DR. YANGA’S COLLEGES, INC.

Wakas, Bocaue, Bulacan

COLLEGE OF HEALTH SCIENCES

NURSING ● MIDWIFERY ● CAREGIVING NC II

This is a Case Study of a Patient

with Obsessive Compulsive Disorder

In Partial Fulfillment of the Requirements in NCM 117

Related Learning Experience

Submitted by:

Alcantara, John Emmanuel

Cruz, Machelle
Dimaiwat, Marvin C.
Dionisio, Alessandra Dennise
Feliciano, Anabelle
Franco, Mary Joy
Garcia, Carl Marvin
Gasgonia, Regine
Meneses, Joy
Torres, Dorina

Submitted to:

CHS Faculty

2023

1
Table of Contents
I. INTRODUCTION .................................................................................... Error! Bookmark not defined.
II. OBJECTIVES .......................................................................................... Error! Bookmark not defined.
III. NURSING HISTORY ........................................................................... Error! Bookmark not defined.
IV. PHYSICAL ASSESSSMENT ............................................................................................................ 11
V. MENTAL STATUS EXAM .................................................................... Error! Bookmark not defined.
VI. DRUG STUDY....................................................................................... Error! Bookmark not defined.
VII. NURSING INTERVETION .............................................................................................................. 30
VIII. NURSING CARE PLAN ................................................................................................................. 37
IX. HEALTH TEACHING ....................................................................................................................... 44
X. JOURNALS ......................................................................................................................................... 46
XI. REFERENCES ................................................................................................................................... 52

2
I. Introduction
Obsessive-compulsive disorder (OCD) is a common, long-lasting disorder
characterized by uncontrollable, recurring thoughts (obsessions) that can lead people
to engage in repetitive behaviors (compulsions). It is a psychiatric condition that
causes major distress or disruption to daily living and role performance.

According to St. Lukes Health (2023), there are five main types of OCD:
Organization, Contamination, Intrusive Thoughts, Ruminations, and Checking. The
first type of OCD is Organization, which involves an obsession with things being
exactly the right place or symmetrical. Next is Contamination, which is characterized
by an obsession with developing an illness or spreading germs. Intrusive thoughts,
which are intense fears of committing a feared action or acting on an unwanted
impulse. The fourth type is compulsive ruminations, which are self-reinforcing
repetitive thoughts or patterns of thinking that occur repeatedly over time. Lastly,
OCD checking is observed in checking compulsions and rituals that are completed
repetitively to reduce the fear of or chance of something bad happening.

Obsessions and compulsions are the main symptoms of OCD. Obsessions are
recurrent thoughts, urges, or mental images that generate anxiety, whereas
compulsions are acts that you feel compelled to repeat in order to relieve your anxiety
or stop the obsessive thoughts. Other symptoms manifested in a person with OCD are
a need for precision and symmetry, worrying about making a mistake, fear of
contamination, hoarding and mental rituals like silently counting.

Risk Factors of Obsessive-Compulsive Disorder include a family history of

having parents or other family members with the disorder and a history of trauma.

A health professional can diagnose Obsessive-Compulsive Disorder. An

assessment of the behaviors, thoughts, and feelings of a person is used to make a
diagnosis based on a psychological evaluation.

The overall medical management of OCD responds to a combination of cognitive-

behavior therapy (CBT) like the exposure and response prevention that gradually
exposing you to the fears or obsessions and medications such as SSRI antidepressants
like Sertraline Hydrochloride, Fluvoxamine, Clomipramine, Paroxetine and
Fluioxetine.

The primary goals of the nursing plan of care should be to prevent injury or self-
harm and to promote adherence to the prescribed course of treatment, but it should
also include supporting the client in recognizing and combating unreasonable
thoughts and encouraging relaxation.

According to the National Institute of Health (NIH), Obsessive-compulsive

disorder (OCD) is a serious psychiatric disorder that affects approximately 2% of the
population of children and adults.

3
REFERENCES:

National Institute of Health. (2022). Obsessive-Compulsive Disorder (OCD.)

https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd

St. Lukes Health. (2023). 5 Common Types of OCD.

https://www.stlukeshealth.org/resources/5-common-types-ocd

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II. Objectives

a. General Objective

The mere purpose of this study is to provide and expand understanding about
obsessive-compulsive disorder for both patient and student nurses. Its goal is to
apply and augment knowledge, skills, and attitude of the many psychiatric nursing
concepts and be self-aware to be physically, spiritually, cognitively, emotionally,
and psychologically prepared to interact in a therapeutic way with psychiatric
patients.

b. Specific Objectives

For the student nurse

At the end of this case study, the student nurse will be able to:

Knowledge

 Understand the case of the patient through systematic readings and research

 Analyze the past personal experiences of the patient that may have contributed
to the development of the behavior.

 Identify predisposing and precipitating factors initiating the development of

psychopathology.

Skills

 Employ a complete and in-depth assessment and evaluation of the patient

exhibiting OCD.

 Propose to implement a nursing care plan that is suitable for the patient's
OCD.

 Demonstrate critical thinking skills necessary for providing safe and effective
nursing care

Attitude

 Build cooperation and unity among other healthcare team by performing

proper nursing interventions.

 Show some compassion to come up with continuous patient interaction.

 Develop a better working relationship by creating a warm environment

between the student and the patient.

5
For the patient
At the end of this case study, the student patient will be able to:

Knowledge:

 Understand the nature of OCD, including its causes, symptoms, and common
triggers.

 Verbalize understanding regarding strategies and techniques to manage OCD

symptoms between therapy sessions.

 Recognize the impact of OCD on daily functioning, relationships, and overall

well-being.

Skills:

 Practice gradual exposure to feared situations or triggers related to their OCD,

while resisting the urge to engage in compulsive behaviors.

 Demonstrate the ability to implement ERP techniques independently, such as

creating hierarchies of anxiety-provoking situations and systematically facing
them without performing rituals.

 Acquire skills and the ability to replace distorted thoughts with more balanced
and realistic ones, reducing anxiety and the need for compulsive behaviors.

Attitude:

 Develop a compassionate attitude towards themselves, acknowledging the

challenges and difficulties they face due to OCD.

 Engage in open and honest communication about their needs and treatment
progress, actively participating in their own care.

 Cultivate an attitude of acceptance towards imperfections and uncertainties,

recognizing that perfection is not attainable or necessary.

6
III. Nursing History

a. Identification
Patient SDC is a 21 years old female. She is Filipino and speaks the
Filipino language. She is baptized as a Roman Catholic. She lives in Matungao,
Bulakan, Bulacan together with her parents. She is now currently in her third
year as a nursing student.

On May 16, 2023, she went to a clinic for consultation with her mother as
a company. Upon consultation, she is diagnosed with obsessive-compulsive
disorder.

b. Chief Complaint
The patient arrived at the clinic accompanied by her mother at exactly
9:00 am on May 16, 2023 with a chief complaint from her mother of “May
napapansin po kasi ako na mga bagay o gawain na paulit ulit ginagawa ng anak
ko na hindi ko maintindihan kung bakit, kaya po nagdesisyon ako na
ipakonsulta siya,” as verbalized by the mother.

According to the patient “May mga ginagawa po ako na parang sa isip ko

gusto ko siya ulit gawin tulad ng paghuhugas po ng kamay.”

c. History of Present Illness

The patient reported experiencing symptoms for the past 10 years. The
onset of symptoms occurred during a period of high stress in her life. She
described experiencing persistent and intrusive thoughts that she recognized as
irrational, but she is unable to control or dismiss them.

She constantly worries about germs and bacteria. As a result, she feels an
overwhelming urge to engage in excessive cleaning rituals, such as washing his
hands repeatedly and meticulously. She constantly organizes her things
repeatedly until everything is in order. She takes a lot of time in locking and
unlocking the door and other plugs repeatedly to be ensured.

3 days prior to consultation, these symptoms became more uncontrollable.

She found it incredibly challenging to resist the urge to engage in her rituals.
She felt more of a sense of guilt and shame associated with her symptoms,
which further exacerbates her anxiety and distress. Her mother noticed her
becoming more stressed and asked her why as getting worried but she did not
say anything.

2 days prior to consultation, the same experiences and feelings were

manifested by the patient.

1 day prior to the consultation, her mother witnessed her washing her
hands repeatedly and meticulously which made her mother decide to have a
consultation.
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 At around 9 in the morning, upon arrival in the clinic and upon evaluation,
the patient appears anxious. Her vital signs are: Temperature: 36.8 BP: 130/80,
HR: 120 RR: 21

d. Developmental History

Erikson's theory proposes that individuals go through various stages of

psychosocial development, each characterized by a specific conflict or
challenge that needs to be resolved. These stages occur throughout the lifespan
and are influenced by social interactions and the individual's sense of identity.

