Reference no: EM134012757

Rupesh: Hi, I'm Rupesh, my pronoun is he, and this is Duncan, my partner, pronouns also he. No, we aren't married. Yes, we live together-we have a life commitment, and I'm asexual. Just wanted to get that out there upfront because I know you are going to ask.

Rupesh: [sighs deeply] Remember your first months as a new nurse? I just finished orientation and I'm struggling to keep up now. I'm... I'm having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.

Duncan: He's told me he sometimes washes his hands six times in a row. Maybe even seven or eight to be sure. He does this at home, too.

Rupesh: Yeah, he's right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times, before I can finish the chart. My charge nurse says I'm overdoing the cleanliness a bit, but I just have to do it. And it's not just cleanliness. At home, I'm the last to bed because I have to check the doors at night five to six times at night.

Duncan: Even if I've already locked up and he saw me do it.

Rupesh: Well, I feel like I have to have some control over my world. And, um, Duncan doesn't know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep."

Duncan: Actually, I did know about that, Rupesh. I'm also concerned because Rupesh will get focused on something and then not be able to shut his mind down. He perseverates and I cannot distract him for anything."

Rupesh: I, uh, well, I think I've pretty much always had these kinds of symptoms, but they seem to be getting worse recently. I do feel kind of depressed, mainly because of the OCD symptoms that are causing so much trouble. I know you're going to ask, so I can head this off!I don't have any SI, HI, or auditory or visual hallucinations.

1. What screening or diagnostic tools would you use for Rupesh? Explain your rationale and interpretation of chosen tool.

2. Rupesh needs medication to control his anxiety. What SSRI do you prescribe to Rupesh? Please include rationale,  starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education

3. Compare and contrast at least two medications that Rupesh could take as needed. Include the generic and the brand names, and the pros and cons for each medication. Which one do you prescribe? Include your rationale, along with the starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education

4. What community and support resources would you provide to Rupesh?