Anxiety Disorders: Client Cases (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    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.

    About the Lecture

    The lecture Anxiety Disorders: Client Cases (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Anxiety and Anxiety Disorders: GAD, Phobias, OCD, PTSD (Nursing).

    Included Quiz Questions

    1. Reducing anxiety
    2. Gaining control
    3. Reducing the need for medications
    4. Increasing the effectiveness of coping mechanisms
    1. Trichotillomania
    2. Hoarding
    3. Hypochondriasis
    4. Conversion disorder

    Author of lecture Anxiety Disorders: Client Cases (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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