In the context of OCD, the relevant stage of Erikson's theory is the stage
of autonomy versus shame and doubt, which occurs during early childhood
(ages 1 to 3). During this stage, children are developing a sense of
independence and autonomy. They learn to assert their will and control their
environment. Success in this stage results in feelings of self-confidence and a
sense of personal control.

If a child experiences excessive shame or doubt during this stage, it may

contribute to the development of OCD symptoms later in life. The patient
during this stage, was repeatedly criticized or punished for her behaviors and
feels a sense of guilt or shame for having certain thoughts or desires, that lead
to an excessive need for control and perfectionism as a way to alleviate those
feelings.

Another relevant stage of Erikson's theory is the stage of industry versus

inferiority, which occurs during middle childhood (ages 6 to 11). At this stage,
children are focused on mastering new skills and gaining a sense of
competence. They strive to meet expectations and seek recognition for their
achievements. Success in this stage leads to a sense of confidence and
competence.

The patient experienced frequent feelings of inferiority or inadequacy, it

can contribute to the development of OCD symptoms. The patient engaged in
repetitive behaviors or rituals as a way to gain a sense of control and alleviate
anxiety related to feelings of inadequacy.

e. Past Medical History with Immunization History

Patient SDC does not have a history of any other major psychiatric
disorders such as major depressive disorder, bipolar disorder, or schizophrenia.

The patient has no significant medical conditions or physical health issues

that directly relate to his OCD.

The patient's immunization history is up to date. She has received the

standard childhood vaccinations, including the vaccines for measles, mumps,

8
 rubella (MMR), diphtheria, tetanus, pertussis (DTaP), polio, varicella
(chickenpox), and hepatitis B. Additionally, she has received the annual
influenza vaccine and any recommended booster shots as per the appropriate
vaccination schedule.

f. Family History

g. Educational History
The patient completed her primary and secondary education in a private
school system. During this time, she was a conscientious student who
consistently achieved good grades. However, she experienced high levels of
anxiety related to academic performance. She often felt compelled to double-
check her assignments, ensuring they were error-free, which consumed a
significant amount of his time and caused distress.

After completing high school, the patient enrolled in a university. In her

college education, she is now pursuing a degree in nursing. The academic
demands and the pressure to excel in a competitive environment significantly
increased her stress levels. This period coincided with the onset of her OCD
symptoms, as the anxiety surrounding exams and the need to meet self-imposed
perfectionistic standards intensified.

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h. Social History
Patient SDC has a small circle of close friends. They noticed some of her
symptoms but some of the time they got irritated as patient SDC took longer
periods in doing things. This affects Sandra’s anxiety in social settings.

Patient SDC tends to avoid gatherings or events that she perceives as

potentially contaminated or stressful. As a result, she may miss out on social
opportunities and limit her engagement in certain activities

i. Nutritional History with Patterns of Elimination

Patient SDC generally follows a regular eating pattern and consumes three
meals a day. She usually avoids food that is not raw or undercooked foods and
shared dishes.

Patient SDC hydration patterns appear to be generally normal. She drinks

an adequate amount of water throughout the day.

For the elimination pattern, patient SDC does not experience pain in
urinating and urinates about 5-6 times a day. She has a regular bowel movement
once or twice a day.

24 Hour Diet Recall

Time Food Intake
Breakfast 6:00 AM Bread with Nutella and Milk
Snack 9:30 AM Lasagna and 1 glass of water
Lunch 12:00 PM Rice with Menudo and a glass of
water
Snack 3:00 PM Biscuit and water
Dinner 7:00 PM Rice and fried chicken

j. Hygiene
Patient SDC exhibits excessive handwashing. She washes her hands
repeatedly and for an extended period of time which she believes will ensure
cleanliness. Her fear of contamination and germs drives this behavior, leading to
dry and irritated skin.

She also manifests consciousness when it comes to her clothing. She may
feel compelled to iron her uniform every morning before going to school when
noticing wrinkles on it.

k. Values
Patient SDC places a high value on cleanliness and orderliness. She strives
to maintain a pristine and organized environment, free from perceived
contaminants.

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 She also puts value on personal responsibility and holds herself
accountable for her actions and their consequences. She believes it is her duty to
take necessary precautions and engage in compulsive behaviors to prevent harm
or avoid potential dangers associated with contamination or other obsessive
fears.

Perfectionism is an important value for Patient SDC. She feels compelled

to achieve perfection in various aspects of her life, including her study, personal
hygiene, and daily routines.

Lastly, she highly values safety and security. She engages in rituals and
behaviors to create a sense of safety and minimize perceived risks in her daily
life.

IV. Physical Assessment

a. General Survey

The patient appears well groomed, clean, and appropriately dressed

according to the weather. The patient cooperated and talked but somewhat the
patient appears to be anxious and tense. She is alert, awake, and well-oriented to
the time, place, and date.

Vital signs are as follows: Temperature: 36.8 BP: 130/80, HR: 120 RR:
21.

b. Physical Assessment

PARTS METHOD NORMAL ACTUAL ACTUAL CLINICAL

FINDINGS FINDING FINDING SIGNIFICANCE
DAY 1 DAY 2

Skin Inspection Skin warm, dry, The patient’s The patient’s Scars on the skin are a
with good skin is warm skin is warm typical problem in
turgor, No and in the and in the OCD patients due to
abnormal standard color. standard color. their compulsion that
pigmentation, Some segments Some segments is caused by excessive
bleeding, rash, of skin near the of skin near the and recurrent hand
or other lesions. hands have hands have washing that may
scars. scars. result in irritation.

Skull and Inspection/ Face is The patient’s The patient’s Breakage and scars of
Face symmetrical. No face is face is scalp is a common
Palpation involuntary symmetrical. symmetrical. problem in OCD
muscle Upon the Upon the patients due to
movements. Can inspection the inspection the excessive and

11
 move facial patient’s scalp patient’s scalp repetitive combing
muscles at will. has a breakage has a breakage hair. To recognize
No tenderness and some scars. and some scars. their obsession with
on scalp upon the perfect flow of
palpation, no their hair that results
lesions upon in irritation and
inspection. breakages of the
scalp.

Upper and Inspection/ Both extremities The patient’s The patient’s The patient’s both
Lower Palpation are equal in size upper upper hands have wounds
Extremities and also have extremities, extremities, and redness. It is a
the same usually both usually both common problem in
contour with hands, have hands, have OCD due to intrusive
prominences of wounds and wounds and thoughts to clean their
joints. No redness. The redness. The hands that result in
voluntary patient's lower patient's lower excessive behavior or
movements, no extremities are extremities are mental acts used to
edema, and the atraumatic in atraumatic in reduce anxiety.
color is even and appearance appearance
has an equal without without
contraction tenderness or tenderness or
deformity. deformity.

V. Mental Status Exam

a. Physical Appearance
The patient presents herself as well-kept and presentable. Sitting
still with eyes occasionally looking at the examiner. The client also
appears properly groomed and wears neat semi-formal clothes.
Furthermore, clients have some wounds on their hands related to excessive
hand washing.

On the other hand, the patient's posture upon standing is upright

and when sitting is slightly slouched. Moreover, the client walks smoothly
with a routine of right foot first then left foot. Then, all the gestures and
facial expressions are appropriate to what the client is stating with some
hand movements.

b. Mood and Affect

The patient has drastic fluctuations in mood related to unwanted
thoughts or impulses. The patient has an irritated mood in response to
obsessive thoughts and compulsions. Despite this, the affect is congruent
to the mood of the client.

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c. Speech
Patient speaks in a Filipino language in which words are common.
Tones and pitch of voice are appropriate to the statements. Speech rate is
normal and the volume of the voice is appropriate to the way statements
are spoken. However, there are some questions that answer with
hesitation.

d. Thinking
The client has obsessive and unwanted thoughts which interfere
with daily life activities. Thus, the uncontrollable thoughts of the client
need to be performed to satisfy the thoughts in the mind. The client has
thoughts of repetitively washing hands to make sure that it is well cleaned.
Furthermore, a repetitive action of double checking the doors because of
the thoughts that it is not well locked. Also, the client has unwanted
thoughts as evidenced by the fact that there are times that she thinks of
being late in going to school, however, her thoughts in her mind make her
do action of checking all the plugs.

e. Sensorium
The client appears alert and oriented to time, person, and place.
Recent memory is intact as evidenced by being able to recall recent
activities days ago such as studying. Furthermore, remote memory is intact
as evidenced by being able to recall past traumatic experiences and how
she is being treated in her childhood. Also, short-term memory is intact as
evidenced by being able to recall names and her parents.

The patient's sensorium appears intact, with a clear understanding

of their environment and the purpose of the examination.

f. Insight
Upon admission the client has no insight to the condition as
evidence by stating that “ Normal lang lahat ng ginagawa ko , na kelangan
maging maayos at pantay pantay lang lahat ng bagay “. However, after
being diagnosed by the attending physician, the client has insight into the
current condition.

