NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

Assessing and Treating Pediatric Clients

Introduction

The case study is on an 8-year-old boy, manifesting psychiatric symptoms. The mother reported that the client had become very nervous and worried. He also spends most of the time cleaning his hand because he fears his hands could get contaminated and become sick like he previously did. The client has also been avoiding playing with his friend and attending school. Other symptoms include irritability and sleep problems. Accordingly, this assignment involves making decisions about the diagnosis for the client and treatment choices. The paper will conclude by discussing ethical aspects likely to impact the treatment of the client.

Decision Point One

According to the presented symptoms for this client, the decision regarding the diagnosis of the client is that he has…

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You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

 

Case #2
Anxiety disorder, OCD, or something else?

8-year-old black male

BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/index.html

Obsessive Compulsive Disorder was chosen for the diagnosis in Decision 1
Begin Fluvoxamine immediate release 25mg orally at bedtime was chosen for Decision 2
Augment therapy with cognative behavior therapy was chosen for Decision 3 NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision.
Why were they different?

Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.
Why were they different?

Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning
Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.
Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

 

Assessing and Treating Pediatric Clients

Introduction

The case study is on an 8-year-old boy, manifesting psychiatric symptoms. The mother reported that the client had become very nervous and worried. He also spends most of the time cleaning his hand because he fears his hands could get contaminated and become sick like he previously did. The client has also been avoiding playing with his friend and attending school. Other symptoms include irritability and sleep problems. Accordingly, this assignment involves making decisions about the diagnosis for the client and treatment choices. The paper will conclude by discussing ethical aspects likely to impact the treatment of the client. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point One

According to the presented symptoms for this client, the decision regarding the diagnosis of the client is that he has obsessive-compulsive disorder (OCD). The reason why this decision was selected is that he presents symptoms akin to OCD symptoms. According to the DSM-5 criteria, symptoms of OCD include repetitive ritualized behaviors and intrusive obsessions. The symptoms of OCD lead to anxiety and distress to the client (Sachs & Eefurth, 2018). Examples of compulsions in people with OCD consist hand washing, avoidance, routine praying, routinized behaviors, among other behaviors (Sachs & Eefurth, 2018). In this case study, the client manifests anxiety and the ritualistic compulsive behavior include handwashing.

The intrusive obsession presented by this client is his fear of his hand becoming contaminated with germs and as a result, becoming sick (Sachs & Eefurth, 2018). Nonetheless, the client may also be having social phobia as manifested by his school avoidance and avoiding socializing with his friends.

 

Decision Point Two

The second decision for this client is to begin Fluvoxamine immediate release 25 mg orally at bedtime. The reason why this medication was chosen is that it is an SSRI and it is FDA approved for children who are 8-years and above (Pittenger & Bloch, 2014). The medication works by hindering the reuptake of serotonin within the brain. Additionally, evidence has demonstrated the efficacy of Fluvoxamine in treatment of OCD in children by improving the symptoms. In addition, the medication has been shown to be tolerable and safe for pediatric population. Because fluvoxamine has sigma-1 antagonist effects and thus causes sedation, it is supposed to be administered during bedtime (Thamby & Jaisoorya, 2019). NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Selection of this decision hoped that the OCD symptoms in the client would decrease. This can be manifested by reduced handwashing and reduced fear of contamination as well as reduced anxiety. This is because the efficacy of the drug has been demonstrated in treatment of OCD in children (Pittenger & Bloch, 2014). Secondly, it was hoped that the client would tolerate the drug and thus not have any adverse side effect.

The result of this decision was just as it was expected because there was a decrease in the symptoms in the client in the client as the handwashing reduced and anxiety as well. The sociability of the client also improved as he began interacting with his friend. The symptom improvement in this client is attributable to the efficacy of fluvoxamine in improving symptoms of OCD (Thamby & Jaisoorya, 2019). In addition, the client did not report any side effects from the medication. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point Three

The chosen third decision was for the client to augment the treatment using cognitive behavior therapy. The reason for this choice is because CBT has been demonstrated to be effective when treating OCD and the therapy does not carry any side effects or risks (Wu et al, 2016). When treating OCD, cognitive behavior therapy uses exposure and response prevention (ERP) and cognitive therapy to alter the thoughts and behavior of an individual. During the step of exposure-response prevention (ERP), the person with OCD is kept in a situation likely to expose him/her to the obsessions and the client is advised not to conduct compulsions that they normally perform to ease the anxiety and distress (Tundo et al, 2016). In this case the client would be exposed to a contaminated area and requested not to perform hand-washing NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay. After this, cognitive therapy is then applied where the therapist helps the client to alter the negative thinking pattern associated with the obsession and compulsive behavior (Tundo et al, 2016). The client is helped to identify the patterns that cause distress and negative behavior such as the compulsions and adopt a more adaptive thinking pattern and hence reduce the anxiety, distress, as well as the negative behavior associated with performing the compulsive acts (Wu et al, 2016).

Ethical Considerations

The ethical considerations that could affect the client’s treatment plan include informed consent. Since medications such as Fluvoxamine is associated with specific side effects, it would be important to inform the parents of the client about the possible side effects as well as provide full information about all available treatment options to enable them to make an informed treatment choice (Pittenger & Bloch, 2014) NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Conclusion

The client’s diagnosis is OCD because the client is obsessing with his hands becoming contaminated and performs compulsive behavior of ritualistic handwashing. The second decision is for the client to start client fluvoxamine immediate release 25 mg due to the medication’s efficacy in the treatment of OCD in children.  the last decision is to augment the treatment with CBT due to its efficacy in lowering OCD symptoms. Lastly, the ethical consideration applicable for this client is informed consent to allow the parents make an informed treatment choice. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

 

References

Pittenger C & Bloch M. (2014). Pharmacological treatment of obsessive-compulsive disorder. Psychiatr Clin North Am. 37(3), 375–391.

Sachs G & Eefurth A. (2018). Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment. Int J Neuropsychopharmacology. 21(1), 59–62.

Thamby A & Jaisoorya T. (2019). Antipsychotic augmentation in the treatment of obsessive-compulsive disorder. Indian J Psychiatry. 61(Suppl 1), S51–S57.

Tundo A & Necci R. (2016). Cognitive-behavioral therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence. World J Psychiatry.  6(4), 449–455.

Wu Y, Lang Z & Zhang H. (2016). Efficacy of Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis. Med Sci Monit. 1(22), 1646–1653. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.