Student Name
Capella University
NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care
Prof. Name
Date
Concept Map: The 3Ps and Mental Health Management
Obsessive-Compulsive Disorder (OCD) is a psychiatric condition characterized by persistent, intrusive thoughts known as obsessions, and repetitive behaviors or mental rituals called compulsions, which are performed to relieve anxiety. OCD commonly emerges during adolescence, affecting approximately 1–3% of youth (Brock et al., 2024). In the case of Wesley Blanco, a 13-year-old non-binary Filipino-White adolescent, symptoms included excessive guilt, repetitive praying, and ritualized behaviors, such as chewing food a specific number of times. The compulsions intensified during stressful events, interfering with school performance and social interactions. After being diagnosed with OCD, Wesley began treatment with fluoxetine and experienced significant improvements in mood, sleep, and anxiety during follow-up.
Case Study
Who is Wesley Blanco, and what are their symptoms?
Wesley Blanco is a 13-year-old non-binary adolescent of Filipino and White heritage. Wesley exhibited intense guilt, anxiety, and compulsive behaviors. Their mother observed frequent crying, excessive apologies, and repetitive praying. Wesley reported intrusive thoughts about minor past events before tasks, such as breaking a mug, and engaged in ritualistic behaviors like chewing food exactly 15 times or repeating certain phrases to prevent perceived harm.
What factors exacerbate Wesley’s symptoms?
Symptoms were most pronounced under stress, particularly related to schoolwork. Although there was no personal psychiatric history, Wesley’s father has Tourette’s syndrome, indicating a potential genetic predisposition. Physically, Wesley was healthy and denied suicidal ideation.
What was the clinical diagnosis and treatment plan?
Clinical evaluation confirmed an OCD diagnosis, a neuropsychiatric disorder marked by obsessions and compulsions. Treatment included fluoxetine, a selective serotonin reuptake inhibitor (SSRI), alongside ongoing therapy. After one month of treatment, Wesley demonstrated reduced obsessive thoughts, improved mood, and better school performance. Emphasis was placed on culturally sensitive family involvement and inclusive communication to support recovery (Sohel et al., 2024).
Mental Health Diagnosis Concept Map
Pathophysiology
OCD arises from neurobiological and genetic factors. An imbalance in serotonin, a neurotransmitter responsible for regulating mood and behavior, plays a central role. Brain regions such as the frontal lobe and basal ganglia demonstrate hyperactivity, resulting in repetitive thoughts and compulsive behaviors. Genetic predisposition further increases the likelihood of developing OCD (Majdari et al., 2021).
Pharmacology
Wesley Blanco’s OCD treatment includes fluoxetine, which increases serotonin availability in the brain. This reduces intrusive thoughts and repetitive behaviors, improving mood, focus, and overall functioning. Treatment typically begins with a low dose to minimize side effects, with gradual adjustments as needed. Fluoxetine has been shown to be both safe and effective in children and adolescents with OCD (Sobel et al., 2024).
Physical Assessment (Signs and Symptoms)
| Question | Observation and Evidence |
|---|---|
| What physical signs and behaviors were present? | Wesley displayed restlessness, tension, and difficulty relaxing. Ritualistic behaviors included chewing food exactly 15 times and repetitive praying or chanting. Anxiety symptoms worsened under stress, impacting sleep and concentration. |
| What is the evidence from literature? | Repetitive rituals, excessive worry, and heightened anxiety are common in adolescents with OCD (Cui et al., 2023). |
Nursing Diagnosis
What are Wesley Blanco’s nursing diagnoses?
- Anxiety related to intrusive thoughts and compulsive behaviors: Wesley experiences distress when unable to perform rituals, leading to heightened anxiety and sleep disturbances.
- Ineffective coping: Reliance on compulsions to reduce anxiety reflects difficulty implementing adaptive coping strategies.
How can nurses support OCD management?
Nurses play a crucial role by observing behavioral patterns such as excessive checking, ritualistic behaviors, or anxiety-driven actions. They provide education, coping strategies, and monitor treatment adherence and side effects (Brock et al., 2024).
Mental Health Diagnosis
What is Wesley Blanco’s mental health diagnosis?
Wesley has Obsessive-Compulsive Disorder (OCD), characterized by unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that interfere with daily functioning. Common manifestations include checking, handwashing, or ritualistic mental exercises. OCD can affect school performance, social engagement, and family routines. Early diagnosis and intervention significantly improve outcomes, and evidence-based therapies have been shown to reduce OCD symptoms in children and adolescents (Yan et al., 2022).
Risk Factors
| Question | Risk Factors |
|---|---|
| What factors increase Wesley’s risk of developing OCD? | Family history of Tourette’s syndrome, high school-related stress, bicultural identity pressures, and personality traits such as guilt and perfectionism (Cui et al., 2023). |
Diagnostic Procedures
How is OCD diagnosed in children like Wesley?
OCD diagnosis relies on clinical observation and structured interviews rather than laboratory tests. In Wesley’s case, the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used to measure symptom severity and monitor progress. The CY-BOCS is a validated tool for assessing OCD in pediatric populations (Yan et al., 2022).
Complications
What are potential complications of untreated OCD?
Without proper treatment, Wesley could experience severe anxiety, difficulty concentrating, poor sleep, social withdrawal, and disruption of daily routines. Untreated OCD may also increase the risk of developing depression or other mental health conditions. Early intervention with SSRIs significantly mitigates these risks (Sobel et al., 2024).
Nursing Interventions
| Intervention | Description and Evidence |
|---|---|
| Anxiety reduction | Teach coping strategies such as deep breathing and mindfulness. Encourage structured daily routines. |
| Compulsion management | Gradual exposure to feared situations in a safe, controlled manner to reduce ritualistic behaviors. |
| Support and communication | Provide positive reinforcement and maintain culturally sensitive communication. Involve family members in care. |
| Medication monitoring | Track adherence and side effects of SSRIs like fluoxetine, ensuring therapeutic effectiveness (Sobel et al., 2024). |
Conclusion
Wesley Blanco’s case highlights the profound impact of OCD on adolescent daily life, school performance, and social functioning. Early detection and treatment using evidence-based approaches, including fluoxetine and cognitive-behavioral therapy, are essential for symptom management. Family involvement and culturally sensitive care enhance recovery and reduce the likelihood of relapse. This case underscores the importance of individualized mental health interventions for diverse youth populations.
References
Brock, H., Hany, M., & Rizvi, A. (2024). Obsessive-Compulsive Disorder (OCD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553162/
Cui, J., Zhu, K., Wen, J., Nie, W., & Wang, D. (2023). The relationship between moral judgment ability, parenting style, and perfectionism in obsessive–compulsive disorder patients: A mediating analysis. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1133880
NURS FPX 4015 Assessment 3 Concept Map: The 3Ps and Mental Health Care
Majdari, B., Bey, K., Boberg, J., & Burton, C. (2021). Genetics of obsessive-compulsive disorder. Psychological Medicine, 51(13), 1–13. https://doi.org/10.1017/s0033291721001744
Sohel, A. J., Shutter, M. C., & Molla, M. (2024). Fluoxetine. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459223/
Yan, J., Gu, Y., Wang, M., Cui, Y., & Li, Y. (2022). The obsessive–compulsive symptoms in tic disorders and the psychometric properties of children’s Yale–Brown–Compulsive Scale: An evidence-based survey in a Chinese sample. Frontiers in Pediatrics, 10. https://doi.org/10.3389/fped.2022.794188