13
 VI. Drug Study

General Actua Mechanism Indication Contraindic Advers Nursing

Name l of Action ation e Effect Responsibility
Dosag
e

Sertraline Minim Sertraline Sertraline is Hypersensiti Nausea, - Assess

Hydrochl um selectively indicated vity to drug dizzines allergy to the
oride Dose: inhibits the for the or its s, drug
reuptake of managemen components drowsin
50 serotonin at t of major ess, dry - Caution
mg/day the depressive • MAO mouth, patient of the
Brand presynaptic disorder inhibitor loss of different side
Name Maxim neuronal (MDD), use within appetite effects
um membrane, post- past 14 ,
Zoloft Dose: thereby traumatic days increase - Obtain
increasing stress d baseline vital
200 serotonergic disorder •Concurren sweatin signs
Classific mg/day activity. This t pimozide
(PTSD), g,
ation use - Prepare drugs
results in an obsessive- diarrhea
Patient's properly at the
selective increased compulsive , upset
Dose:
synaptic disorder •Concurren stomac right dosage.
serotonin t use of
reuptake 50 concentratio (OCD), h, or
disulfiram - Monitor
inhibitors mg/tab n of panic
(oral
trouble
liver function
(SSRIs) PO OD serotonin in disorder
concentrate
sleepin
test results and
the CNS (PD), g may
) BUN and
Route: which leads premenstru occur
serum
PO to numerous al dysphoric
creatinine
functional disorder
levels, as
changes (PMDD),
appropriate.
associated and social
with anxiety - Watch
enhanced disorder closely for
serotonergic (SAD). suicidal
neurotransmi Common tendencies,
ssion. These off-label especially
changes are uses for when therapy
believed to sertraline starts and
be include the dosage
responsible prevention

14
for the of post changes.
antidepressa stroke
nt action and depression - Caution
beneficial generalized patient to
effects in anxiety avoid driving
obsessive- disorder and other
compulsive fibromyalgi hazardous
(and other a, activities until
anxiety premature he knows how
related ejaculation, drug affects
disorders). It migraine concentration
has been prophylaxis and alertness
hypothesized , diabetic
that neuropathy,
obsessive- and INTERVENT
compulsive neurocardio ION/E
disorder, like genic VALUATION
depression, syncope
is also
caused by
- Verify
the
patient's
disregulation
identity
of serotonin.
-] Explain to
patient the
purpose of
medication

Advise patient
to take once a
day, either in
morning or
night, with or
without food.

15
General Actual Mechanis Indicati Contraindi Adverse Nursing
Name Dosage m of on cation Effect Responsibili
Action ty

Clomipra Capsule Hypersensiti Dizziness, Baseline

mine, Clomipra s USP is vity to drowsines Assessmen
The mine is a indicate clomiprami s, dry t
usual potent d for the ne or mouth,
Brand adult inhibitor treatme excipients, constipatio Assess for
Name of nt of cross- n, stomach the
dose serotonin obsessio sensitivity upset, mentioned
is reuptake, ns and to tricyclic nausea, cautions
100- but its compuls antidepressa vomiting, and
Anafranil 200 desmethyl ions in nts of the changes in contraindic
metabolit patients dibenzazepi appetite/w ations (e.g.
mg e inhibits with ne group. eight, drug
Classifica dally. allergies,
norepinep Obsessi flushing,
tion The Additional: hepatorenal
hrine ve- sweating,
(NE) Compul tiredness diseases,
Anti maxi Hypersensiti
reuptake sive and psychosis,
depressan mum vity to drug.
Disorde blurred glaucoma,
ts, dose Recovery
r vision may etc.) to
tricyclic is phase of
(OCD). occur prevent any
myocardial untoward
antidepres 300 infarction. complicatio
sants mg MI) MAO ns.
(TCAS) daily inhibitor use
within past Assess for
14 days. history of
seizure
disorders,
psychiatric
problems,
suicidal
thoughts
and
myelograph
y within the
past 24
hours or in

16
the next 48
hours to
avoid
potentially
serious
adverse
reactions.

Perform a
thorough
physical
assessment
to establish
baseline
data before
drug
therapy
begins, to
determine
the
effectivenes
s of
therapy,
and to
evaluate for
the
occurrence
of any
adverse
effects
associated
with drug
therapy.

Monitor
results of
electrocardi
ogram and
laboratory
tests (e.g.
renal and
liver
function
tests) to
monitor the
effectivenes

17
 s of the
therapy and
provide
prompt
treatment to
developing
complicatio
ns.

INTERVENT
ION/ E
VALUATIO
N

Monitor
patient
response to
therapy (e.g.
alleviation of
signs and
symptoms of
depression).

Monitor for
adverse
effects (e.g.
hypotension,
suicidal
thoughts,
cardiac
arrhythmias,
etc).

Evaluate
patient
understandin
g on drug
therapy by
asking the
patient to
name the
drug, its
indication,
and adverse
effects to
watch for.

18
 Monitor
patient
compliance
to drug
therapy.

General Actual Mecha Indicat Contraind Adverse Effect Nursing

Name Dosag nism ion ication Responsibilit
e of y
Action

Fluoxeti Immedi - Headache, .Baseline

ne ate- Presyn Fluoxet Hypersen asthenia, Assesment:
release aptic ine is sitivity to insomnia,
oral seroton indicate fluoxetin anxiety, -Supervise
Brand formulat in d for e. drowsiness, suicidaI-risk
Name ions: (5HT1 both nausea, diarrhea, patient
A) acute - Use of decreased closely
Adolesc recepto and MAOIs appetite, during early
ents and rs are mainte within 5 dizziness, therapy as
Prozac higher in the nance weeks of tremor fatigue depression
weight dorsal treatme discontin vomiting, lessen
children raphe nt of uing constipation, dry energy
Classifi : FLUoxeti improv
nucleu major mouth,
cation ne or increase
s and depress abdominal pain,
Initial project ive within 14 nasal suicide
dose: 10 to the disorde days of congestion, potential
Selectiv mg prefron r, discontin diaphoresis,
e orally - Watch out
tal obsessi uing rash, flushed

19
function once a cortex. ve MAOIs. skin, for signs
. day, Fluoxe compul lightheadedness, symptoms
serotoni increase tine sive - nitiation impaired SSRI's
n d to 20 exerts disorde in concentration. toxicity.
reuptake mg its r, and patient’s Make sure
inhibitor orally effects bulimia receiving - May increase that the
once a by nervosa linezolid risk of suicide. antidote in
day blockin howeve or Agitation, coma, on the bed
after 2 g the r, it is methylen diarrhea, side.
weeks reuptak only e blue. delirium,
e of indicate Use with hallucination. Ne INTERVEN
Mainten seroton d for pimozide rvousness, TION/E
ance in into acute thioridazi insomnia, anxiety, VALUATI
dose: 20 presyn treatme ne. headache, tremor, ON
to 60 aptic nt of drowsiness, dry
mg seroton panic mouth, nausea, - Arrange
orally in disorde vomiting, for lower or
per day neuron r sweating, less frequent
s by indepen Hyponatraemia; doses in
Maximu blockin dent of elevation of elderly
m dose: g the whethe hepatic enzymes. patients and
60 mg reuptak r patients with
orally e agorap hepatic or
per day transpo hobia is renal
rter present. impairment.
Lower protein Fluoxet
weight located ine - BLACK
children in the may BOX
: presyn also be WARNING:
aptic used in Establish
Initial suicide
termin combin
dose: 10 precautions
al. ation
mg for severely
with
orally depressed
olanzap
once a patients.
ine to
day, Limit
treat
increase quantity of
depress
d after capsules
ion
several dispensed;
related
weeks if high risk in
to
sufficien children and
Bipolar
t clinical adolescents.
I
improve
Disorde
ment is - Administer
r and
not drug in the
treatme
observe morning.
nt

20
d resistan
t - Monitor
Mainten depress patient for
ance ion. response to
dose: 20 Fluoxet therapy for
to 30 ine is up to 4 wk
mg additio before
orally nally increasing
once a indicate dose.
day d for
the - Switch to
treatme once a week
nt of therapy by
female starting
patients weekly dose
with 7 days after
premen last 20
strual mg/day
dyspho dose. If
ric response is
disorde not
r satisfactory,
(PMD reconsider
D) daily dosing.

Patient/
Family
Teaching.

- It may
take up to 4
weeks before
the full
effect
occurs. Take
in the
morning. If
you feel
sleepy or
tired, you
may take it
at night. If
you are
taking the
once-weekly

21
capsule,
mark
calendar
with
reminders of
drug day.

