesting in the sense that what you have previously described is feeling that other people are judging you or other people are doing things that umm… is hurtful to you, and yet, you say, your worry is that you would blurt out something that would be hurtful to someone else. What do you do when you have those thoughts that you could stumble or you could blurt? How do you cope with that feeling or impulse?

03:25LAUREN I do what I always do.

03:30KAREN Lauren, what do you always do?

LAUREN I think of something in my head.

03:35KAREN Something?

03:40[sil.]

03:45LAUREN Umm… And I think about it a lot and I, actually all the time actually, throughout the day.

03:55KAREN And thinking about this something helps you to cope with the worry that you could stumble or you could blurt out something?

04:10LAUREN Yeah.

KAREN It takes away the worry?

LAUREN Yeah.

04:15KAREN Is it the same something all the time?

04:20LAUREN Yeah.

04:25[sil.]

04:30KAREN It’s hard to talk about?

04:35[sil.]

04:40LAUREN Did I say was the same something?

KAREN You said, it’s the same something that you think about.

04:45LAUREN Oh, yeah. I, I repeated over and over in my mind.

04:50KAREN And what is that?

04:55LAUREN It’s a book.

05:00KAREN You repeat the name of the book over and over or you repeat the story?

05:05LAUREN The story of the book.

KAREN What book is that?

05:10LAUREN Goodnight Moon.

05:15KAREN This Goodnight Moon have a particular significance for you? Something special about it?

05:25LAUREN It’s my favorite child.

05:30KAREN So it calms down your worry? At least enough, so that you could stay umm… where you are in the environment you’re in. Not enough where you can then interact and talk. Okay. So it’s been there for comfort. But it doesn’t quite do enough.

06:00LAUREN Yeah.

KAREN That’s good to know, Lauren. That’s important to know. It’s a good start.

Segment 3

00:25KAREN Hi, Lauren. Glad you’re here. I was hoping that we could talk a little bit more about the difficulties it that about having happening recently and umm… just explore a little further. Some of the things that you’ve been having to deal with. The more and the better that I get to know, what kinds of things you grapple with, the more helpful I can be. So, if, that’s okay with you? Like, "To just ask you few questions?" I would like to start was some of the things that you might worry about some of the worries that you might carry in your head more than just a passing worry or right, here and they are worry. But, worries that just don’t seem to change. Like, what?

01:35LAUREN Umm… Yes, umm… I’m falling down or saying the wrong thing.

01:40KAREN You worry that you’re going to fall down while you’re walking?

01:45LAUREN Yeah.

KAREN Blurt out something that you didn’t mean to say?

01:50LAUREN Yeah. Like what if… during my presentations I have to get in the ca… get in front of the class, I just feel sick all the time standing up there but if, what if I told them that I hate all of them or that.

02:10KAREN And that goes through your mind that that could be lurted out that something that could happen?

02:15LAUREN Yeah.

KAREN That you worry about.

02:20LAUREN Yeah.

KAREN And you worry about tripping? Are… are you are you umm… uncoordinated or clumsy umm…

02:30LAUREN No.

KAREN Do you trip often?

02:35LAUREN No.

KAREN No, it’s just something you worry will happen.

02:40LAUREN Yeah.

KAREN In front of other people. You worry about things that will happen that would embarrass you?

02:45LAUREN Mm-hmm, okay.

02:50KAREN When you have these worries and they sound terrible umm… a burden to have to carry around, is there something that you do or think about that helps you to get control of it to contain it?

03:15LAUREN How would you know that?

03:20KAREN Well, actually Lauren, I don’t know, I’m asking you. Umm… That is something people with that have recurrent worries over and over. It’s not an uncommon thing to then have something to think about to help that.

03:40[sil.]

03:45LAUREN Yeah, I do.

KAREN And what is that?

03:50LAUREN Umm… I repeat the lines of a book over in my head.

03:55KAREN And that calms you or ticks away the thoughts and worry about tripping or blurting?

04:05LAUREN Yeah.

04:10KAREN What’s the lines of what story?

04:15LAUREN Umm… My favorite childhood book.

04:20KAREN What is that?

LAUREN Goodnight Moon.

04:25KAREN Was that something that was very comforting to you as a child?

04:30LAUREN Yeah.

04:35KAREN And it seems to be helping to a certain point now.

04:40LAUREN Yeah.

04:45KAREN Okay, well, I think that the issues and some of the worries that you are dealing with are interfering more than you deserve to have your life interfered with. And, although your childhood story is a comfort and that’s a wonderful thing, it’s not enough. So I’d… like us to continue talking about this and see if we can expand in other ways to cope. You can have more control with your life. You in agreement, Lauren?

05:30LAUREN Sure.

KAREN Work on it together.

LAUREN Okay.

05:35[sil.]

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