Lauren has been diagnosed with Social Anxiety Disorder and…

QuestionAnsweredLauren has been diagnosed with Social Anxiety Disorder and…Lauren has been diagnosed with Social Anxiety Disorder and experiences obsessive thoughts that result in compulsive behaviors. This has a major impact on her life and day to day functioning.She worries about things can happen in front of other people that can embarrass her, like trip and fall during presentation in school. She repeats the lines of a book over in her head to help deal with worries (her childhood book “Goodnight moon”)She worries about her grandpa that something can happen to him. Every 5 min she thinks about it, though no worries to think about him. Also she worries about saying something she didn’t mean, something that can embarrass other people. between Lauren and her doctor:KAREN Hi, Lauren. I’m glad that you came in today and I would like for us to have a discussion about maybe some sensitive issues, but I think it will be helpful in getting to know what you struggle with, and order to be able to be helpful. So I’ll be completely honest with you. I need you to be as honest you can be with me. And this conversation will stay here unless there’s some reason that you or somebody else could be in danger. Our conversation would stay in this room. So are you on board to maybe explore few areas along with me?LAUREN Sure. Okay.KAREN Wanna talk about some of the things that maybe interfering and making things difficult for you on a daily basis and one of ’em is thoughts that may come in your head umm… and particularly thoughts that happen a lot. The same thought over and over. Mm-hmm, often they tend to be worries, umm… or things that make you uncomfortable. Are there any thoughts that you find with repeat for you over and over, particular kinds of worries?LAUREN Umm… That something might happen to my grandpa.KAREN Okay. So, how often would you say that you think about that something could happen to your grandpa?LAUREN Every five minutes.KAREN That’s a lot. It enters your mind that frequently? Wow! Umm… Is that reason to be worried about your grandpa?LAUREN No.KAREN Is he ill or…LAUREN Nope.KAREN Old?LAUREN Nope.KAREN But you worry about him?LAUREN YesKAREN Okay. Is there any other worries that come up or thoughts that come up for you. As much… you know, as much as that or even anywhere near as much as that worry?LAUREN Umm… Uh… that umm… I might say something wrong.KAREN That you might say something wrong, when?LAUREN Just in general.KAREN You mean, something would come out of our mouth that you didn’t intend to or…LAUREN Yeah.KAREN … You would say something but wouldn’t come out the mean it. What you mean example of what you mean.LAUREN Saying something that I don’t I mean to say something aloud and it just happens.KAREN So can you give me an example of that could happen or time that you’re worried about it happening?LAUREN If someone shoe laces aren’t even, I’ll notice and I’ll say something to them and then I’ll be embarrassed about it.KAREN So you have said something or you worry that you could say something like that?LAUREN I worry that I could I say something like that.KAREN So but it has that ever happened?LAUREN No.KAREN Okay. And, how often is that a worry for you?LAUREN Everyday. All the time.KAREN Do you have an idea of when this first began, when the worrying began?LAUREN Umm… When I was little, I think.KAREN What’s your memory of when you’re worrying began?LAUREN Umm…KAREN In this way, where was this same worries over and over?LAUREN Umm… I woke up, when I was little and I was with my mom in the kitchen and umm… I was just thinking that something could happen to grandpa and I saw him sitting there and I just figured what if, one day something happens to him and it just, it just grew up with me.KAREN Are there other kinds of health or safety worries that you have, you worry about anybody else or do you worry about getting sick or anybody else getting sick? Were people around you that could be sick and give it you, any kind of worries like that?LAUREN If someone sick and doesn’t stay something and they’re around me then like I wouldn’t even know. I can end up the flu or something worse.KAREN So do you worry that there could be somebody sick around you?LAUREN Yes.KAREN And how often is that you worry?LAUREN Everyday when I’m in school around people.KAREN Do you have worries about touching things that you could be picking up germs or that things could be dirty and you could get sick or anything like that?LAUREN Not really, not like that.KAREN Okay, it’s mostly that somebody else might be sick and spread it you and unbeknownst to you?LAUREN Yeah.KAREN Okay.