- Do not
take this
drug during
pregnancy.
If you think
that you are
pregnant or
wish to
become
pregnant,
consult your
health care
provider.

- Keep this
drug, and all
medications,
out of the
reach of
children.

- You may
experience
these side
effects:
Dizziness,
drowsiness,
nervousness,
insomnia
(avoid
driving or
performing
hazardous
tasks);
nausea,
vomiting,
weight loss
(eat small
frequent

22
 meals;
monitor your
weight loss);
sexual
dysfunction;
flulike
symptoms.

- Report
rash, mania,
seizures,
severe
weight loss.

General Actual Mechanis Indicati Contraind Adverse Nursing

Name Dosage m of on ication Effect Responsibilit
Action y

Fluvoxam
ine Tablet The exact Indicate Co- Dizzines Baseline
mechanis d administrat s. fever, assessment:
50 mg m of predomi ion of sweating
Brand qHS action of nantly thioridazin , -
Name initially; fluvoxami for the e, confusio Hypersensitiv
may ne has not manage terfenadine n, fast or ity to
increase been fully ment of , irregular fluvoxamine;
by 50 determine depressi astemizole, heartbeat lactation;
Luvox mg/day d, but on and cisapride, , and impaired
q4- appears to for pimozide, severe hepatic
7Days be linked Obsessiv alosetron muscle function;
Classific up to to its e or stiffness suicidal
ation 100-300 inhibition Compuls tizanidine or tendencies;
mg/day of CNS ive with twitchin seizures;
Antidepre mania; CV
neuronal Disorder fluvoxamin g,
ssants, Dose disease; labor
uptake of (OCD) e maleate agitation
SSRIs >100 and delivery;
serotonin Label. is ,
mg/day Label,1,2. Has also contraindic hallucina pregnancy

23
should Fluvoxam been ated. tions,
be ine blocks used in Fluvoxami loss of -Weight; T;
divided the the ne maleate coordina skin rash,
q12hr reuptake manage tablets are tion, lesions;
of ment of contraindic nausea, reflexes;
serotonin bulimia ated in vomiting affect; bowel
at the nervosa patients , or sounds; liver
<8 serotonin with a diarrhea. evaluation; P,
years: reuptake history of pain, peripheral
Safety pump of hypersensit burning, perfusion;
and the ivity to numbnes LFTs, renal
efficacy neuronal fluvoxamin s, or function tests
not membran e maleate. tingling
establis e, in the INTERVEN
hed enhancing hands or TION/E
the feet. VALUATIO
actions of shaking N
serotonin of a part
Ages 8- -Give lower
on of the
17 years or less
5HT1A body
(conven frequent
autorecep that you
tional doses in
tors cannot
tablets): elderly
Label,1,2. control.
25 mg patients and
Studies
PO qHS with hepatic
have also
initially; or renal
demonstr
may impairment.
ated that
titrate
fluvoxami
by 25 -BLACK
ne has
mg/day BOX
virtually
increme WARNING:
no
nts Establish
affinity
every 4- suicide
for α1- or
7 days precautions
α2-
to 50- for severely
adrenergi
200 depressed
c, β-
mg/day patients,
adrenergi
children, and
c,
adolescents.
muscarini
Limit
Not to c,
quantity of
exceed dopamine
tablets
200 mg D2,
dispensed.
(for histamine
ages 8- H1, -Administer
11 GABA- drug at
benzodiaz

24
years) epine, bedtime. If
or 300 opiate, 5- dose exceeds
mg for HT1, or 100 mg,
adolesce 5-HT2 divide dose
nts receptors, and
despite administer
having the largest
dose at
Give bedtime.
doses
>50 -Monitor
mg/day patient for
divided therapeutic
q12hr response for
up to 4–7
days before
increasing
dose.

-Monitor
patient for
serotonin
hypertension
syndrome,
elevated
fever, severe
anxiety,
rigidity.

-WARNING:
When
discontinuing
the drug,
taper dose by
50 mg/day
every 5–7
days.

Patient/
Family
Teaching.

Take this
drug at
bedtime; if a
large dose is

25
needed, the
dose may be
divided but
take the
largest dose
at bedtime.

Do not stop
taking this
drug
abruptly; it
should be
discontinued
slowly.

You may
experience
these side
effects:
Dizziness,
drowsiness,
nervousness,
insomnia
(avoid
driving or
performing
hazardous
tasks),
nausea,
vomiting,
weight loss
(eat frequent
small meals),
sexual
dysfunction
(reversible).

Report rash,
mania,
seizures,
severe weight
loss.

26
General Actu Mechani Indicati Contraindic Advers Nursing
Name al sm of on ation e Responsibility
Dosa Action Effect
ge

Paroxetin 20 block the Major - Paroxetine Feeling Baseline

e mg serotonin depressi may cause a sick Assessment
PO reuptake ve serious (nausea
qDay transporte disorder condition ) History:
Brand initial r (SERT) (MDD) called Hypersensitivit
Name ly; and thus Obsessi serotonin Headac y to paroxetine,
may increase ve syndrome if hes renal or hepatic
Paxil incre the compul taken impairment,
ase concentra sive together Being seizure
by 10 tion of disorder with some unable disorder;
Classifica mg synaptic (OCD) medicines. to sleep pregnancy,
tion qWee serotonin. Panic Do not use lactation
k, not disorder paroxetine Diarrho
selective ea Physical:
to (PD) with
serotonin- Orientation,
excee busprone
reuptake Feeling reflexes; P, BP,
d 60 (Buspar),fen
inhibitors tired or perfusion; R,
mg/d tanyl
(SSRIs). weak. adventitious
ay (Abstral},
Duragesic), sounds; bowel
Serious sounds, normal
lithium side
(Eskalith, output; urinary
effect output; liver
Lithobid),
tryptophan, evaluation;
-lose or
St. John's LFTs, renal
gain
wort, function tests
weight
amphetamin without
es, or some INTERVENTI
trying ON/E
pain or
migraine VALUATION
-have
medicines change BLACK BOX
(eg, s in WARNING: Be
rizatriptan, your alert for
sumatriptan, periods increased
tramadol, such as suicidality in
Frova, heavy children and
Imitrex, bleedin adolescents.
Maxalt, g,
Relpax, spottin Administer
Ultram, g or once a day in

27
Zomig). bleedin the morning.
g
-a disorder betwee Shake
with excess n suspension well
antidiuretic periods before using.
hormone
called -get Ensure that
syndrome of constan patient
inappropriat t swallows CR
e headac tablets whole;
antidiuretic hes, do not cut,
hormone long crush, or chew.
lasting
-low confusi Limit amount
amount of on or of drug given to
sodium in weakne potentially
the blood ss, or suicidal
frequen patients.
-an t
increased muscle Abruptly
risk of cramps discontinuing
bleeding – these the drug may
can all result in
-manic be discontinuation
behavior signs of symptoms
low (agitation,
-manic- palpitations);
sodium
depression consider
levels
in your tapering.
-suicidal
thoughts blood
Advise patient
-cough to avoid using if
-serotonin pregnant or
syndrome, a up
blood lactating.
type of
disorder or have
with high blood
Patient/
serotonin in your
Family
levels pee
Teaching.

-closed -have
Take this drug
angle black
exactly as
glaucoma or red
directed and as
poo or
long as
-liver blood
directed. Shake
problems in your
suspension well
vomit –
before using.

28
 these Swallow
-bleeding can be controlled-
from signs of release tablets
stomach, bleedin whole; do not
esophagus g from cut, crush, or
or the gut chew.
duodenum
- Abruptly
-seizures bleedin stopping the
g from drug without
-a feeling of the tapering the
restlessness gums dose may cause
with or have symptoms
inability to bruises including
sit still that agitation and
appear palpitations.
-broken without
bone due to a This drug
disease or reason should not be
illness or that taken during
get pregnancy or
-risk of when nursing a
bigger
angle- baby; using
closure -feeling barrier
glaucoma restless contraceptives
due to or is advised.
narrow cannot
angle of sit or You may
anterior stand experience
chamber of still these side
eye effects:
-get Drowsiness,
-chronic blurred dizziness,
kidney vision tremor (use
disease caution and
stage 4 avoid driving or
(severe) performing
other tasks that
-chronic
require
kidney
alertness); GI
disease
upset (frequent
stage 5
small meals,
(failure)
frequent mouth
-kidney care may help);
disease with alterations in
likely sexual function.

29
 reduction in
kidney Report severe
function nausea,
vomiting;
palpitations;
blurred vision;
excessive
sweating;
thoughts of
suicide.

