NUR 6670 Week 6 Captain of the Ship OCD Case
NUR 6670 Week 6 Captain of the Ship OCD Case
Obsessive-compulsive Disorder Sample Paper
The patient, Ms. Shalin, is a 35-year-old female of African American descent who was referred to the clinic by her doctor for psychiatric evaluation. The patient presented with insecurities of leaving her doors unlocked and it was serious such that every time she would report for work, she had to go back home like twice to check whether her door was closed. She always reported to work late primarily because she kept checking repeatedly whether she had locked her door. Her work performance was poor and this resulted in most of her employers terminating her employment.
The patient has a history of diabetes type 2 which has been kept under control. She is currently on buspirone and occasionally uses alcohol. She has a positive family history of anxiety disorder and bipolar disease. The patient has agreed to and signed the informed consent. Assessment reveals a well-groomed 35-year-old lady, with no acute distress. She is talkative but loses concentration after some time. She maintains eye contact while communicating. Her thoughts are preoccupied and circumstantial with compulsion and obsession. The clinical impression is a diagnosis of Obsessive-Compulsive Disorder (OCD) (APA, 2013 NUR 6670 Week 6 Captain of the Ship OCD Case).
Psychopharmacology
OCD can present a significant management challenge. OCD can be treated using pharmacotherapy. The patient displays an impairment in function, both at home and occupational functionality. Pharmacotherapy is therefore recommended (Greenberg, 2018). The treatment starts with prescription of Selective serotonin reuptake inhibitors (SSRIs) which are the recommended first line intervention for OCDs. SSRIs inhibit serotonin transporter (SERT) at the presynaptic axon terminal to prevent serotonin reuptake. Evidence has shown that SSRIs for OCD are more efficacious when used in high doses (Kayser, 2020 NUR 6670 Week 6 Captain of the Ship OCD Case). For Prozac, doses up to 80 mg are accepted. Starting dose of Prozac 20 mg PO once a day in the morning. This should be increased gradually by 20 mg to achieve a maintenance dose of 20-60 mg if the desired clinical outcomes are not met (Salehi et al., 2019). OCD, however, takes long to respond to SSRI therapy. Clomipramine, a TCA can be added to SSRI to improve the symptoms of OCD. TCA have more serious side effects hence the preference for SSRIs. Clomipramine is therefore used in lower doses when given in combination with SSRIs so as to achieve the benefits of clomipramine while minimizing the side effects in patients (DiVall & Woolley, 2019 NUR 6670 Week 6 Captain of the Ship OCD Case). The expected outcome of the drugs is to reduce the obsessions and compulsions which interfere with the patient’s performance both at home and at work.
Psychotherapy
Cognitive Behavioral Therapy (CBT) and pharmacotherapy are the first line choice of treatment for OCD and are proven to reduce symptoms significantly (Greenberg, 2018). The effectiveness of cognitive-behavioral therapy is the same as that of pharmacotherapy in the treatment of OCD although behavioral therapy has beneficial effects which are long lasting. Behavioral therapy can be applied for both inpatient and outpatients and should be undertaken by a trained and experienced psychotherapist, preferably a behaviorally trained psychologist. Noteworthy is that most of behavioral approaches require total commitment from the patients. Further, for OCD patients, the primary goal of behavior therapy is exposure and response prevention (ERP). Often, the intervening behaviorist gradually exposes the patient to specific symptom triggers while at the same time training the patient on how to effectively suppress their response. While this is generally distressing to the patient, it tends to promote the cycle of learning and unlearning of the obsession and compulsion tendencies when correctly done. Also, when tackling OCD, the therapist can identify and challenge cognitive distortions that relate to the patient’s OCD and make the patient aware of them. This would be a first step in helping the patient counter such thoughts. The therapy is aimed at changing the behavior, reducing dysfunction and improving the client’s life. NUR 6670 Week 6 Captain of the Ship OCD Case
Medical Management
The patient should get her consultations from her Personal Care Physician (PCP). The patient has diabetes type 2 and needs continuous screening and monitoring by the primary care team. The PCP should be involved to ascertain if the patient develops any side effects to the medication. Prozac has been linked with hypoglycemia and poor glycemic control in diabetic patients. TCA have been associated with adverse effects such as orthostatic hypotension which may lead to dizziness and fall (Ulrich et al., 2020 NUR 6670 Week 6 Captain of the Ship OCD Case). The patient should be aware of these side effects and should visit the PCP as soon as she notices any anomaly. Suicide risk is also increased in this patient and therefore the PCP who is the first contact for this patient plays a significant role in identifying and appropriately referring this patient.
