Personality and Mood Disorders Q 1
The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be:
A. Ineffective coping
B. Impaired adjustment
C. Personal identity disturbance
D. Sensory/perceptual alterations
Correct Answer: A. Ineffective coping
Ineffective coping is the impairment of a person’s adaptive behaviors and problem-solving abilities in meeting life’s demands; ritualistic behavior fits under this category as a defining characteristic. During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate panic level of anxiety.
Option B: Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. Encourage independence and give positive reinforcement for independent behaviors. Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors.
Option C: Personal identity disturbance is not a priority diagnosis for the client. Assess client’s level of anxiety. Investigate the types of situations that increase anxiety and result in ritualistic behaviors. Helping the client recognize the precipitating factors is the first step in teaching the client to interrupt the escalating anxiety. Initially meet the client’s dependency needs as necessary. Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more.
Option D: This nursing diagnosis is appropriate, but it is not the priority. Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. Provide positive reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors.