- Anxiety related to Conflicting beliefs Unwanted thoughts (obsessions) and Repetitive behaviours (compulsive behaviours) as evidenced by verbalized feelings of insecurity and hypersensitive body sensations
- Ineffective coping related to inadequate confidence in dealing with a situation and
Inadequate sense of control as evidenced by Obsessive-compulsive behaviours and
Inability to cope with stressors - Social Isolation related to Obsessive-compulsive behaviours and unacceptable thoughts and behaviours as evidenced by Inadequate psychosocial support system and Lack of social support
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: -Feeling nervous -Verbalizing a sense of impending danger -Difficulty controlling one’s worrying Objective Data: -Restlessness and tense appearance -Tachycardia -Tachypnea -Hyperventilation -Diaphoresis -Trembling/tremors -Weakness or tiredness -Difficulty concentrating -Difficulty sleeping -GI distress | Anxiety related to Conflicting beliefs Unwanted thoughts (obsessions) and Repetitive behaviors (compulsive behaviors) as evidenced by verbalized feelings of insecurity and hypersensitive body sensations | Patient will express understanding about OCD and how it relates to their anxiety. Patient will demonstrate interventions to reduce stress without turning to obsessive-compulsive behaviors. | 1. Acknowledge the feelings the patient is experiencing. Acknowledging the patient’s feelings will help the patient feel she or he is being heard and can assist the patient in becoming more trusting and comfortable with the nurse. 2. Administer medication as appropriate and as ordered. Individuals with a history of anxiety may have PRN anxiety medications to assist with breakthrough anxiety/panic attacks. 3. Provide active listening to the patient. Sometimes patients need to discuss what exactly they are feeling and what is causing them to feel this way. Providing active listening will allow for a trusting therapeutic relationship between nurse and patient to be developed. 4. Instruct the patient through guided imagery or other relaxation techniques/methods. This will promote relaxation for the patient and the release of endorphins that will further reduce anxiety. 5. Educate patient on new coping mechanisms or previously used ones that were effective for the patient. This will allow the patient to build confidence in oneself in being able to handle these difficult situations and will gain the individual independence once discharged home. 6. Identify resources the patient can use at home, in the future, along with a plan to follow for breakthrough episodes of anxiety. This will allow the patient more independence at home and comfort in having already developed a plan to follow if another episode of anxiety occurs. | Patient acknowledged and discussed fears and concerns. Patient verbalized feelings of anxiety and present ideas of how to handle those feelings. Patient developed and demonstrated problem-solving techniques. Patient identified appropriate resources. Patient’s vital signs returned to stable baseline state. Patient maintained regular sleep routine. |
| Subjective Data: -Verbalizes an inability to cope and handle stressors -Complaints of secondary concerns from lack of coping (sleep disturbances, fatigue, lack of appetite) Objective Data: -Insufficient skills to meet goals, problem-solve or reach resolutions -Behaviors that impede progress -Inability to handle life responsibilities and activities of daily living -Multiple acute illnesses or chronic pain -Depression | Ineffective coping related to inadequate confidence in dealing with a situation and Inadequate sense of control as evidenced by Obsessive-compulsive behaviors and Inability to cope with stressors | Patient will eliminate or lessen the practice of ritualistic behaviors. Patient will be able to develop healthy coping strategies to manage their distress. | 1. Keep track of OCD behaviors. An OCD diary tracks the patient’s triggers and how often they employ compulsions. It evaluates the severity of the OCD and monitor’s progress. 2. Exposure therapy. Exposure Response Prevention Therapy exposes a person to a trigger causing an obsession. Controlled exposure to a triggering situation teaches the patient how to respond and cope effectively. 3. Slow down the rituals. Advise facing the triggers and wait 10 seconds before acting on the compulsion. It increases the length of time before employing the ritual. This can potentially lessen the compulsive behavior and its interference. 4. Encourage self-help techniques. Encourage the patient to try deep breathing, meditation, and progressive muscle relaxation to reduce tension and release fears. 5. Provide positive feedback. Coping with OCD is challenging. Provide positive feedback and acknowledge minor successes. | Patient identified their disruptive behaviors and how they prevent them from coping effectively. Patient verbalized appropriate coping strategies and resources to prevent ineffective coping. Patient expressed confidence in handling their stressors and when to ask for help. |
| Subjective Data: -Feelings of loneliness and rejection -Insecurity in relationships Fear and anxiety -Interests, values, or behavior are viewed as socially or culturally different or unacceptable Objective Data: -Absence of support through family or friends -Irritable or hostile demeanor -Physical limitation that prevents social interaction -Nonverbal or poor ability to communicate; speech impediment -Inappropriate social cues or behavior | Social Isolation related to Obsessive-compulsive behaviors and unacceptable thoughts and behaviors as evideced by Inadequate psychosocial support system and Lack of social support | Patient will establish a relationship with others. Patient will participate in social activities. Patient will discuss their thoughts and feelings with a trusted family member. | 1. Involve the patient’s significant others in their care. The patient’s family and friends often want to help but may need to learn how. The patient needs time and support to deal with their condition. 2. Provide safety. Harm OCD (HOCD) is characterized by intrusive thoughts to harm oneself or commit violence against others. The nurse should assess for these thoughts and provide safety to the patient and others. 3. Encourage family therapy. Patients with OCD should focus on receiving treatment for their condition. Family therapy may help the provider understand the patient’s obsessions and advise on how they can help. 4. Encourage small steps. Have the patient begin with a small action like a phone call or video chat. This can help build their confidence in communicating and interacting with others. 5. Offer support groups. The patient may benefit from support from others who also struggle with OCD. Advise on community resources or online groups. | Patient expressed desire to interact with others and will seek social engagement. Patient learned social and communication skills to improve relationships. Patient expressed feeling of improved self-worth and confidence. Patient will participate in activities with others that align with their interests and mental/physical capabilities. |