00:01
Let's try a couple of questions.
00:03
Mr. M keeps washing his hands
over and over and over and over,
even though he
knows they're clean.
00:11
He might be washing his
hands like this because:
A. He doesn't want to
get an infection or cold.
00:19
B. His anxiety is reduced
when he washes his hands.
00:24
C. It makes him feel
better about himself.
00:28
Or D. Mr. M needs to feel like he
has control over his environment.
00:38
If you chose B. His anxiety is
reduced when he washes his hands.
00:44
You are correct.
00:46
Remember, these maladaptive
behaviors are an effort
to be able to reduce anxiety.
00:57
Now, when you admit
Mr. M to your unit,
your first therapeutic intervention
and your plan of care should be:
Discussing Mr. M's hand washing
and exploring its impact on him.
01:15
Lock the bathroom door so that Mr. M
can't possibly wash his hands.
01:20
Provide Mr. M with
hand sanitizer,
so we can stay clean without
having to actually wash his hands.
01:27
Or isolate Mr. M from
the others in the unit
so that his behaviors
do not affect others.
01:37
If you chose A.
01:39
Discuss Mr. M's handwashing,
and explore its impact on his life.
01:45
You are correct.
01:47
We want to help the patient start getting a
little bit of insight into their behaviors,
why they're doing them, and how to find
alternative and acceptable behaviors
that reduce anxiety in
a more acceptable way
so that the patient can get back to
their activities of normal living.
02:11
Which nursing diagnosis do you think
would be appropriate for Mr. M?
And there might
be more than one.
02:19
A. Disturbed body image
B. Ineffective impulse control
C. Anxiety
D. Chronic pain
Which one do you think
would be correct?
Well, there are two.
02:36
Ineffective impulse control
because he must wash his hands
and anxiety which is the reason
why he's washing his hands.
02:45
The disturbed body
image and chronic pain
are not the OCD kind of
compulsions that you see.
02:56
They are the somatoform.
02:59
Now you're a patient,
a new patient.
03:02
Mendez has been diagnosed
with trichotillomania.
03:07
What symptoms are
you expecting to see?
Fear of thunderstorms,
inability to stop
intrusive thoughts,
hoarding of objects, inability to let
go of things regardless of their value
or hair pulling and
patches or baldness.
03:26
If you chose hair pulling and patches
of baldness, you are on the right track.
03:32
Now after Mendez had a
visit from the family,
you enter the community room.
03:38
And you notice that
Mendez is sitting alone,
rocking back and forth,
sucking their thumb.
03:46
This is a defense
mechanism called:
A. Isolation
B. Regression
C. Projection
or D. Compensation
If you picked regression,
again, you are 100% correct.
04:06
It's important to remember
that with any anxiety disorder,
it is when that disorder becomes
so large in the person's life
that it interferes with their
activities of daily living,
that it is considered
a diagnosis.
04:25
And the individual has to
struggle every single day.
04:29
And as nurses we
respect their struggle.
04:33
We see them as an individual who
is struggling to have a good life.
04:39
And the way we can help them
medications, therapies,
supporting them to gain insight to
connect with resources in their community.
04:50
And we always want
to keep them safe.
04:53
So we always do our
education with them.
04:55
If ever they are put on any medication that
will alter their ability to drive a car,
maybe lose their balance.
05:06
We will make sure that we are explaining
to them how to keep themselves safe
and for us to document
so we can keep them safe
when they are in
our environment.