23 Nov 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 r
Assemble nursing care interventions for clients with behavioral or cognitive disorders.
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.
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.
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.
00:30 KAREN Hi, Lauren. I’m glad that you came in today and I would like for us to have a discussion about maybe some sensitive issues, but I think it will be helpful in getting to know what you struggle with, and order to be able to be helpful. So I’ll be completely honest with you. I need you to be as honest you can be with me. And this conversation will stay here unless there’s some reason that you or somebody else could be in danger. Our conversation would stay in this room. So are you on board to maybe explore few areas along with me?
01:20 LAUREN Sure. Okay.
KAREN Wanna talk about some of the things that maybe interfering and making things difficult for you on a daily basis and one of ‘em is thoughts that may come in your head umm… and particularly thoughts that happen a lot. The same thought over and over. Mm-hmm, often they tend to be worries, umm… or things that make you uncomfortable. Are there any thoughts that you find with repeat for you over and over, particular kinds of worries?
02:15 LAUREN Umm… That something might happen to my grandpa.
KAREN Okay. So, how often would you say that you think about that something could happen to your grandpa?
02:25 LAUREN Every five minutes.
02:30 KAREN That’s a lot. It enters your mind that frequently? Wow! Umm… Is that reason to be worried about your grandpa?
02:40 LAUREN No.
KAREN Is he ill or…
02:45 LAUREN Nope.
KAREN But you worry about him?
02:50 KAREN Okay. Is there any other worries that come up or thoughts that come up for you. As much… you know, as much as that or even anywhere near as much as that worry?
03:10 LAUREN Umm… Uh… that umm… I might say something wrong.
03:20 KAREN That you might say something wrong, when?
03:30 LAUREN Just in general.
KAREN You mean, something would come out of our mouth that you didn’t intend to or…
03:35 LAUREN Yeah.
KAREN … You would say something but wouldn’t come out the mean it. What you mean example of what you mean.
03:40 LAUREN Saying something that I don’t I mean to say something aloud and it just happens.
03:45 KAREN So can you give me an example of that could happen or time that you’re worried about it happening?
03:55LAUREN If someone shoe laces aren’t even, I’ll notice and I’ll say something to them and then I’ll be embarrassed about it.
04:05KAREN So you have said something or you worry that you could say something like that?
LAUREN I worry that I could I say something like that.
04:10KAREN So but it has that ever happened?
KAREN Okay. And, how often is that a worry for you?
04:15LAUREN Everyday. All the time.
04:25KAREN Do you have an idea of when this first began, when the worrying began?
04:35LAUREN Umm… When I was little, I think.
04:40KAREN What’s your memory of when you’re worrying began?
KAREN In this way, where was this same worries over and over?
04:55LAUREN Umm… I woke up, when I was little and I was with my mom in the kitchen and umm… I was just thinking that something could happen to grandpa and I saw him sitting there and I just figured what if, one day something happens to him and it just, it just grew up with me.
05:20KAREN Are there other kinds of health or safety worries that you have, you worry about anybody else or do you worry about getting sick or anybody else getting sick? Were people around you that could be sick and give it you, any kind of worries like that?
05:40LAUREN If someone sick and doesn’t stay something and they’re around me then like I wouldn’t even know. I can end up the flu or something worse.
05:55KAREN So do you worry that there could be somebody sick around you?
KAREN And how often is that you worry?
06:05LAUREN Everyday when I’m in school around people.
06:10KAREN Do you have worries about touching things that you could be picking up germs or that things could be dirty and you could get sick or anything like that?
06:25LAUREN Not really, not like that.
06:30KAREN Okay, it’s mostly that somebody else might be sick and spread it you and unbeknownst to you?
06:45KAREN Lauren, when you have these worries, how do you deal with it and how do you cope with it in the time. Do you just walk around with the worries in your head?
07:05LAUREN Why are we talking about this?
07:10KAREN Because it’s important.
LAUREN Stop! You don’t care, you’re getting paid to do this.
07:15KAREN Well, actually Lauren, I do care and I care because somebody who has to deal with what you’re dealing with is suffering, and suffering more than you deserve to be. You deserve to be able to feel as comfortable in the world as everybody else. And that’s we need to talk about it. Because you deserve to get help for.
07:55KAREN Okay. So let me ask you again. How do you deal with the worries?
08:00LAUREN Which one?
KAREN Well, let’s say your grandpa being, something happening to him. How do you deal with that worry? Seems to be there all the time.
08:10LAUREN Umm… Well, everyday, at 9 o’ clock in the morning, I’ve to make breakfast for him and I have to make sure it’s done by 9.
08:25KAREN And do you get that done every day?