VII. Nursing Inteventions

a. Pre-orientation Phase
 Before the meeting, review the client’s record and other sources of
important information to have background information and of the client’s
condition.
 Obtain online information about the client's condition to learn about
potential advantages as well as disadvantages.
 Recognize the client’s beliefs, attitude, fears, and feelings that could have
an impact on interaction and relationship with the client.
b. Orientation Phase
 Gather necessary paperwork and background materials available on the
client.
 Explain the role, rules, goal, purpose, parameters, and expectations with
the client to establish a therapeutic relationship.
 Arrange a quiet, private, and comfortable setting.
 Establish self-assessment. For the nurse to consider personal strengths and
limitations in working with the client.
 Build rapport with the client and establish a contract.
 Explain to the client different personnel that may be included in the
treatment plan
 Provide the client with explanations on when the session will be
terminated.
c. Working Phase
 Provide information about the condition,prognosis, and treatment needs of
the client.
 Identify client’s problems by encouraging verbalization of feelings.

30
  Discuss and help the client to identify cognitive behavior concerns, needs,
and methods to satisfy needs.
 Promote a client’s positive self concept by letting the client make a list of
her positive qualities that can help her physical, mental, and emotional
well-being.
 Encourage the client to verbalize obsessions and what repetitive behaviors
did the client attempt to neutralize the anxiety caused by obsession.
 Provide client with time to perform compulsions.
 Be empathetic toward the client and be aware of their need to perform
rituals.
 Reinforce and recognize positive non ritualistic behaviors.
 Provide clarification and education that might be needed about behavior
functioning, effective coping mechanisms, and healthy relationship.
 Encourage the use of systematic desensitization to gradually manage the
compulsion of the client.
 Discuss possible referrals with the client and refer client to cognitive-
behavioral therapies, if necessary. Lifestyle medications affect the
likelihood of recovery of the client.
d. Termination Phase
 Guide the client in her own identification of the specific changes in
thoughts, feelings, and behaviors that have occurred.
 Encourage client to form relationship with future counselors and new
friends by pointing out benefits from the nurse-patient relationship.
 Finalize referrals to appropriate resources which can support patients,
encourage treatment compliance, and promote ongoing development.
 Discuss the client’s reaction on the relationship regardless of the length,
frequency and intensity of the relationship.
e. Conversation
(client, nurse, therapeutic communication and analysis)

31
 Nurse Client Therapeutic Technique Analysis

Pre- Orientation
Phase

Goodmorning ako si
Sandra po Giving Information Informing the patient
nurse Anabelle at ikaw
regarding the names of
naman ay si?
the nurse, purpose of
the activity, and until
when the activity will
last. The patient
expressed his
understanding by
simply nodding.

Kamusta ka naman Okay lang po Exploring The nurse explored the

patient’s basic
information, the patient
appropriately answered
the question.

May gusto ka bang Mga nakaraan po kasi, Exploring The nurse explored the
pagusapan ngayong yun nga po nadiagnose patient’s basic
araw na maaari mong ako na may obsessive information, the patient
ishare saakin compulsive disorder appropriately answered
(OCD) the question.

Opo, sabi po ng doctor The nurse explored the

Mayroon ka bang Exploring
nakuha ko po siya dahil patient’s basic
nalalaman tungkol dyan
sa mga traumas or information, the patient
sa sakit mo?
nakuha ko po siya dahil appropriately answered
yung nanay ko meron the question.
din po siyang OCD.

Hindi ko po siya totally

Kailan mo napansin na Exploring The nurse explored the
napansin, napansin po
may OCD ka? patient’s basic
siya ng ibang tao
specifically yung nanay information, the patient
ko, kasi yung mga appropriately answered
32
 ginagawa ko daw po the question.
nakikita daw po niya
yung sarili niya sakin
noon.

Meron ka pa bang Tapos po yung mga Exploring The nurse explored the
gustong ikwento, sige kaibigan ko po patient’s basic
lang ituloy mo lang napansin din po nila na information, the patient
parang meron po akong appropriately answered
mga bagay na ginagawa the question.
na paulit- ulit kahit
naman po para saakin
normal naman po siya.

Pwede ka bang Pag sa mga gamit ko po The nurse explored the

magbigay ng mga inaayos ko po siya Exploring patient’s basic
bagay na ginagawa mo paulit-ulit pero iniisip information, the patient
ng paulit-ulit. ko po na okay lang po appropriately answered
yun eh kaso nasa isip the question.
ko po siya na gusto ko
po siyang paulit ulit na
gawin.

Pag ginagawa mo ba The nurse explored the

Pagka nasatisfy po ako
siya may patient’s basic
dun sa bagay na ginawa Exploring
nararamdaman ka ba sa information, the patient
ko pag ayos na ayos po
sarili mo appropriately answered
siya feeling ko po yung
the question.
naiisip ko po nafufullfil
po.

Orientation Phase

Nung nagpacheck up ka Opo, iinom po ng

sa doctor may nasabi ba medication tapos po Exploring The nurse explored the
sayo ang mga maaari merong session po na patient’s basic
mong gawin para sa theracom na information, the patient
karamdaman mo kakausapin po ako mga appropriately answered
ganun po para po mas the question.
mapabuti po yung
kalagayan ko po

33
Napagdesisyonan mo Opo, napagdesisyunan Giving Information Giving the patient an
na ba sa sarili mo na ko naman po at information increases
ready ka na natatanggap ko naman his knowledge and
magundergo sa mga po kung ano po yung what to expect.
session sakit na meron ako at
naiintindihan ko po

Kung ganon, ngayon is

Exploring The nurse explored the
ipapaliwagan ko sayo Opo
patient’s basic
kung papaano ang
information, the patient
magiging takbo ng
appropriately answered
pagkakaroon natin ng
the question.
therapy, ok, so
magsisimula tayo
ngayong araw na ito at
magkakaroon tayo ng
12 sessions. Sa loob ng
12 sessions nayun ay
uunti-untiin natin,
ipoproseso natin siya
kung saan yung mga
nakakasanayan mo na
gawin ng paulit-ulit ay
unti-unti nating
pawawalain. Ok?

Working Phase

Sa mga oras na Okay lang naman po

The nurse explored the
pinaguusapan yung sakin kasi alam kong Exploring patient’s basic
tungkol sa kalagayan makakatulong naman
information, the patient
mo komportable ka ba po sakin tong mga
appropriately answered
o hindi? ginagwa na to na pag
the question.
inom ng gamut at itong
session na ito.
Natatakot lang po ako
na magpatingin sa
doctor kasi po eh baka
po isipin ng mga tao na
baliw ako lalo na po sa
psychiatric ganyan po,
baka isipin makakasakit
na agad ako. Saka po
nalulungkot din ako na
akala ko po kasi normal

34
 lang ako pero hindi po
pala, hindi naman po sa
parang hindi normal,
hindi lang po kasi siya
parang usually
ginagawa ng normal na
tao.

Natatakot ka dahil sa Exploring The nurse explored the

mga bagay nato tulad Opo patient’s basic
ng sasabihin sayo ng information, the patient
ibang tao? appropriately answered
the question.

Kagaya ng nasabi mo
The nurse explored the
kanina, sabi ng doctor Opo Exploring patient’s basic
is isa sa mga dahilan
information, the patient
kung bakit ka
appropriately answered
nagkaroon ng ganyang
the question.
kondisyon ay dahil sa
genetics, tama ba?

So, ang nanay mo ay The nurse explored the

Opo
nadiagnose din ng Exploring patient’s basic
OCD? information, the patient
appropriately answered
the question.

Pareho kayo ng Ahm, meron po siyang Exploring

kundisyon ng nanay mga routine na
mo, may napapansin ka ginagawa na parang The nurse explored the
ba na ginagawa niya na normal naman po kasi patient’s basic
kagaya din ng siya sa paningin ko information, the patient
ginagawa mo? Pwede pero sometimes po appropriately answered
mo ba siyang ibahagi nadodoubt din po ako the question.
bakit po siya paulit ulit
na ganun, na
napapansin ko po sa
mga pagaayos niya sa
bahay namin sa mga
gamit namin
napapatingin po ako

35
 sakanya at nagtataka po
ako na bakit ganun po
yung way na nanay ko
ng paglilinis, okay na
naman po uulitin
nanaman po niya na
hindi ko po napansin na
ganun din po pala yung
ginagawa ko.

So ngayon na natapos Ahm, mas naliwanagan The nurse explored the

na ang unang session na po ako sa mga Exploring patient’s basic
natin, ano yung nangyayari po saakin, information, the patient
nararamdaman mo, sa mga bagay na dapat appropriately answered
pwede mo bang ishare? kong gawin atsaka po the question.
mas nakakatulong po
saakin yung mag
gantong usapan yung
pag gagamot tsaka po
mas nalalaman ko po
yung mga dapat
ipriority sa buhay na
gagawin ko at para
makatulong din po
kaligayahan ko po.

Kagaya ng sinabi mo
Giving the patient an
mas naliwanagan ka at Opo Giving Information
information increases
nagkaroon ka ng
his knowledge of what
encouragement na
to expect.
magpatuloy sa mga
session natin, tama ba?

