Nursing MANAGEMENT of Obsessive compulsive disorder SlideShare

Obsessive-compulsive disorder (OCD) is a mental health condition that happens when a person becomes enmeshed in a chain of obsessions and compulsions.

Obsessions are intrusive, unwelcome ideas, desires, or visions that cause incredibly upsetting emotions. Compulsions are actions someone takes in an effort to suppress their obsessions and/or lessen suffering.

Individuals who do not have OCD experience upsetting ideas or repetitive activities. However, it rarely interferes with normal everyday life.

For those who have OCD, the symptoms are uncontrollable, take up at least an hour of each day, and significantly disrupt everyday life.

Signs and Symptoms of Obsessive-Compulsive Disorder (OCD)

Obsessions and compulsions are the two basic categories of OCD symptoms.

1. Obsessions frequently have common characteristics, such as:
   • intolerance of contamination or dirt.
   • having doubts and difficulty accepting uncertainties.
   • requiring symmetry and order in everything.
   • ideas that are violent or horrifying about the loss of control and hurting oneself or others.
   • unfavorable ideas, such as those that are hostile or have sexual or religious issues.
   • continuous attention to breathing, and other bodily sensations.
   • suspicion of infidelity without solid evidence to support it.

1. Compulsions frequently have characteristics, similar to obsessions, including:
   • cleaning and washing
   • checking
   • counting
   • orderliness
   • maintaining a strict schedule
   • requesting reassurance

Causes of Obsessive-Compulsive Disorder (OCD)

It is still unclear to the experts what the exact cause of the obsessive-compulsive disorder is. OCD is more common in females than in males. Young people and teenagers usually exhibit symptoms first. The principal theories on what causes OCD are:

• Serotonin levels. The brain is a highly complicated part of the body. It has countless billions of nerve cells or Neurons as a result. For the body to work appropriately, they must coordinate and communicate with one another by exchanging signals electrically. Neurotransmitters are substances used in the transmission of these electrical signals. Serotonin is a neurotransmitter with numerous vital roles throughout the body, including regulating mood and sleep. According to some data, OCD may have something to do with how serotonin affects the brain.
• Brain structure, and functioning. According to the National Institute of Mental Health, the illness has also been related to abnormal development and damage in specific brain regions. Some scientists suggest that OCD is caused by problems in the neural connections between the brain regions involved in planning and judgment and another region that filters communications that coordinate and give instructions to the body about movement and function.
• Genetic factors. Additionally, there is data that suggests the possibility of parental transmission of OCD symptoms. The condition’s alleged causing genes, however, have not yet been found. According to its theory, there is a larger likelihood that a person will get OCD if a close family member does.

Risk Factors to Obsessive Compulsive Disorder (OCD)

The following factors raise the risk of developing OCD:

• Stress. A person may be more likely to acquire OCD or experience worsening symptoms if they are under a lot of stress at their job, at school, at home, or in their personal relationships.
• Personality. Specific personality traits, such as they struggle to cope with complexity, intense feelings of responsibility, or perfectionism, can be linked to OCD. However, there are strong disagreements on whether these are more malleable learned behaviors or rigid ones that cannot be modified.
• Child Abuse. The likelihood of acquiring OCD is higher in children who have experienced abuse or other highly traumatic events in their childhood, such as bullying.
• Childhood acute neuropsychiatric symptoms. Some children get an illness followed by a quick onset of OCD. PANDAS, which stands for pediatric autoimmune neuropsychiatric diseases related to streptococcus, is the term used to describe this condition following a streptococcal infection. But symptoms might also be caused by other illnesses or infections.
• Traumatic Brain Injury. A study published in 2021 reported that after a brain injury, OCD symptoms may manifest for the first time.
• Other mental health conditions. OCD patients frequently have other mental health issues, including attention deficit hyperactivity disorder (ADHD), Tourette syndrome, major depressive disorder, eating disorders, and anxiety disorders being the most prevalent.

