A nurse at a mental health clinic is caring for a client.

The client reports they have been overeating since they were 14 years old. The nurse is reviewing the client's medical record.

Based on the information, which of the following actions should the nurse take? For each potential action, specify if the potential action is anticipated or contraindicated for the client.

Choice A: Limit the amount of time available to interact with others

While the client's behavior may indirectly limit their interactions with others by occupying their time, this is not the primary function of their actions. The core motivation lies in reducing anxiety, not social avoidance.

Choice B: Manipulate and control others' behaviors

Although the client's cleaning may influence others to tidy up, this is not a deliberate attempt to control their behavior. The primary drive stems from the client's internal need for order and cleanliness, not a desire to dictate the actions of others.

Choice C: Focus attention on meaningful tasks

While the act of cleaning can be productive and contribute to a pleasant environment, it's not the primary function or intention behind the client's behavior. Their actions are primarily driven by the need to quell anxiety, not necessarily to accomplish meaningful tasks.

Choice D: Decrease anxiety to a tolerable level

This is the most accurate rationale for the client's behavior. Individuals with OCD engage in compulsions, like excessive cleaning, to alleviate the intense anxiety associated with their intrusive thoughts and obsessions. In this case, the act of picking up after others provides the client with a sense of order and control, thereby reducing their anxiety to a manageable level.

Elaboration:

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Individuals with OCD experience significant anxiety due to their obsessions and feel compelled to engage in compulsions to manage that anxiety.

In the scenario presented, the client's constant cleaning behavior likely stems from an obsession with order and cleanliness. This obsession triggers anxiety when the environment is perceived as messy or disorderly. The act of picking up after others serves as a compulsion, a ritualistic behavior performed to reduce the anxiety caused by the obsession. By restoring order and cleanliness, the client temporarily alleviates their anxiety and achieves a sense of control over their environment.

It's important to recognize that the client's cleaning behavior, while seemingly productive, is primarily driven by their internal need to manage anxiety, not by a genuine desire to help others or maintain a tidy environment. This understanding is crucial for the nurse to effectively support the client and guide them towards healthier coping mechanisms for managing their OCD symptoms.

The correct answer/s is Choice/s A, E, and G.

Choice A rationale: Administering 0.9% sodium chloride IV is a common practice in emergency departments to ensure the patient is well-hydrated. This is particularly important for patients experiencing acute mania, as they may have neglected their physical health, including hydration, during their manic episode.

Choice B rationale: Flumazenil is an antagonist for benzodiazepines and is typically used to reverse the sedative effects of benzodiazepines. It is not typically used in the treatment of bipolar disorder or acute mania.

Choice C rationale: Preparing the client for intubation is usually reserved for situations where the patient is unable to maintain their own airway or adequate ventilation. This is not typically necessary in cases of acute mania unless there are other complicating factors.

Choice D rationale: Beginning chest compressions is a response to cardiac arrest. There is no indication in the that the patient is experiencing cardiac arrest, so this would not be a typical anticipation for a patient experiencing acute mania.

Choice E rationale: Administering IV naloxone is done in cases of suspected opioid overdose. While it’s not directly related to treating acute mania, it’s possible that the patient could have comorbid substance use issues, given the high rate of comorbidity between bipolar disorder and substance use disorders.

Choice F rationale: Administering activated charcoal is done in cases of certain types of poisoning or drug overdose. It is not typically used in the treatment of bipolar disorder or acute mania.

Choice G rationale: Preparing the client for electroconvulsive therapy (ECT) could be an appropriate anticipation for a patient experiencing acute mania. ECT is considered a highly effective treatment for severe mania, particularly when other treatments have failed or when rapid stabilization is required.