08:30KAREN You don’t… you never missed one?
LAUREN Once I did.
08:35KAREN And, how did you deal with that?
LAUREN I went through the whole day with my body shaking, I felt uncomfortable, my hands just kept tapping and tapping and I just worried about him.
08:50KAREN So somehow making breakfast by 9 o’ clock. Somehow, makes it okay that you… then don’t have worry the whole rest of the day or worry to the degree of being shaky?
KAREN Okay. And, what about that you might say something that you don’t mean to say, something just popping out of you in appropriately or embarrassing, how do you deal with and cope with that worry?
09:25LAUREN If I notice something that bothers me or that’s I have to talk about I, I said in my head, "Hoping that I don’t say it out loud."
09:40KAREN Does that sometimes or ever have the effect of making the worry worse? By going over and over it.
KAREN So how do you deal with that?
09:55LAUREN I don’t really know how I deal with that, and just…
KAREN Okay. Think about it, think about it because if you need to do something that does help with your worry with your grandpa and going to surmise that there’s something that you do that helps control that worry.
10:20LAUREN If I see something I… I have to write it down, I guess. That’s usually what I do. I have to write it down and someone’s backpacks straps are uneven and I worry about saying something to them I have to write it down which is what I usually find myself doing.
10:40KAREN Okay, you’ve given two examples of shoe laces and backpack about things being uneven. Is that something that gets your attention and that you notice a lot things that are uneven?
11:00LAUREN Yeah, mostly.
KAREN And do you have a memory of when that begin.
11:10LAUREN Umm… When I was little in the car, driving with my parents I would count all the cars on the street and if they didn’t match the number of cars on the other side. I had to make sure that the numbers match.
11:30KAREN And what would happen if they didn’t?
LAUREN I’d either have to go back to where we came from or the day just wouldn’t, it wouldn’t be uh… okay.
11:40KAREN Did they go along with that?
11:45LAUREN Yeah, they didn’t know.
KAREN They didn’t know why you were asking them to redo the route. They just would do it.
11:50LAUREN Yeah, I mean, sometimes I guess my mom give me a weird book but she don’t know.
12:00KAREN Are there other things that you can think of that need to be even or the same?
12:15LAUREN I guess the number of kids in my class.
KAREN And what’s out about?
12:20LAUREN Just it… in Spanish class there are 17 kids. There always has to be 17 kids myself included. I can’t count anything less than 17.
12:30KAREN And what if it’s more or less than 17?
12:35LAUREN I get really, really uncomfortable.
12:40KAREN And how many times do you count the students in the class.
12:45LAUREN Through the entire class period until I make sure I get it right.
12:50KAREN Okay. I’m gonna ask you some specific things just based on what you’ve talked about already Lauren and it’s real helpful. Because it sounds like this is interfere terribly in your life and I repeat, you deserve to be able to go through life with more freedoms than that. Then having to do what you do, think what you think. The behaviors that happened. Umm… But it’s obviously working in some way to help you. Uh… To help you feel better, to help you feel less worried. And then the question is, where did those worries and feeling badly come from? But, let’s… let’s talk a little bit more about what does happen. So, for example, do you have any rituals things you need to do when you’re bathing? Start taking a shower.
14:00LAUREN Umm… Yeah.
KAREN And what’s that about?
LAUREN Umm… So in the shower, there has to be three different kinds of body washes there. No less, no more and the shower has to be at the same temperature, every single time.
14:15KAREN And, if there, if those things aren’t in place what happens?
14:20LAUREN Like, I… I can’t take a shower or if I get in the shower and the water changes, I… I have to get out, right, I can’t, I can’t shower.
14:35KAREN And what about hand washing? Are you able to wash your hands in a reasonable amount of time, so a day a reasonable, length of time?
14:45LAUREN I think so, yeah, uh… the water just has to be warm. Can’t be cold or hot.
14:55KAREN And what about your room at home? What’s your room look like? You keep it neat?
15:05LAUREN I try to.
KAREN You try to. Tell me about that.
LAUREN Every night I… the room has to look the same as it did the night before. I have to make sure the pictures aren’t crooked. I have to make sure my remotes are exactly where they were the day before, my lights have to be off at a certain time. My… my pillows have to be straight and umm… my blanket corners have to match up, and if they don’t I have to start all over again and, unwrapping then wrap it back wrap it back up.
15:40KAREN How long does that take?
15:45LAUREN A couple hours, usually the whole night.
15:50KAREN It sounds like a link the process before you can get in bed.
15:55LAUREN It is.
KAREN You’re tired a lot?
16:00LAUREN Yeah. Most mornings.
KAREN I can understand why. How about your closet and your drawers? How are they organized?
