Boy with Handwashing and Germs Case Study

Boy with Handwashing and Germs Case Study

Boy with Handwashing and Germs Case Study


Question Description
I don’t know how to handle this Nursing question and need guidance.

I need to Paraphrase this paper.

Case Study Two

This case study involves Tyrel, an 8-year-old boy that seems to be having some concerns about germs and handwashing.He has recently been ill and since then has developed what his mother feels an obsession with washing his hands to the point he is missing school and has stopped playing with his friends.His hands are noticeably dry from over washing. He states that he is worried he missed some spots on his hands and is nervous about getting germs on that area. His medical and mental exams are all within normal parameters.

Decision One

At this time there is a decision to make between three different diagnoses: Generalized Anxiety Disorder, Obsessive Compulsive Disorder, and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.The decision I have chosen is Obsessive Compulsive Disorder, (OCD).

OCD is diagnosed when obsessions and compulsions are time consuming, cause significant distress and interfere with daily functioning in school, social activities, family relationships, or normal routines, (, 2017). Tyrel is describing his hand washing as a compulsion because he is afraid he will get sick if his hands are not washed. He is missing school and not playing with his friends due to the fear of getting sick.

Children with OCD suffer from obsessions and compulsions that distress them significantly enough to interfere with daily functioning and relationships, (APA, 2013). Obsessions are persistent fears or doubts and upsetting thoughts or images that a child cannot ignore or dismiss. Compulsions are repetitive actions or rituals intended to relieve the anxiety caused by the obsessions. The relief is temporary, however, because performing compulsions ultimately reinforces the obsessions, (, 2017). Some compulsions are physical, such as washing, checking doors, tapping, or walking in a certain pattern.

Although there are similarities between OCD and PANDAS, the characteristics that are more seen in OCD are the compulsion of handwashing, with PANDAS the more defining symptoms are urinary frequency, tics or purposeless motor movements, (, 2018). While people with GAD tend to worry a lot, they don’t typically engage in compulsive, ritualistic behaviors to cope with their anxiety. GAD is pervasive and uncontrollable and tends to involve a lot of catastrophizing or other distortions in thinking and decision making, (Goodwin, 2015).

Decision Two

My second decision for the treatment plan would to start Tyrel on Fluoxetine IR 25 mg orally at bedtime. Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD, (Riddle, Reeve, Yaryura, 2001), fluoxetine affects the chemicals in the brain that are not working properly. The dose of sertraline 50mg exceeds the recommended starting dose and could cause more adverse effects.Fluoxetine 100mg in the morning is more than the recommended dose and by giving it in the morning will cause drowsiness and possibly upset stomach.

Decision Three

For my third decision I would be to increase Fluoxetine to 50 mg at bedtime.Since Tyrel is showing some decrease in symptoms since beginning the 25mg dose and no reports of severe adverse effects, increasing the dose to 50mg of the Fluoxetine is the most appropriate choice.

Legal and Ethical Concerns

Ethical decision making is essential in competent clinical care.The provider should monitor and provide care for the patient that will benefit from treatment.Cognitive behavior therapy in conjunction with psychopharmacology to treat OCD will provide a complete treatment.Working along a team of colleagues to create a plan for the ongoing treatment of OCD is important as to maintain communication and ensure that improvement is being made in the symptoms. It is up to the provider to follow the therapeutic guidelines are followed and that the client meets maximum benefit of treatment.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Goodwin, G. M. (2015). The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 17(3), 249–260.

OCD in Kids – For Mental Health Professionals. (2018). Retrieved from

Riddle MA, Reeve EA, Yaryura-Tobias JA, et al. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: A randomized, controlled, multicenter trial. J Am Acad Child Adolescent Psychiatry. 2001;40(2):222–9.

What Is Obsessive-Compulsive Disorder? (2017, July). Retrieved from…nur

Boy with Handwashing and Germs Case Study

Boy with Handwashing and Germs Case Study

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.


Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.