Complications of Obsessive Compulsive Disorder (OCD)

The compulsive and obsessive symptoms of OCD may cause further problems such as secondary medical issues. These includes:

• Depression. Patients with OCD frequently experience embarrassing emotions and stressful therapies, which can result in depression. Having to live with such a difficult and uncomfortable situation every day would lead to losing hope. Living can be remarkably tough for individuals with OCD, making them more prone to depression.
• Isolation. The routine actions that emerge from obsessions and compulsions may cause isolation for many individuals suffering from OCD. Fear or the incapacity to fulfill compulsive behaviors outside of their residence may be the reason for this. Many additional mental health issues, such as depression and substance abuse problems, have been linked to isolation, according to studies.
• Social problems. Social interaction is challenging for people suffering from OCD. This difficulty may appear as a problem keeping relationships as well as issues engaging in social events and fulfilling commitments. This might worsen the isolation already experience caused by obsessive-compulsive disorder.
• Suicide. Both the emergence of other mental problems and the intensity of manifestations in OCD can increase the danger of committing suicide. OCD is a disorder that tends to cause disruption and significantly lowers the well-being of many individuals by interfering with daily life activities.
• Physical difficulties. For patients with compulsions to clean or wash things, this particularly applies. Frequently taking showers or excessively scrubbing the skin may irritate the skin, severely dries the skin, and delayed healing.

Diagnosis of Obsessive Compulsive Disorder (OCD)

The sequence of obsessions and compulsions must become so extreme that it takes up too much time and interferes with important tasks that the person gains in order for an obsessive-compulsive disorder diagnosis to be decided.

However, just because other people possess obsessive thoughts and/or compulsive behaviors for some time in life doesn’t always mean that we suffer “some OCD.” Because OCD symptoms might resemble those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia, or other mental health problems, diagnosing OCD can be challenging at times.

Following are some methods for diagnosing obsessive-compulsive disorder:

• Psychological Assessment. In order to ascertain whether a person suffers from obsessions or compulsive behaviors that affect their quality of life, this involves talking about their thoughts, feelings, symptoms, and behavioral patterns. This may involve speaking with the families or friends with their consent.
• OCD Diagnostic Standards. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association may be used by the attending doctor.
• Physical Examination. This could be done to look for any associated consequences and also to help rule out any other issues that could be the source of the symptoms. To assist rule out pharmaceutical side effects or other diseases, the doctor may also ask about the patient’s medical history, a list of the medications, and any further mental health or physical symptoms they may be experiencing. The patient and the doctor need to work together to achieve an accurate diagnosis and provide proper care and treatment.

Treatment for Obsessive Compulsive Disorder (OCD)

Treatment for obsessive-compulsive disorder can help put symptoms at bay so they don’t interfere with the patient’s everyday life, even if it may not be a solution. Some patients may require longer periods, persistent, or even more comprehensive treatment depending on how serious their OCD is. Psychotherapy and medications are the two main OCD treatments. Treatment is often most successful when these are used in combination.

• Psychotherapy. Therapy regulates undesirable ideas, alters dysfunctional traits, enhances relaxation, and deals with emotional discomfort. The following therapeutic modalities are advised for OCD:
  • Cognitive Behavioral Therapy. Among many patients with OCD, this therapy is effective. It involves being skilled at seeing and reframing undesirable or destructive ideas and behavior patterns.
  • Exposure and Response Prevention. ​​This form of cognitive behavioral therapy (CBT) includes exposing patients to frightening scenarios or thoughts that cause obsessions or compulsions gradually. It teaches participants to control the suffering that obsessions bring about without reverting to compulsive behavior.
  • Mindfulness-based cognitive therapy. It entails practicing mindfulness techniques in order to deal with the distress brought on by my thoughts and feelings.
• Medications. The obsessions and compulsions of OCD can be managed with the intervention of specific psychiatric medications. A psychiatric professional who can issue prescriptions might do so.
• Antidepressant. Antidepressants are typically used initially. U.S. Food and Drug Administration (FDA) approved antidepressants are prescribed by the doctor to treat OCD symptoms.
• Selective Serotonin Reuptake Inhibitors (SSRIs). By raising serotonin levels in the brain, SSRIs primarily assist people in managing diseases like depression.

Nursing Diagnosis for OCD

Nursing Care Plan for OCD 1

Nursing Diagnosis: Anxiety as related to earlier life conflicts secondary to obsessive-compulsive disorder (OCD) as evidenced by a decline in social and role performance, repeated behaviors, and recurrent thoughts.

Desired Outcomes:

• The patient will verbally express their knowledge of the importance of habitual actions and how they relate to anxiety.
• The patient will demonstrate the capacity to handle stressful circumstances successfully without turning to compulsive or obsessive thoughts or behaviors.