Termination Phase

Kung ganon sasabihin

ko sayo kung kailan ka Opo, Thank you po.
ulit babalik at kung
kailan ulit tayo
magkakaroon ng
panibagong session. Sa
susunod na linggo
parehas na araw at oras

36
babalik tayo para sa
pangalawang session,
okay lang ba?

VIII. Nursing Care Plan

Assessment Planning Intervention Rationale Evaluation
Subjective: Independent After all the
“May mga times po Short Term: nursing
na naaanxious ako After 3 hours of  Establish a  Anything that intervetions, the
lalo na po pagdating nursing intervetion connection by makes the patient was able to
sa mga bagay bagay the patient will demonstrating patient uneasy indetify healthy
like sa pag appeared relaxed kindness, will make their ways to deal with
organized ng gamit and able to express empathy, and ritualistic and expresss
ko, lalo na po anxiety. respect. Use actions worse. anxiety as
pagdating sa mga responsive By building evidenced by
safety ganyan..” Long Term: actions to exhibit trust, the nurse decreased wariness
After 3 days of a genuine shows the and decrease
Objective: nursing intervetion interest in the patient that the feelings of anguish.
 Increase the patient will be client as a nurse
wariness able to deal with person. recognizes her
 Feelings of anxiety and as an individual
tension reduced to with the choice
 Anguish manageable level. of self-
 Excessive determination
handwashing and offers
Diagnosis assistance.

Anxiety as related  Provide comfort  Meeting basic

to earlier conflicts measures )e.g., human needs,
secondary to calm or quiet decreasing
obsessive- environment, isolation, and
compulsive disorder soft music, assisting client
warm bath, back to feel less
rub) anxious.

 Recognize  Ritualistic
actions without actions can be
drawing lessened by in
attention to the attention. There
patient. is a little need
Expressing for behaviours
empathy for the as anxiety
patient’s lowers. The
condition is severity of the
prefereable to repetitive
disapproval or activity may be
37
 judgement. lessened by
analyzing the
patient’s
emotions.

 Maintain a  The patient will

peaceful feel less
atmosphere and worried as a
talk to the result of any
patient’s effort to
condition is alleviate stress,
preferable to which could
disapproval or lessen the
judgement. severity of the
compulsive
activities.

 Guide the patient  Repetitive

in developing activities will
stress feel less
management worried as a
skills. These result of any
include effort to
visualiztion, alleviate stress,
deep breathing which could
exercises, lessen the
relaxtion severity of the
techniques and compulsive
thought- activities.
stopping.

 Determine what  Organized

the patient finds events give
relaxing such as patient less time
taking a warm to engage in
bath or listening compulsive
to music. behaviour and
Participate in thoughts.
productive
hobbies like
calm, attention-
requiring games
and creative arts
like painting,
needlepoint,
woodworking

38
 and pottery.

 Advise the  Anxiety can be

patient to angage reduced
in regular through
exercise routine. exercise.

 Support non-  With this

compulsive strategy, the
behaviour and patient won’t be
refrain from able to benefit
wearding from their
compulsive unhelpful habits
attitudes. Helped in any other
loved ones way.
understand the
importance of
acoiding
repetitive habits.

Dependent

 Administer  Anti-anxiety
medications medications
prescribed by the help reduce the
physician. symptoms of
anxiety or
extreme fear
and worry.

Assessment Planning Intervetion Rationale Evaluation

Subjective Partially Independent After nursing
“May mga kaibigan Compensatory interventions done,
naman po ako pero  Monitor the  This will help the patient
kaunti lang” Short Term patient's social in document improved her social
After 5 days of engagement any changes or interaction as
Objective nursing intervetion progress on evidences by
 Difficulty in the patient will be patient’s social increased
initiating and able increase engagement. engagement in
maintaining engagement in social activities and
relationships social activities and  Provide a safe  Allowing the interactions.
 Difficulty in interactions. space for the patient to
initiating patient to express these
conversation Long Term express their emotions in a
 Social After 1 week of feelings, safe and non-

39
 withdrawal nursing intervetion concerns, and judgmental
the patient will be frustrations environment
able to improve provides an
overall quality of outlet for
life and sense of emotional
belonging. release. It
validates their
experiences and
helps them
process and
cope with their
Diagnosis feelings
effectively.
Impaired social
interaction related to  Educate the  Patients can
anxiety secondary to patient about the gain insight
OCD relationship into how their
between OCD, OCD symptoms
anxiety, and contribute to
impaired social social
interaction. difficulties.
This knowledge
helps them
make
connections
between their
thoughts,
emotions, and
behaviors,
fostering self-
awareness and
promoting a
sense of control
over their
condition.

 Assist the  Creating a

patient in hierarchy
creating a allows for a
hierarchy of systematic and
anxiety- gradual
provoking social approach to
situations. facing anxiety-
provoking
situations. It
helps the

40
 patient break
down their
fears into
smaller,
manageable
steps, starting
with situations
that evoke less
anxiety and
gradually
progressing to
more
challenging
ones. This
approach
prevents
overwhelming
the patient and
promotes a
sense of
accomplishmen
t as they
successfully
navigate
through each
step.

Collaborative
 Collaborate with  It will help in
the addressing the
interdisciplinary unique
team to facilitate challenges
referral to a associated with
qualified social anxiety
therapist for and impaired
CBT, social
specifically interaction.
targeting social They can
anxiety and provide tailored
social interventions
interaction and techniques
skills. that specifically
target these
areas, ensuring
the most
effective

41
 treatment
outcomes.

 Collaborate with  By involving

the patient, their the patient,
family, and the their family,
interdisciplinary and the
team to create a interdisciplinar
supportive y team, a
environment holistic
that promotes approach to
social care can be
interaction and implemented.
inclusion. This approach
considers the
various factors
that influence
the patient's
social
interaction,
including their
personal
preferences,
family
dynamics, and
environmental
factors.

Assessment Planning Intervention Rationale Evaluation

Subjective Supportive  Provide  It can reduce After a week of
Educative information self-stigma by nursing intervetions
“May mga times po about how OCD reassuring the the patient
na sa sobrang gusto Short Term symptoms can patient that their demonstrated
ko maging perfect interfere with struggles are improved
dahil may mga After 3 days of occupational valid and shared occupational
thoughts po ako na nursing functioning and by others with functioning as
di mapigilan, interventions the the importance the same evidenced by the
minsan hindi po patient to engage in of managing condition. This ability to engage in
nagiging maganda fewer compulsive these symptoms knowledge can school-related tasks
yung resulta ng behaviors or rituals to maintain empower the with reduced
ginagawa ko.” that can disrupt productivity and patient to seek interference from
their school success. help without obsessive thoughts
Objective performance. feeling ashamed and compulsive
 Excessive time or isolated. behaviors.
spent on OCD- Long Term
related rituals or

42
 intrusive After 1 week of  Teach the  Patient will gain
thoughts nursing intervention patient about a sense of
 Express the patient to strategies to control over
perfectionisim develop and utilize reduce the their symptoms
effective coping impact of and develop the
strategies to obsessive skills needed to
Diagnosis manage obsessive thoughts and effectively
thoughts and compulsive navigate
Risk for Impaired compulsive behaviors on occupational
Occupational behaviors in the their work or challenges.
Functioning related occupational school
to obsessive setting. performance.
thoughts and
compulsive  Assist the  It helps
behaviors. patient in individuals with
developing OCD minimize
effective time distractions that
management may exacerbate
strategies to their symptoms.
optimize
productivity and
reduce stress in
the occupational
setting.

Collaborative
 Collaborate  This
with the collaboration
interdisciplinary allows for a
team, including tailored and
therapists, targeted
educators, and treatment plan
employers, to that is effective
develop an in addressing
individualized the patient's
treatment plan unique needs.
that addresses
the patient's
occupational
challenges.

 Facilitate  This will ensure

referral to a that the patient
qualified receives a
therapist for treatment
CBT, which can approach with a

43
 help the patient strong scientific
develop basis and
strategies to patient will
challenge develop
obsessive strategies to
thoughts, effectively
reduce anxiety, manage their
and modify symptoms in
compulsive the context of
behaviors in the their
context of their occupational
occupational tasks.
tasks.

IX. Health Teaching

M-edications Advise the patient to take all medications prescribed. Compliance with
the medications is the most effective means of treating and managing the
disorder.

Educate the patient about home medications that should be taken such as
proper dosing, adverse effects, and complications that need to be
reported immediately to the healthcare provider.

Educate the patient about the mechanism of action of each of these

medications: Sertraline Hydrochloride, Fluvoxamine, Clomipramine,
Paroxetine and Fluioxetine.

E-nvironment Advise the patient to avoid an environment that may trigger trauma from
past experiences.

