Mental Health Nursing
A 45 year-old man who is hospitalized feels the constant need to keep things in order, particularly whilst…
A 45 year-old man who is hospitalized feels the constant need to keep things in order, particularly whilst eating. The nurse observes him arranging the food on his plate into symmetrical and equal bite sized pieces, he constantly worries that the food served could be outdated and potentially causes illness. Which nursing diagnosis is most important?
Explanation
Core Concept: The patient exhibits classic symptoms of Obsessive-Compulsive Disorder (OCD), characterized by obsessions (fear of outdated food/illness) and compulsions (arranging food symmetrically). The underlying driving force and primary nursing diagnosis for these distressing, intrusive thoughts and rituals is severe Anxiety.
Clinical Presentation:
- Symptoms: Intrusive thoughts, repetitive behaviors, rigid routines, and extreme distress if routines are interrupted.
- Complications: Malnutrition (due to food rituals), severe functional impairment, and social isolation.
Diagnosis:
- First-line/Gold Standard: Clinical psychiatric evaluation using DSM-5 criteria and standardized tools like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Management:
- Acute: Provide a calm environment, do not abruptly interrupt rituals initially as it spikes anxiety, and ensure adequate nutritional intake.
- Definitive: Cognitive Behavioral Therapy (CBT) specifically Exposure and Response Prevention (ERP), combined with SSRIs.