Nursing Interventions for OCDRationaleEstablish a connection by demonstrating kindness, empathy, and respect. Use responsive actions to exhibit a genuine interest in the client as a person.Anything that makes the patient uneasy will make their ritualistic actions worse. By building trust, the nurse shows the patient that the nurse recognizes him or her as an individual with the choice of self-determination and offers assistance.Recognize actions without drawing attention to the patient. Expressing empathy for the patient’s condition is preferable to disapproval or judgment.Ritualistic actions can be lessened by inattention. There is little need for behaviors as anxiety lowers. The severity of the repetitive activity may be lessened by analyzing the patient’s emotions.Maintain a peaceful atmosphere and talk to the patient in a comfortable manner.The patient will feel less worried as a result of any effort to alleviate stress, which could lessen the severity of the compulsive activities.Guide the patient in developing stress management skills. These include visualization, deep breathing exercises, relaxation techniques, and thought-shopping.Repetitive activities can be replaced with stress management approaches to change habitual practices.Determine what the patient finds relaxing, such as taking a warm bath or listening to music. Participate in productive hobbies like calm, attention-requiring games and creative arts like painting, needlepoint, woodworking, and pottery.Organized events give the patient less time to engage in compulsive behaviors and thoughts.Advise the patient to engage in regular exercise routine.  Anxiety can be reduced through exercise. Please remember that not all exercise needs to be vigorous or aerobic to have the desired impact.Support non-compulsive behavior and refrain from rewarding compulsive attitudes. Help loved ones understand the importance of avoiding repetitive habits.With this strategy, the patient won’t be able to benefit from their unhelpful habits in any other way.

Nursing Care Plan for OCD 2

Nursing Diagnosis: Social Isolation is related to past experiences of difficulty in interaction with others secondary to Obsessive Compulsive Disorder as evidenced by lack of confidence in public, inability to make eye contact, lack of communication, obsession with one’s own ideas; repetitious meaningless behavior.

Desired Outcomes:

• The patient will voluntarily participate in treatment sessions with a reliable support person.
• The client will freely partake in activities with other patients and staff members.
• ​​The patient will express the desire to develop better relationships and to improve social and communication skills.
• The patient will mention feeling more confident and having self-worth.

Nursing Interventions for OCDRationaleMake short, but frequent encounters to express a welcoming and optimistic attitude.A positive attitude that is accommodating fosters trust and enhances self-worth.  Show the patient compassion that is steadfast.To express the belief that the patient is a worthy person.During group activities that may be uncomfortable or tough for the client, be there to provide support.The patient feels emotionally stable when a trustworthy person is around.Be sincere and honor every commitment with the patient.A trustworthy and reliable connection to each other is important.Note any out of the ordinary social conduct or absent social indicators.    As hurdles to effective socialization, the nurse can look for irregular communication, a lack of comprehension of humor or sarcasm, or a dislike of contact.Maintain an appropriate distance when engaging with the patient. Give the patient additional space and a way out if he starts to feel too worried.An individual having panic-level anxiety could view contact as a potentially dangerous act.As directed, administer medications to the patient and keep an eye out for negative side effects.Most people’s symptoms can be controlled with brief, appropriate medication use.  Discuss with the client about the warning indications of worsening symptoms and ways to stop the reaction, including breathing techniques, meditation, and mindfulness training.Whenever OCD attacks are more frequent, disruptive behaviors become prevalent.  Recognize and reward patients for their spontaneous interaction with others.  Positive feedback boosts confidence and promotes the recurrence of appropriate behaviors.

Nursing Care Plan for OCD 3

Nursing Diagnosis: Ineffective Coping related to situational crises secondary to obsessive-compulsive disorder as evidenced by obsessive conduct or ritualistic habits, failing to do something for basic necessities, failure to respond adequately to responsibilities, and poor problem-solving abilities

Desired Outcomes:

• The patient will engage in a less ritualistic activity.
• The patient will exhibit effective coping skills.
• In order to keep OCD symptoms at a moderate level, the patient will express any indications and symptoms of growing OCD.
• The patient will show that they are able to stop obsessive thoughts in their tracks and abstain from repetitive actions.

Nursing Interventions for OCDRationaleDetermine the client’s OCD severity. Look at the circumstances that exacerbate symptoms and cause ritualistic behavior.The first step in training a client to stop an escalating situation is to assist the client in recognizing the precipitating elements.Assist the patient with dependency needs as necessary.Eliminating sources of dependency abruptly and completely would stress the client and add to their load. Encourage positive acknowledgment for self-reliant actions.Self-esteem is raised and desired behaviors are encouraged to be repeated via constructive feedback.Allow plenty of time for rituals at the beginning of treatment. Avoid passing judgment or voicing any displeasure with the action.The level of anxiety that can be induced by denying the patientEncourage and support the patient’s interest in understanding the significance and rationale behind the behavior.  It’s possible that the client is not aware of the link between emotional issues and obsessive habits. Prior to change occurring, challenges must be acknowledged and accepted.Promote awareness of a series of events that led to ritualistic or compulsive behavior.The first step in educating a client on how to stop worry from escalating is recognition of the precipitating circumstances.Encourage non-ritualistic behavior by giving it positive feedback.  Enhancing one’s self-esteem and promoting the repetition of desired behaviors are two benefits of positive reinforcement.