Advise the patient to prevent stress factors that may precipitate the
disorder.

Advise having a calm, quiet, and clean surroundings to lessen prompting

OCD.

T-reatment Instruct the patient to continue prescribed medications to prevent further

complications.

Educate the patient about adhering to the full treatment regimen and
provide support.

H-ygiene Instruct the patient to perform frequent oral hygiene with an alcohol-free

44
 mouthwash.

Take a bath at least once a day.

Washing hands with soap after touching things with dirt.

Having clean, cool and comfortable clothing.

O-utpatient Instruct the patient about the continuity of prescribed medications and
adherence to scheduled follow-up checkups.

Remind the patient to avoid things that may provoke anxiety from the
disorder.

D-iet Emphasize the importance of a well-balanced diet that includes a variety

of fruits, vegetables, whole grains, lean proteins, and healthy fats.
Encourage the patient to consume nutrient-dense foods that provide
essential vitamins, minerals, and antioxidants to support overall physical
and mental health.

Educate the patient about the potential impact of caffeine and other
stimulants on anxiety levels. Encourage moderation in the consumption
of caffeinated beverages (such as coffee, tea, and energy drinks) and
advise them to monitor their individual response to caffeine.

S- Advise to have support from a therapist through counseling to help

afety/Spiritual/Sexual manage thoughts and actions. Participating in one-on-one or group
therapy may help as well to be able to share and express similar thoughts
and sentiments.

Discuss home safety measures with the patient, focusing on reducing

potential hazards that may contribute to their OCD symptoms or increase
the risk of accidents. This may include ensuring proper storage and
disposal of cleaning chemicals, organizing belongings to prevent trip
hazards, and addressing any specific safety concerns related to their
compulsive behaviors.

45
X. Journals

1.

Obsessive Compulsive Disorder is characterized by a pattern of unpleasant

thoughts and obsessions that cause an individual to engage in repetitive activities.
These compulsive behaviors and obsessions seriously disrupt the person's daily living
activities. The more the individual tries to stop the obsessions, the more it only
increases the distress and anxiety in which even a person makes an effort to suppress
or ignore unwanted ideas or urges, it will only make them keep it going and returning.
However, there are ways of getting the right treatment for a person with obsessive
Compulsive Disorder.

An article by Carey (2019) states information on how individuals should deal

with Obsessive Compulsive Disorder. It is said that in dealing with OCD patients
must find the right treatment applicable for them. An individual has the right to be
assertive in questioning the ability of the health care provider. The article informs the
patients with OCD to question the importance of the therapy and how well they are in
the field. Furthermore, in this way, it provides a less awkwardness and will also build
rapport which is a big help along the treatment. On the other hand, it also states that
in treating OCD, the patient, and the health care provider must not make a goal of
going away from the thoughts or ceasing it. But the goal of the treatment is to make
the thoughts of the patient irrelevant. It is advised to avoid using negative imagery
and instead make positive thinking. Besides, it is stated that in treating OCD the more
attempts in suppressing a disagreeable thought, ensures that it will return. Therefore,
a therapy like exposure and response prevention is a one way of dealing with OCD.
This therapy helps patients to recognize and resist their mental compulsions like
replaying painful memories until they feel resolved. As a result, patients will
eventually learn that they can put up with even our most distressing thoughts and they
do not actually need to do anything about it.

2.

Less is known about the COVID-19 pandemic's possible impact on OCD, despite
the fact that the effects on general mental health and the rise in anxiety and sadness
are obvious. A study of Zaccari et al. (2021), compares the results of two
psychodiagnostic examinations and gathers new data to monitor the symptomatic
condition of OCD patients during the COVID-19 emergency period.

They enlisted 11 OCD patients and their therapists. Between December 2019 and
January 2020 (t0), all patients had a particular psychodiagnostic examination for
OCD (SCL-90; OCI-R; Y-BOCS self-report), as well as cognitive behavioral therapy
(CBT) and an exposure and prevention of response protocol (ERP) before the
lockdown. All patients received the psychodiagnostic evaluation that was completed
at time zero and again at time one, along with a set of qualitative questions gathered

46
 through an online survey. The respective therapists were instructed to use a semi-
structured interview (Y-BOCS) and a qualitative interview to record the state of the
therapy and the monitoring of symptoms. There were non-parametric analyses carried
out.

Patients claimed that their OCD symptoms had significantly lessened. 11

participants' scores on the Y-BOCS (SR) total self-report and the severity of their
OCD symptoms as measured by the OCI-r and SCL-90 r OC subscales decreased
between t0 and t1, according to data analysis. The Y-BOCS (I) revealed marginally
significant improvements and lower scores in relation to the parameters identified by
psychotherapists. 90.9% of the clinical sample reported an improvement in
symptoms, and this was corroborated by 45.4% of the therapists, who reported that
their patients had made moderate progress.

Even though they represent a small sample, the findings obtained from
standardized assessments taken at two distinct periods acquire therapeutic value.
Some research in the literature shows that OCD is getting worse. The type of
treatment, the detection period, and the intervention period are frequently not well-
described in research. These findings support the efficacy of CBT/ERP as an optional
treatment for OCD using a particular intervention technique.

3.

In an article by Nichols (2023), it was stated that the mental health disease
known as OCD is characterized by distressing behaviors, recurrent thoughts, and an
obsession or compulsion. This can significantly affect one's life and their well-being
since routine tasks can be difficult for someone with OCD to do. There is
approximately 2% of the population who have this disease whereas symptoms tend to
appear during their childhood or adolescence stage but rarely happen after 40 years of
age. Mostly, people with OCD suffer from different types of symptoms such as
concern with checking, fear of contamination, hoarding, intrusive thoughts, symmetry
and orderliness, obsessions, and compulsions. The cause of this disease is unknown
but said to be either genetic, autoimmune-related, behavioral, cognitive, or
environmental. Meanwhile, doctors diagnose through the presence of obsessive,
compulsive, or both, time-consuming obsessions and compulsions, symptoms from
OCD that do not result from the use of substances or medications and symptoms that
cannot be explained by another health issue. Lastly, treatments for this disorder are
cognitive behavioral therapy that needs to comply as scheduled and medications such
as Escitalopram, Fluvoxamine, Paroxetine, Fluoxetine, and Sertraline.

4.

Obsessive-compulsive disorder is distinguished by the symptoms such as the

occurrence of obsessions, obsessive routines, or most of the time, both. People who
have OCD are intrusive, persistent, and repetitive thoughts, urges, or pictures that
generate a lot of anxiety. Obsessions might include unpleasant ideas or feelings.

47
 pictures of loved ones being harmed, constant worries that one has not closed the
doors or turned off the electrical appliances, thoughts of being tainted, and morally or
ethically sexually unpleasant ideas. In addition, the compulsion includes repetitive
behavior such as recurrent hand washing, repetitive praying, counting, or thinking
positive ideas to reverse or replace negative thoughts. However, its compulsion
prevents anxiety.

There is no laboratory testing for obsessive-compulsive disorder, and the

diagnosis is done through a clinical interview. To make a diagnosis based on the
Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), the individual
who is affected with this disorder can see such as time-consuming more than 1hr per
day or may interfere with normal functioning. However, this disorder has been linked
to altered serotonin dysregulation that may result in hypersensitivity of postsynaptic
serotonin receptors. Furthermore, in obsessive-compulsive disorder, the dopamine
system may be disturbed. Nevertheless, in terms of cognitive and behavioral aspects,
the person with OCD. The cognitive-behavioral approach proposes that obsessions
and compulsions come from particular types of dysfunctional beliefs, the strength of
which affects a person's risk of developing obsessions and compulsions.

5.

Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition

that is associated with substantial global disability. OCD is characterized by the
presence of obsessions and/ or compulsions. Obsessions are repetitive and persistent
thoughts, images, impulses or urges that are intrusive and unwanted, and are
commonly associated with anxiety. Compulsions are repetitive behaviors or mental
acts that the individual feels driven to perform in response to an obsession according
to rigid rules, or to achieve a sense of completeness. People with OBD might have
difficulty in identifying or describing obsessions, but most adults can recognize the
presence of both obsessions and compulsions.

The clinical criterion states that a diagnosis of OCD requires obsessions and
compulsions that are associated with clinically significant distress or functional
impairment, which is important given that intrusive thoughts and repetitive behaviors
are common, and that rituals are a normal part of development. The diagnostic
hierarchy criterion states that the obsessions and compulsions are neither a
manifestation of another mental disorder, nor are they attributable to the physiological
effects of a substance (such as a drug of abuse or a medication) or another medical
condition. As previously mentioned, obsessions and compulsions in patients with
OCD fall into a small number of symptom dimensions.

