Obsessive Compulsive Disorder Nursing Care Plan - Severe Anxiety

Nursing actions Rationale
Establish relationship through use of empathy, Anything about which the client feels anxious will serve to increase the ritualistic behaviors.
warmth, and respect. Demonstrate interest in client Establishing trust provides support and communicates that the nurse accepts the client as a person
as a person through use of attending behaviors. with the right to self-determination.
Acknowledge behavior without focusing attention
on it. Verbalize empathy toward client’s experience
Lack of attention to ritualistic behaviors can diminish them. As anxiety is reduced, the need for
rather than disapproval or criticism. Better to say,“I
behaviors is reduced. Reflecting the client’s feelings may reduce the intensity of the ritualistic
see you undress 3 times every morning. That
behavior.
must be tiring for you,” rather than “Try to dress
only 1 time today.”
Any attempts to decrease stress will help the client
Use a relaxed manner with the client; keep the
to feel less anxious, which may reduce the
environment calm.
intensity of the ritualistic behaviors.
Assist client to learn stress management, (e.g.,
Stress-management techniques can be used,instead of ritualistic behaviors, to break habitual pattern.
thought-stopping, relaxation exercises, imagery).
Identify what the client perceives as relaxing
Planned activities allow the client less time for
(e.g.,warm bath, music). Engage in constructive
warm bath, music). Engage in constructive activities
activities such as quiet games that require
such as quiet games that require concentration, as
concentration,as well as arts and crafts such as
well as arts and crafts such as needlework,
needlework,woodworking, ceramics, and painting.
Encourage participation in a regular exercise Exercise therapy can help relieve anxiety. Note:Exercise does not need to be aerobic or intensive to
program. achieve the desired effect.
Give positive reinforcement for noncompulsive
behavior. Avoid reinforcing compulsive
This approach will prevent the client from obtaining secondary gains from the maladaptive behaviors.
behavior.Help significant other(s) learn the value
of not focusing on the ritualistic behaviors.
Encourages client to problem-solve ways to limit own behaviors while recognizing that behaviors
cannot be stopped by others without increasing anxiety. If the time required for performing the
Assist client to find ways to set limits on own
ritual(s) is not considered in planning care, client will feel rushed and anxious while performing
behaviors. At the same time allow adequate time
behaviors. A mistake in compulsive behavior is more likely to be made if client feels rushed, and the
during the daily routine for the ritual(s).
whole ritual will have to be started again, resulting in increased anxiety—possibly to an
unmanageable level.
Limit the amount of time allotted for the Provides initial control of maladaptive behaviors until client can enforce own limits and substitute
performance of rituals. Encourage client to more adaptive response(s) to stress.
gradually decrease this time.
Encourage client to explore the meaning and
This exploration provides an opportunity to begin to understand the process and gain control over the
purpose of behaviors; to describe the feelings when
obsessive-compulsive sequence. When the opportunity for ritualistic behavior does not occur,the
the behaviors occur, intensify, or are
client fears that something bad will happen.Recognizing precipitating factors allows client to interrupt
interrelated;and to examine the precipitating factors
escalating anxiety.
to the performance of the rituals.
Discuss home situation, include family/SO as Returning to unchanged home environment
appropriate. Involve in discharge plan. Increases risk that client will resume compulsive behaviors.
These drugs help balance serotonin levels,decreasing feelings of anxiety, reducing need for ritualistic
Administer medications as
behavior(s), and allowing client to learn of other methods of stress reduction. Note: Luvox is
indicated,e.g.:Fluvoxamine(Luvox),clomipramine
classified as a selective serotonin reuptake
(Anafranil),fluoxetine (Prozac)
inhibitor and has fewer side effects than tricyclics.
Administer Buspirone (BuSpar) and lithium
Clients who are refractory to antidepressants may require combination therapy (e.g., buspirone and
(Eskalith),Sertraline (Zoloft), venlafaxine (Effexor)
fluoxetine or lithium and clomipramine).
medications as indicated.

Obsessive Compulsive Disorder Nursing Care Plan - Severe Anxiety

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Nursing actions Rationale

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