Nursing Care Plan for OCD 4

Nursing Diagnosis: Self-Care Deficit related to excessive ritualistic habits secondary to Obsessive Compulsive Disorder (OCD) as evideced by the refusal to practice self-hygiene, unclean clothes, uncombed hair, a bad body odor, lack of enthusiasm for choosing appropriate attire, and incontinence

Desired Outcomes:

• The patient will express their wish to take charge of their own self-care.
• The patient will be capable of taking care of their own ADLs and show that they are willing to do so.

Nursing Interventions for OCDRationaleUtilize a suitable evaluation tool, such as the Functional Independence Measures (FIM), to gauge the patient’s capacity to carry out ADLs effectively and safely on a regular basis.The patient might just require assistance with a few self-care needs FIM evaluates 18 self-care activities including feeding, bathing, clothing, grooming, managing bowel and bladder function, toileting, transfer, ambulation, and stair climbing.Discuss with the patient short-term objectives regarding self-care and plan on how to achieve them.In order to lessen frustration, assist the patient in creating achievable goals.Provide supervision for every task until the patient successfully demonstrates the skill and is placed in independent care. Conduct regular reviews to ensure that the patient is maintaining the level of skill and is still safe in the current setting.The patient’s capacity to carry out self-care procedures may fluctuate frequently throughout time and will need to be monitored on a regular basis.    Encourage the client to complete activities of daily living or ADLs to the best of their ability.Self-esteem is raised when autonomous tasks are completed successfully.Encourage self-reliance. When a client is incapable to perform, step in and help.Nursing priorities include the client’s security and comfort.Maintain a regular schedule and give the patient enough time to finish the task.  Getting used to a routine makes it easier and less labor-intensive. This aids the patient in planning and executing self-care techniques.Recognize individual accomplishments and provide encouragement.  Self-esteem is raised and desired behaviors are encouraged to be repeated via positive reinforcement.Demonstrate to the patient how to carry out tasks that he is finding challenging.When experiencing severe anxiety, a patient might need straightforward, specific examples of actions that are normally accomplished without issue.Keep careful track of the patient’s food and liquid intake.For proper nutritional evaluation may be made.Between meals, give the patient some healthy snacks and fluids.  The client might not be able to tolerate huge portions of meals or mealtimes and could need extra nutrition.

Nursing Care Plan for OCD 5

Nursing Diagnosis: Deficient Knowledge related to unawareness of potential side effects and unfamiliarity with the drugs being utilized secondary to the new diagnosis of obsessive-compulsive disorder (OCD) as evidenced by verbally expressing a lack of knowledge or expertise or requesting information, conveys a false impression of one’s health, performs desired or recommended health behavior incorrectly.

Desired Outcome: The patient will be able to determine accurate information about drugs and their negative side effects.

Nursing Interventions for OCDRationaleReview the patient’s pathology, prognosis, and expected future outcomes.  This gives the patient a foundation of knowledge to draw upon when making decisions.Describe how the prescribed drug works physiologically to reduce obsessional and compulsive symptomatology.OCD is a result of a neuropsychiatric condition that can be treated with medication alongside lifestyle changes.  Examine the patient for symptoms of nausea, headache, anxiety, sleeplessness, agitation, and sexual dysfunction. Check for signs of cognitive impairment, drowsiness, and exhaustion.The usual side effects of SSRIs and antidepressants are as follows. Starting with modest doses and progressively increasing them as the patient tolerates is the recommended course of action.Before stopping the medication, advise the patient to consult the doctor first. Progressive tapering of the dose may be needed before stopping any medication.OCD recurrence may result from abrupt withdrawal.  Ask the client to examine any underlying emotions that might be fueling their illogical worries. Assist the client in seeing that acknowledging their emotions, as opposed to repressing them, can lead to more flexible coping techniques.The patient may find it easier to accept unsolved concerns if they can express their emotions in a safe setting.    When interacting with the patient, keep a serene and reassuring demeanor.    A common sense among patients is that they lack control. The presence of a person who is composed and in charge of the current circumstance may make the patient feel secure and comfortable.Avoid allowing personal thoughts, emotions, or anxiety to affect the health teaching session or provision of treatment.  A patient’s symptoms and anxiety may become worse if others will share their own emotions with them. Prevent allowing personal thoughts, feelings, or anxiety to interfere with care.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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