Community resources
Patients with OCD experience impairment in occupational functioning and struggle to maintain employment. They can easily go into financial hardship because of this. Such patients can benefit from community resources referral. Organizations such as the National Alliance on Mental Illness (NAMI) provide free information about the disorder, medication and support groups.
Follow-up Plan and Collaboration
The patient should report back after one week for follow up and make sure she is compliant to her medications. A follow-up plan should be made every visit. The objective of the follow-up plan is to monitor for signs of self-harmful behaviors, any urges and the need to give in to such urges. These drugs come with certain adverse effects. The dose should be adjusted if the patient is not tolerating the drug well. The patient should then be monitored every 4 weeks for medication management. Baseline lab tests should also be done monthly. These include the complete blood count, tests on kidney function, as well as liver function tests. The patient should make consultations with the therapist on a weekly basis for updates, questions, and concerns. SSRIs have been associated with the risk of patients being suicidal. The therapist and PCP should therefore be instructed on this possibility and collaborate to watch out for any unusual behaviors that may point towards suicidal tendencies. NUR 6670 Week 6 Captain of the Ship OCD Case
NUR 6670 Week 6 Captain of the Ship OCD Case References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author. NUR 6670 Week 6 Captain of the Ship OCD Case
- DiVall, M. V., & Woolley, A. B. (2019). CHAPTER Pharmacologic Agents. Acute Care Handbook for Physical Therapists E-Book, 431.
- Greenberg, W. M. (2018, May 17). Obsessive-Compulsive Disorder Treatment & Management: Approach Considerations, Pharmacotherapy, Behavior Therapy. Medscape. Retrieved from https://emedicine.medscape.com/article/1934139-treatment#d8.
- Kayser R. R. (2020). Pharmacotherapy for Treatment-Resistant Obsessive-Compulsive Disorder. The Journal of Clinical Psychiatry, 81(5), 19ac13182. https://doi.org/10.4088/JCP.19ac13182
- Salehi, M., Hadizadeh, H., Chang, A., & Grados, M. A. (2019). Recommendations for prescribing SSRIs. Contemporary Pediatrics, 36(11), 24-27. NUR 6670 Week 6 Captain of the Ship OCD Case
- Ulrich, S., Ricken, R., Buspavanich, P., Schlattmann, Peter; Adli, Mazda (2020). Efficacy and Adverse Effects of Tranylcypromine and Tricyclic Antidepressants in the Treatment of Depression. Journal of Clinical Psychopharmacology, 40(1), 63–74. doi:10.1097/JCP.0000000000001153
NUR 6670 Week 6 Captain of the Ship OCD Case Instructions
| MY CASE OCD CAPTAIN OF T HE SHIP Ms Shalin is my client who is 35 years old, female, African American ,married with 2 children .Lives with her family . She was referred to the clinic by her doctor for psychiatric evaluation . The problem Shalin had is that she had insecurities of leaving her doors unlocked at home . Every time she would report for work, she had to go back home like twice to check whether her doors was locked. Psychiartic Hx: Anxiety disorder A well-groomed 35 years lady, with no acute distress. She is talkative but loses concentration after some time. She maintains eye contact while communicating. Her thoughts are preoccupied and circumstantial with compulsion and obsession. The patient denies SI/HI/AVH. To prepare for this Assignment: 1.Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum. In 3–4 pages, write a treatment plan for your client in which you do the following: 2,Describe the HPI and clinical impression for the client. NUR 6670 Week 6 Captain of the Ship OCD Case HPI and clinical impression.) 4,Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices. 5,Identify medical management needs, including primary care needs, specific to this client. 6,Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. 7,Recommend a plan for follow-up intensity and frequency and collaboration with other providers. See Week 6 Discussion Here | |
| Comments / Note |
NURS 6670 Week 7 Case Study: A young woman with Depression
NURS 6670 Week 7 Case Study: A young woman with Depression
NOTE: Please includes introduction and conclusions
Examine Case 2: 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. NUR 6670 Week 6 Captain of the Ship OCD Case
At each Decision Point stop to complete the following:
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. 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. NUR 6670 Week 6 Captain of the Ship OCD Case
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. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family.
A young woman with Depression
SUBJECTIVE
Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep.
