Oppositional defiant disorder Comprehensive Nursing Paper Example

Oppositional defiant disorder Comprehensive Nursing Paper Example

Client ID:  Initials: DA, AGE: 8, Demographics: Hispanic American, Gender: M

Subjective.

Chief complaint: According to the client’s mother, the chief complaint is “ aggressiveness and unsocial behavior towards sibling and peers.”

Source of reliability: Parent.

Present illness: The client’s mother checks her son for treatment for “aggressiveness and unsocial behaviors towards sibling and peer.” The mother reports that DA has increasingly shown “weird” behaviors, including stealing play toys belonging to peers at home and in school even though he does not need them. When accosted over a problem in the house, he becomes argumentative and blames the sister for his mistakes. DA thinks that the sister is loved more especially when the parents fight a mum has to leave with the kid sister leaving him alone with the dad who is not friendly. At times he appears withdrawn, and when agitated, he destroys “stuff” that belongs to her sister and playmates in school and at home. He is involved in physical fights with his peer often. (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Current psych meds:  None reported.

Past Psychiatric Hx: No previous hospitalization or diagnosis.  

Past Medical Hx: No reported.

Surgical history: None.

Allergies: Pollen

Substance use/abuse: No alcohol or narcotics abused.

Past family, social history:

Family psych hx: Has a sibling and lives with the parents. The parents and siblings are alive and well. The father of consistently violent to the mother after alcohol intoxication.  (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Social Hx: Normal upbringing.

Education/Employment/Disability: Grade two. Average academic performance. Not disabled. Primary support system: Parents.

Hobbies: Painting.

Review of systems (ROS):

Constitutional: No fever or chills

Eyes: No vision loss.

ENT: Normal hearing and sense of smell. No sore throat.

Skin: Normal turgor and moisture.

Cardiovascular: No chest pain

Respiratory: Normal heart rate.

GI: Reported: loss of appetite. Denies n/v/.

GU:  No burning urination.

MSK: No joint swelling or pain.

Neurologic: No seizures or numbness.

Endocrine: No polyuria.

Objective.

Vital Signs: T: BP: 119/71 P: 70 R:21 Ht: 4”7” Wt.: 68lbs BMI: 15.8 kg/m²

Appearance: Well dressed. Eye contact avoidant.

Attitude/interaction: Calm and withdrawn.

Activity level/behavior: In acute psychological distress.

Orientation: Appears disoriented.

Speech: Clear and fluent.

Thought content/process/perception: Normal thought-form, perception, and content. Mood/affect: Appears depressed and restricted. (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Judgment/insight/cognitive/memory: Normal judgment and insight. Memory above average.  Difficulty to abstract.

Testing:  Anxiety and Related Disorders Interview Schedule for DSM-5 positive for ODD.

UDS: Negative.

Assessment.

1. Oppositional defiant disorder. ICD-10 code F91.3.TI presents symptoms that meet ODD diagnoses, such as irritability, argumentativeness, and behaviors associated with the immediate social context (American Psychiatric Association, 2013). This is the primary diagnosis. (Oppositional defiant disorder Comprehensive Nursing Paper Example)  
2. Intermittent explosive disorder. ICD-10 code F63.81. TI presents symptoms of aggression, unpremeditated behavioral outbursts involving damage of property,  and distress that affects social and interpersonal functioning (American Psychiatric Association, 2013). This diagnosis is refuted.
3. Childhood-onset conduct disorder. ICD-10 code F91.1. Client’s symptoms such as persistent aggression, threats, theft, and physical fights inform criterion for conduct disorders diagnosis (American Psychiatric Association, 2013). This diagnosis is refuted. (Oppositional defiant disorder Comprehensive Nursing Paper Example)
4. Child affected by parental relationship distress (CAPRD). ICD-10 code Z62.898. TI is brought up in a family with violence and physical abuse, which could impact his mental health and contribute to her change in behavior (American Psychiatric Association, 2013). This is the primary diagnosis.
5. Kleptomania. ICD-10 code F63.3. TI presents symptoms crucial for Kleptomania diagnosis, such as the inability to resist the impulse to steal friends, play with toys for pleasure, and not express anger (American Psychiatric Association, 2013). This diagnosis is refuted. (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Plan.

Start Respired on 0.125 mg  PO OD to manage ODD symptoms. Increase the dosage to a maximum of 0.25 mg  PO OD on subsequent visits depending on the client’s response to medication. Respired to safely and effectively treats ODD by improving conduct and reducing behavioral symptoms (Loy et al., 2017; Pringsheim et al., 2015). Start Parent-child interaction therapy (PCIT) allows parents to use effective parenting techniques and improves parent-child relationships and child behavior (Bjørseth & Wichstrøm, 2016). Start family therapy to reduce stressors and stimuli of the patient’s behavior, allow parents to respond to the patient’s behavior, and reduce strain and stress in the relationship. Lack of family support is associated with poor psychological health outcomes and psychopathology (Ghosh, Ray & Basu, 2017). (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Referral: Pediatric psychotherapist.

Next Visit: After four weeks. For further assessment and recommendation.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.    (Oppositional defiant disorder Comprehensive Nursing Paper Example)

Bjørseth, Å., & Wichstrøm, L. (2016). Effectiveness of parent-child interaction therapy (PCIT) in the treatment of young children’s behavior problems. A randomized controlled study. PloS one, 11(9), e0159845.(Oppositional defiant disorder Comprehensive Nursing Paper Example) https://dx.doi.org/10.1371%2Fjournal.pone.0159845

Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology research and behavior management. (Oppositional defiant disorder Comprehensive Nursing Paper Example) https://dx.doi.org/10.2147%2FPRBM.S120582

Loy, J. H., Merry, S. N., Hetrick, S. E., & Stasiak, K. (2017). Atypical antipsychotics for disruptive behavior disorders in children and youths. Cochrane Database of Systematic Reviews, (8). https://www.aafp.org/afp/2018/0601/p715.html

Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behavior, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60(2), 42-51.(Oppositional defiant disorder Comprehensive Nursing Paper Example) https://dx.doi.org/10.1177%2F070674371506000203