16:10LAUREN They’re color coded.
16:15KAREN And does anybody else go in your room? Anybody come in, do any, you know, you know, like put cloths in or take trash out or drop something off, anybody else have access to your room or does, does your family stay out?
16:30LAUREN Usually my mom tries to clean or take clothes out of my hamper and she… misplaces stuff and I have to put them back exactly where they were.
16:45KAREN So you have uh… a lot of time spent on having to redo things? Undo them, put them back. Well, that’s… that’s part of what we’re talking about. Has it been a time when you actually were able to do the behavior that makes it okay. I know, you say sometimes it hasn’t been exactly right, you had to get it right. Or you didn’t get breakfast done on time and you’re worried all day. But does there been a time were you’ve literally been interrupted and haven’t been able to follow through?
17:25LAUREN Yeah. Sometimes.
17:30KAREN What happens, more what happens?
LAUREN Well, If I’m folding my blankets on my bed, to go to bed and my mom comes in and she tries to help me and she messes up one blanket out of the three that are there. I have to go back to the beginning of my routine and do it all over again. And, when I cook breakfast for my grandpa, sometimes, people take this spatula or they put the plate somewhere else and or they talk to me about something and ask me questions and I, I get discombobulated and I have to do it all over again.
18:05KAREN Sounds very stressful.
18:15KAREN I wanna ask you about other family members. Is there anybody else in your family that tends to have anything even close to the kinds of worries you have and anxieties and the behaviors, and that you’re aware of anybody in your family? Tend to be a worrier?
18:45LAUREN I don’t think so, just my mom sometimes that she was late to pick us up from school. But that’s about it.
18:55KAREN But nobody has any of these kinds of behaviors and worries in your family that you have?
19:00LAUREN No. If they do they don’t talk about.
19:10KAREN And has your, have your parents ever talked about umm… any other family members, aunts, uncles, grandparents, that may have had kind of umm… either corky behaviors or (inaudible) or thing, anything that could have been construed. As… as in terms of worry?
19:40LAUREN Uh… I don’t think so, I mean, my grandma worries a lot about stuff but, you know, it doesn’t.
19:45KAREN Is that your mom’s mom?
19:50KAREN She has worries.
LAUREN Yeah, I guess. If it’s gonna rain on the day that she has to get her hair done or so leaves the stove on too long.
20:00KAREN Well, do… you are you aware if they’ve had any behaviors like and or anybody in your family around having to check things? Making sure the door’s locked and including you, if these are things you’ve done, making sure the doors locked at night and then once checking it’s not enough it needs to be checked multiple times or whether the stove the is off after you’ve cooked or that the lights have been turned off or on?
KAREN Anything like that?
LAUREN I have to check to make sure the doors locked and I before everyone goes to sleep, and then I usually hear my mom in the living room looking at the door to make sure it’s locked. And then I have to go back, I have to make sure that she didn’t locked it or touch and that it’s the same, it’s in the same place. And then I hear footsteps again going to the door, and it’s my mom, checking it again. And then I have to go back and make sure that she didn’t touch it.
21:05KAREN So you and your mom share that kind of checking behavior?
KAREN Okay, but not other things like light switches, or the stove, or anything like that.
KAREN Okay. Well, Lauren, this is real helpful. And I know it hasn’t been easy to talk about, but these thoughts that you have, these worry thoughts, and these behaviors as you well know, have terribly interfered and you having freedom to do what you would like to do and to be the person that you’d like to be. There are ways to help this. And if you’re on board with me, we can look at some of those ways and begin, begin treatment for this very, very unfair interference in your life.
22:20LAUREN I guess,
22:30LAUREN I mean, if it’s gonna help, I…
Adolescent Social Anxiety Disorder,
OCD Assessment V2
00:25KAREN 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?
KAREN But you worry that, that could happen?
01:55KAREN And you worry, you could sit. What you say, say the wrong thing?
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?
02:25KAREN But you worry that you could blurt out something that would offend the other person?
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.
03:45LAUREN 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?
KAREN It takes away the worry?
04:15KAREN Is it the same something all the time?
04:30KAREN It’s hard to talk about?
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.
KAREN That’s good to know, Lauren. That’s important to know. It’s a good start.
Adolescent Social Anxiety Disorder,
OCD Assessment V3
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?
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?
KAREN That you worry about.
KAREN And you worry about tripping? Are… are you are you umm… uncoordinated or clumsy umm…
KAREN Do you trip often?
KAREN No, it’s just something you worry will happen.
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.
03:45LAUREN 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?
04:10KAREN 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?
04:35KAREN And it seems to be helping to a certain point now.
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?
KAREN Work on it together.