This situation needs follow up on several different levels.
First of all, so everyone else will know that she is OCD, it needs to be added to her Diagnosis profile. If her Seroquel has a qualifyer in the order "OCD manifested by .... " , that is sufficient to add it.
I would also care plan her messiness. If she is unable to organize her area I would suggest making an agreement with her that the CNA will meet with her weekly to assist her with organizing her area. Give her the power. If the goal is to make her area more organized and clean it doesn't matter how its accomplished. She can just think its the weekly special time for her to be assisted. Its the fear of not being in control that is the worst. Take baby steps. Just having someone in there once a week with the purpose of "cleaning up" will help the situation for her and the facility.
To me, with her statements of, "just wishing she would die !!!!!!", she is severely DEPRESSED. Weight loss also goes with depression. Tearfullness and crying are both possible indicators of depression. A good psych eval is in order. Remeron and Lexapro are both good antidepressant that also work well with poor appetite. I always suggest a non-psychotropic appetite stimulant prior to the psych approach but clearly she needs both.
I would also look at all her meds. It might not be the Seroquel that is making her sleepy. Also check her night time sleeping. If she is awake at night or gets up very early she may get tired at that time because she doesn't have a good sleep routine.
I have worked with a fair share of OCD patients. I have never worked psych. One thing that I always hear from the OCD patient is why they do what they do. In my experience 100% of them have a reason for what they do and have never had one yet say, "I know this seems silly but I want it this way." they always have a reason or justification. I would care plan the major ones to start with. Like others have suggested add it the to Cardex or the CNA ADL cheat sheets, so everyone knows who works with her can provide her with what she needs.
I would also make sure she has consistent staffing as much as possible. The CNA's more than likely know her every special need. The more she has the same staff she won't have as many changes with people moving things or doing things differently and this could greatly effect her quality of life.
I would also make sure the CNA's know how important it is for this resident to NOT hear anyone laughing at her.
I would also request her primary MD to evaluate her. Maybe her labs need to be drawn again. Rule out any pain she may be having. Is she constipated???? Ask her when she was living independently how often did she move her bowels? Maybe she went twice a day or everyday. We usually don't get concerned until they do go on the third day. It can make a big difference in someones life "Constipation vs. regular bowel pattern". However, the key thing is her regular not ours.
There are so many little things that could be effecting her.
Does she get visitors? Are there any volunteers that can visit her just to read the newspaper or to help her write letters. Maybe she can start a journal. Get her mind off her problems.
And, yes review yourself. You will find as you get more years under your belt that OCD patients are the same but very different.
Here are a few good "reliable" links to check out:
The simple but useful encyclopedia - Wikipedia:
National Institute for Mental Health:
The Mayo Clinic:
The Obsessive Compulsive Foundation:
I keep my own care plan library on dx's, s/sx, etc that I have review over the years. I would suggest the same and update it as you learn. I keep mine on a memory stick that I spend 10$ at Walmart. One of my best investments so far. If I am at work and need to use it, I plug it in. If I am at home and want to update it, I plug it in.
Hope this helps,
Quote from abooker
I'm the nurse for a resident with *severe* symptoms of Obsessive Compulsive Disorder. Her hospice social worker and I were discussing the resident's concerns, and I looked at the social worker's notes and discovered we had discussed "OCD Behaviors." This was a great revelation to me. I've got a colleague w/ OCD and she's *wonderfully* neat and organized and a joy to work with, and this lady's room is profoundly disorganized and messy and she's um ... "challenging" to work with, so I completely missed it.
So ... what do I do now? I can't find that it's documented anywhere but in this social worker's notes. She's being treated with Seroquel which she hates because she says it makes her fall asleep in the middle of dinner so she's not eating well and she *is* experiencing weight loss (hence the justification for hospice - "general decline").
My CNA's are like ... duh ... of *course* she has OCD and they laughed because it's so screamingly obvious if you do her personal care.
Last night, I did some personal care for her and she burst into tears because I wrapped her feet with a towel the wrong way. I put the towel on the mattress first, and wrapped the towel over her feet, and she *needs* the towel put over her feet first, and tucked underneath them, and she told me through her sobs that it doesn't matter how the towel is wrapped and I could see it so clearly matters to *her* and I want to help. Making sure she has a towel available and that it is wrapped the right way is just the tip of the iceberg ...
Her primary issue since I began working for her has been the inadequacy of help with her ADLs. We don't help her enough. I *get* it now, maybe. What she believes that she needs is help acting on her compulsions. She can't physically get a towel from the linen cart and wrap her own feet the right way and she can't physically arrange things in her room the right way and we keep rearranging her stuff and she hates her life and she hates us and she just wishes she would die.
So ... I don't know where to start. Educate the patient? Educate myself? Fax my concerns to the psychiatrist? Tell my DON (whom I'm imagining would take me as seriously as I took my CNAs when they told me these completely unbelievable stories about her unrealistic expectations ... )
oh help ...