You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks.
Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”
OBJECTIVE
Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.
MENTAL STATUS EXAM
Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented. NUR 6670 Week 6 Captain of the Ship OCD Case
At this point, please discuss any additional diagnostic tests you would perform on Stefanie.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?
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.
Bipolar I, current phase, depressed
Bipolar II, current phase, hypomanic
Cyclothymic disorder
NURS 6670 Week 8 Assignment
Explain the diagnostic criteria for delirium.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder thus deliriums\’.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource
NURS 6670 Week 9 Assignment
A 63 year-old male Caucasian, homeless ,with no jobs , retired from the military, has been diagnosed with Schizophrenia and PTSD. NUR 6670 Week 6 Captain of the Ship OCD Case
CC: He states, “During the night, I hear voices in my head, constantly yelling and telling me to do things like jumping my window. I see shadows dancing across the wall and .
Lately whenever somebody comes near me, I fear for my life and my heart rate starts to increase and I start getting paranoid.”
The patient is experiencing the symptoms of hallucinations and voices from his Schizophrenia which is also causing his anxiety to occur and become paranoid around people.
Medication: Buspirone 10mg PO Daily for anxiety.
Olanzapine 10mg PO Daily for his Schizophrenia
Informed consent explained and signed by patient
Pt is alert and oriented x4,
Denies any street drug taken
Denies any alcohol use
Denies any allergy to medications or food
No side effects of any taken medications presently
Sleeps Pattern :Not sleeping well during the night or day, paces around in her room sometimes reading.
Food she stated she cannot eat well now Has gain 1 lb. after her last visit with her psychiatrist Is not pregnant Very compliance with taken medications taken
No suicidal ideations Hearing of voices or seeing any images Sees her regular therapist weekly Goes for individual therapy Family therapy SI/HI/AVH.
Clinical Impression: Based on the diagnostic criteria in APA (2013) Diagnosed: Schizoaffective disorder (ICD-10: F25.9), NUR 6670 Week 6 Captain of the Ship OCD Case.
Psychopharmacology of the patient’s symptoms cause a significant impairment in function or agitation, irritable treatment is based on patients’ signs and symptoms presented, client cannot sleep always on the edge ,easily irritated ,dissociate herself from friends and family and has decrease in her appetite.
Medication Management :Increase buspirone 15mg PO Daily continue to for month.
Olanzapine 15mg po for a month .
Decreases all active activities before bedtime ,getting her family involve especially.
Sees her regular therapist weekly Goes for individual therapy Family therapy monthly Family and client educated about her illness to watch for any suicidal ideations .
Advise given to husband not arguing with client. Read or dim lights or noise around her sleeping room Patient to see her PCP for regular checkup and labs Return for evaluation in a month time. NUR 6670 Week 6 Captain of the Ship OCD Case
Questions
In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
•
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
•
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
•
• Identify medical management needs, including primary care needs, specific to this client.
•
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. NUR 6670 Week 6 Captain of the Ship OCD Case
•
•
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
NURS 6670 Week 10 Schizophrenia Case
CASE
Charlie A 49 years-old male AA, is a homeless man had never been in a relationship, works at a local grocery store as a stocker, has been diagnosed with schizophrenia, complains of hearing voices even while at work which distracts her from what she needs to do, she also states that she feels hopeless in some situations which cause her to be anti-social. NUR 6670 Week 6 Captain of the Ship OCD Case
Medication:
Olanzapine-15mg PO Daily
Seroquel-200mg at night
At each Decision Point, stop to complete the following:
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. NUR 6670 Week 6 Captain of the Ship OCD Case
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? NUR 6670 Week 6 Captain of the Ship OCD Case
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. 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. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family. NUR 6670 Week 6 Captain of the Ship OCD Case
Week 10 Discussion – Sleep/Wake Disorders
topic :Insomnia
- Explain the diagnostic criteria for your assigned sleep/wake disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder. NUR 6670 Week 6 Captain of the Ship OCD Case
• Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.
• Support your rationale with references to the Learning Resources or other academic resources.
NURS 6670 6670 Week 11
To prepare for this Discussion:
TOPIC IS GENDER DYSPHORIA
Select a gender dysphoria, that interests you.
Review the Learning Resources.
By Day 3
Post:
Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
Support your rationale with references to the Learning Resources or other academic resource. NUR 6670 Week 6 Captain of the Ship OCD Case