Chief Complaint
"I feel like I have to wash my hands after touching anything. It's getting worse — I'm late to class and stay up all night checking the locks."
Symptoms Reported
- Washing hands 20–30 times daily
- Repeatedly checking locks for up to an hour each night
- Avoiding public transportation
- Trouble concentrating in class
- Feeling anxious if compulsions are not completed
Mental Status Exam
- Alert and oriented ×4
- Anxious affect
- Insight: Partial
- No suicidal ideation or hallucinations
- Judgment: Fair
Physical Review of Systems
- Denies any pain
- Both hands are severely chapped, erythematous, with scant sanguineous drainage and tender to the touch
Current Medications
- None
Past Treatment History
- None, the client reports they are ready for treatment today
Diagnosis
- Obsessive-compulsive disorder
1558: Client presents for an initial evaluation. On assessment, the client is alert and fully oriented. The client's breathing is unlabored. Skin is warm and normal for ethnicity. Significant erythema noted on both hands. Capillary refill is 3 seconds. Peripheral pulses 2+. No peripheral edema. The client's physical assessment was interrupted multiple times by the client going to the sink and washing their hands. Vital signs: T 98.6° F (36.4 °C), P 72, RR 15, BP 131/85, pulse oximetry reading 97% on room air.
The nurse reviews the client's history and physical and is planning care.
➢ For each potential nursing intervention, click to specify whether the intervention is indicated or not indicated for the care of the client.
- A. Obtain a prescription for a selective serotonin reuptake inhibitor
- B. Interrupt compulsive behaviors
- C. Obtain an order to refer the client for dialectical behavior therapy
- D. Obtain an order to refer the client to a dermatologist for evaluation
- E. Obtain a prescription for an antipsychotic
- F. Educate the client on a schedule that distracts from the behaviors
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