[sil.]KAREN Lauren, when you have these worries, how do you deal with it and how do you cope with it in the time. Do you just walk around with the worries in your head?LAUREN Why are we talking about this?KAREN Because it’s important.LAUREN Stop! You don’t care, you’re getting paid to do this.KAREN Well, actually Lauren, I do care and I care because somebody who has to deal with what you’re dealing with is suffering, and suffering more than you deserve to be. You deserve to be able to feel as comfortable in the world as everybody else. And that’s we need to talk about it. Because you deserve to get help for.LAUREN Fine!07:55KAREN Okay. So let me ask you again. How do you deal with the worries?08:00LAUREN Which one?KAREN Well, let’s say your grandpa being, something happening to him. How do you deal with that worry? Seems to be there all the time.08:10LAUREN Umm… Well, everyday, at 9 o’ clock in the morning, I’ve to make breakfast for him and I have to make sure it’s done by 9.KAREN And do you get that done every day?LAUREN Yes.KAREN You don’t… you never missed one?LAUREN Once I did.KAREN And, how did you deal with that?LAUREN I went through the whole day with my body shaking, I felt uncomfortable, my hands just kept tapping and tapping and I just worried about him.KAREN So somehow making breakfast by 9 o’ clock. Somehow, makes it okay that you… then don’t have worry the whole rest of the day or worry to the degree of being shaky?LAUREN Yes.KAREN Okay. And, what about that you might say something that you don’t mean to say, something just popping out of you in appropriately or embarrassing, how do you deal with and cope with that worry?LAUREN If I notice something that bothers me or that’s I have to talk about I, I said in my head, “Hoping that I don’t say it out loud.”KAREN Does that sometimes or ever have the effect of making the worry worse? By going over and over it.LAUREN Sometimes.KAREN So how do you deal with that?LAUREN I don’t really know how I deal with that, and just…KAREN Okay. Think about it, think about it because if you need to do something that does help with your worry with your grandpa and going to surmise that there’s something that you do that helps control that worry.LAUREN If I see something I… I have to write it down, I guess. That’s usually what I do. I have to write it down and someone’s backpacks straps are uneven and I worry about saying something to them I have to write it down which is what I usually find myself doing.KAREN Okay, you’ve given two examples of shoe laces and backpack about things being uneven. Is that something that gets your attention and that you notice a lot things that are uneven?LAUREN Yeah, mostly.KAREN And do you have a memory of when that begin.LAUREN Umm… When I was little in the car, driving with my parents I would count all the cars on the street and if they didn’t match the number of cars on the other side. I had to make sure that the numbers match.KAREN And what would happen if they didn’t?LAUREN I’d either have to go back to where we came from or the day just wouldn’t, it wouldn’t be uh… okay.KAREN Did they go along with that?LAUREN Yeah, they didn’t know.KAREN They didn’t know why you were asking them to redo the route. They just would do it.LAUREN Yeah, I mean, sometimes I guess my mom give me a weird book but she don’t know.KAREN Are there other things that you can think of that need to be even or the same?[sil.]LAUREN I guess the number of kids in my class.KAREN And what’s out about?LAUREN Just it… in Spanish class there are 17 kids. There always has to be 17 kids myself included. I can’t count anything less than 17.KAREN And what if it’s more or less than 17?LAUREN I get really, really uncomfortable.KAREN And how many times do you count the students in the class.LAUREN Through the entire class period until I make sure I get it right.KAREN Okay. I’m gonna ask you some specific things just based on what you’ve talked about already Lauren and it’s real helpful. Because it sounds like this is interfere terribly in your life and I repeat, you deserve to be able to go through life with more freedoms than that. Then having to do what you do, think what you think. The behaviors that happened. Umm… But it’s obviously working in some way to help you. Uh… To help you feel better, to help you feel less worried. And then the question is, where did those worries and feeling badly come from? But, let’s… let’s talk a little bit more about what does happen. So, for example, do you have any rituals things you need to do when you’re bathing? Start taking a shower.LAUREN Umm… So in the shower, there has to be three different kinds of body washes there. No less, no more and the shower has to be at the same temperature, every single time.KAREN And, if there, if those things aren’t in place what happens?LAUREN Like, I… I can’t take a shower or if I get in the shower and the water changes, I… I have to get out, right, I can’t, I can’t shower.KAREN And what about hand washing? Are you able to wash your hands in a reasonable amount of time, so a day a reasonable, length of time?LAUREN I think so, yeah, uh… the water just has to be warm. Can’t be cold or hot.KAREN And what about your room at home? What’s your room look like? You keep it neat?LAUREN I try to.KAREN You try to. Tell me about that.Describe at least three clinical signs of Anxiety observed in the videos.Describe at least three Obsessive-Compulsive behaviors observed in the videos.Explain at least three therapeutic communication techniques used by the nurse in the videos.Discuss at least two nursing interventions appropriate for Lauren. Support your choices with rationales.Support your ideas with at least two credible resources.Health ScienceScienceNursingShare Question

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