Common sets of obsessions and compulsions in patients with OCD include

concerns about contamination together with washing or cleaning, concerns about
harm to self or others together with checking, intrusive aggressive or sexual thoughts
together with mental rituals, and concerns about symmetry together with ordering or

48
 counting. These symptoms dimensions have been observed around the world,
indicating that in some ways OCD is a seemingly homogenous disorder.

DSM-5 diagnostic criteria for OCD emphasize that OCD is characterized by the
presence of obsessions and/or compulsions. Obsessions are defined by the following:
Recurrent and persistent thoughts, urges, or impulses that are experienced, at some
time during the disturbance, as intrusive and unwanted, and that in most individuals
cause marked anxiety or distress and the individual attempts to ignore or suppress
such thoughts, urges, or images, or to neutralize them with some other thought or
action (that is, by performing a compulsion). Compulsions are defined by the
following: Repetitive behaviors (for example, hand washing, ordering or checking) or
mental acts (for example, praying, counting or repeating words silently) that the
individual feels driven to perform in response to an obsession or according to rules
that must be applied rigidly and the behaviors or mental acts are aimed at preventing
or reducing anxiety or distress, or preventing some dreaded event or situation;
however, these behaviors or mental acts are not connected in a realistic way with
what they are designed to neutralize or prevent, or are clearly excessive.

The obsessive-compulsive symptoms are not attributable to the physiological

effects of a substance or another medical condition.

Twin studies have shed light on the genetic and environmental contributors to
OCD. One meta-analysis of twin studies suggested that addictive genetics affects
accounted for 40% of the variance, and non-shared environment accounted for 51%
of the variance in obsessive-compulsive symptoms.

OCD was initially believed to be quite rare. More recent nationally representative
surveys have confirmed that OCD has a lifetime prevalence of 2–3%, although
figures vary across regions, and that it is associated with substantial comorbidity and
morbidity. OCD is more common in females than in males in the community,
whereas the ratio of females to males is often fairly even in clinical samples.
Similarly, OCD is found in individuals across socioeconomic classes, as well as in
low-income, middle-income and high-income countries. OCD typically starts early in
life and has a long duration. In the National Comorbidity Survey Replication (NCS-
R) study, nearly a quarter of males had onset before 10 years of age. In females, onset
often occurs during adolescence, although OCD can be precipitated in the peripartum
or postpartum period in some women. Consistent with the early age of onset, the
strongest sociodemographic predictor of lifetime OCD is age, with the odds of onset
highest for individuals 18−29 years of age.

6.

Obsessive-compulsive disorder (OCD) is a chronic illness characterized by

obsessions, compulsions, or distressing intrusive thoughts that cause discomfort.
Obsessions, or repeated undesirable ideas and actions that cause an intense want to
repeat certain behavior, are frequently experienced by people with OCD. The patient

49
 may engage in compulsions or rituals to help them cope with the anxiety and distress
brought on by these ideas.

According to an article by Robinson (2021), obsessive-compulsive disorder has

two main types of symptoms, obsession, and compulsion. Obsessive thoughts or
unwanted and disturbing ideas that you can't manage to leave behind these thoughts
can vary widely, but a few common themes include worrying about germs, dirt, or
illness, a need to have your possessions aligned, orderly, or symmetrical, worries
about the health and safety of yourself or your loved one and fear of saying
something offensive or obscene. On the other hand, compulsions are repeated actions
or ideas that a person has to counteract, neutralize, or make their obsessions
disappear. Some examples of compulsions are washing of hands, objects, or body
organizing or aligning objects in a specific way, counting and also, and repeating
specific phrases or sentences. The actual causation of OCD is unknown but a family
history of the disorder may be a significant factor. A person is more likely to have
OCD if a close relative does. In the event that someone is genetically predisposed to
OCD, additional variables may further raise the risk of developing the disorder such
as stress or trauma, abuse during childhood, or traumatic brain injury.

The combination of psychotherapy and medication such as selective serotonin

reuptake inhibitors (SSRIs) etc., can be used as a treatment for Obsessive Compulsive
Disorders. Therapies include Cognitive behavioral therapy which learns to identify
and reframe patterns of unwanted or negative thoughts and behaviors, a person can
also be gradually exposed to feared situations, or the concerns at the root of
obsessions or compulsions by using Exposure and response prevention therapy. Other
therapy approaches recommended include Mindfulness-based cognitive therapy
where mindfulness skills are learned to cope with distress triggered by obsessive
thoughts.

7.

Obsessive compulsive disorder (OCD) is characterized by distressing or anxious

intrusive thoughts, images, or desires as well as recurrent thoughts or activities that
the person feels driven to engage in. It may seem possible to stop a horrible thing
from happening or there is a different decision could result in a negative outcome.

As stated by Grant (2014), obsessions are persistent and recurrent cravings to

harm others, different images of violent, or repetitive contaminated thoughts and fear
on things that may happen. Obsessions can cause an unwelcome, intrusive ideas that
are upsetting or anxious for the person. Another mental or behavior compulsion that
can occur this might drive the person to makes an effort to ignore or suppress these
obsessions. Compulsions or rituals are repetitive actions that a person feels compelled
to do out as a result of an obsession. Compulsions are designed to offset or lessen a
person's misery or to stop them from experiencing a dreaded situation. These patients
may experience severe discomfort even while touching seemingly innocuous objects,
and they may engage in obsessive behaviors for hours, which may cause them harm.
In some circumstances, these aggravating behavior or routines lead to patients being

50
 unable to do daily needs. The available treatments for OCD have drawbacks despite
its disturbing nature and significant financial load.

8.

In an article according to Smith M. Robinson (2023). Obsessive-compulsive

disorder (OCD) is characterized by uncontrollable, unwanted thoughts and repetitive
behaviors that interfere with daily life. OCD causes the brain to become stuck on a
particular thought or urge, causing individuals to perform repetitive behaviors for fear
of causing harm. Although these behaviors may provide some relief, they do not
provide a sense of pleasure. To break free from OCD, individuals can avoid situations
that trigger or worsen symptoms or self-medicate with alcohol or drugs. OCD
involves obsessions and compulsions, which are involuntary thoughts, images, or
impulses that persist repeatedly. These thoughts can be disturbing and distracting,
while compulsions are behaviors or rituals driven to alleviate obsessions. However,
these compulsions often return stronger, and the obsessions become more demanding
and time-consuming, creating a vicious cycle.

OCD symptoms include obsessive thoughts and behaviors, which can cause
distress, interfere with daily life, and interfere with relationships. Most individuals
experience both obsessions and compulsions, but some experience just one or the
other.

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XI. References

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder.

The Lancet, 374(9688), 491–499.
https://doi.org/10.1016/s0140-6736(09)60240-3

Carey, P. (2019). Experts talk about how to get the best OCD treatment. NOCD.
https://www.treatmyocd.com/blog/ocd-articles-by-ocd-
experts?fbclid=IwAR0iDN41O3f26agVXVk4Wqo9mwxs3-
Ez2VLz4yaHeMjbRBRn8p6avRVcTg

Grant, J. E. (2014). Obsessive–Compulsive Disorder. The New England Journal of

Medicine, 371(7), 646–653. https://doi.org/10.1056/nejmcp1402176

National Institute of Health. (2022). Obsessive-Compulsive Disorder (OCD.)

https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd

Nichols, H. (2023). What is obsessive-compulsive disorder (OCD)?

MedicalNewsToday.
https://www.medicalnewstoday.com/articles/178508?fbclid=IwAR39w0QvvkDZ
6TdIl2jnnpQatvPDVrfdkVO36UkawZeIExork4plAE4w7PQ_aem_ASh9VmcujIx
9Ov0qapnsG_F41ODfySgwDC4VlV6JDWxfXNWoGUyqCLwN8XztueZcZfk

Robinson, D. (2021). Everything You Need to Know About Obsessive-Compulsive

Disorder. Healthline. https://www.healthline.com/health/ocd/social-signs

Smith, M., Robinson, L., & Segal, J. (2023). What is obsessive-compulsive disorder
(OCD)?. HelpGuide. org. https://www.helpguide.org/articles/anxiety/obssessive-
compulsive-disorder-ocd.htm

St. Lukes Health. (2023). 5 Common Types of OCD.

https://www.stlukeshealth.org/resources/5-common-types-ocd

Stein, D., Costa, D., Lochner, C., & Miguel, E. (2019). Obsessive-compulsive
disorder. National Library of Medicine. 5, 52.
https://doi.org/10.1038/s41572-019-0102-3

Zaccari V. et al. (2021). An Observational Study of OCD PAtients Treated with

Cognitive Behavioral Therapy During the COVID-19 Pandemic.
https://www.frontiersin.org/articles/10.3389/fpsyt.2021.755744/full?fbclid=IwAR
0kuQdyvUy-m8cFWGK3L57MXgzQasCjpPxaArtdoWuXaVcoDsBoSr3WqAg

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