| Course | NUR-7641 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Child and Adolescent Populations, Part B |
|---|---|
| Module | Module 4 |
| Paper type | Case analysis: pediatric obsessive-compulsive disorder |
| Length | About 1,004 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7641 Module 4
Hands That Crack in December: Rating, Explaining and Treating Contamination OCD in a 13-Year-Old With Exposure Therapy and Sertraline
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7641: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Child and Adolescent Populations, Part B
Mentor Name
Month Day, Year
Hands That Crack in December: Rating, Explaining and Treating Contamination OCD in a 13-Year-Old With Exposure Therapy and Sertraline
Forty Washes a Day
Gabriela, an invented patient, is 13 and in eighth grade in Elizabeth. Over the past year she has become afraid that germs from doorknobs, school desks and her younger brother will make her family seriously ill. She washes her hands until the skin cracks and bleeds, up to forty times a day, showers for two hours each night in a fixed order and asks her mother many times a day whether something is clean. She avoids the school cafeteria and has stopped visiting her cousins because their dog might carry germs. Her mother has started washing the doorknobs for her and answering every question to calm her down.
She knows her fears are excessive, but says that if she does not wash, the feeling that something terrible will happen becomes unbearable. Her grades have dropped because she is late to school and cannot finish homework after her long showers. There is no history of a sudden onset after an infection, no tics and no eating restriction. She feels sad about missing her cousins but denies thoughts of self-harm.
Rating the Severity
The Children's Yale-Brown Obsessive Compulsive Scale rates time spent, interference, distress, resistance and control, separately for obsessions and compulsions, giving a total from 0 to 40. Scahill et al. (1997) tested it with 65 children and adolescents with OCD and found high internal consistency and good to excellent agreement between raters for the total and obsession scores. The total correlated more strongly with a self-report of obsessive-compulsive symptoms than with depression or general anxiety scales, supporting its validity. They also noted that reliability can depend on the child's age and on combining parent and child reports.
Gabriela's total is 27, with 13 for obsessions and 14 for compulsions, in the moderate to severe range. Her mother's account was combined with Gabriela's own, and where they differed, such as the number of reassurance questions, her mother's count was higher. The diagnosis of OCD, with good insight, is clear.
What Keeps the Cycle Going
The paper explains OCD to the family as a loop: a fear about germs brings anxiety, washing brings brief relief, and that relief teaches her brain that washing was needed, so the fear returns stronger. Her mother's cleaning and reassurance work the same way. Understanding this is the basis of treatment, because exposure therapy breaks the loop by letting the anxiety rise and fall without the ritual. Explaining it as the illness, not her character, helps Gabriela and her mother work as a team against it.
The POTS Trial
The Pediatric OCD Treatment Study randomly assigned 112 young people aged 7 to 17 to CBT, sertraline, the two together or placebo for 12 weeks (Pediatric OCD Treatment Study Team, 2004). All three active treatments beat placebo, and combined treatment beat each one alone. Remission, defined as a total score of 10 or less, was reached by 54 percent on combined treatment, 39 percent on CBT alone, 21 percent on sertraline alone and 4 percent on placebo. The authors concluded that young people with OCD should begin with CBT plus a serotonin reuptake inhibitor or with CBT alone.
| Treatment in POTS | Remission at 12 weeks |
|---|---|
| CBT plus sertraline | 54 percent |
| CBT alone | 39 percent |
| Sertraline alone | 21 percent |
| Placebo | 4 percent |
The Plan
Given the severity of her symptoms, her cracked skin and her falling grades, the family chose combined treatment. Sertraline starts low and is raised gradually over several weeks toward a moderate dose, since OCD often needs higher doses and a longer wait than depression for full effect. The suicidality warning is explained, and her mother is told what changes to report.
Exposure and response prevention runs for 14 sessions. With her therapist, Gabriela ranks feared situations from 0 to 10 to form her ladder: touching a school desk and waiting five minutes before washing, touching a doorknob and eating a snack without washing, hugging her brother after he comes in from outside, and finally visiting her cousins and petting the dog. At each step she stays with the anxiety until it falls on its own, and practices at home between sessions. Showers are shortened in steps with a timer, and hand washing is limited to before meals and after the toilet, with a fragrance-free moisturizer to let her skin heal.
The Family's Part
Her mother learns to step back from the rituals in a planned way: she stops cleaning doorknobs, answers a reassurance question once with a set phrase, "That sounds like the OCD asking," and praises Gabriela for brave steps. Her father, who works nights, attends two sessions so both parents respond in the same way. Her brother is told in simple words why his sister is practicing touching his things.
If She Responds Only Partly
Franklin et al. (2011) studied 124 young people with OCD who still had significant symptoms on a serotonin reuptake inhibitor. Adding full CBT with exposure produced response in 69 percent, against 34 percent when the prescriber gave brief CBT instructions and 30 percent with medicine management alone. Brief tips from the prescriber did no better than medicine alone. If Gabriela improves only partly, the plan is to make sure her exposure therapy is complete and well practiced before changing her medicine.
Measuring Progress
She is rated again on the CY-BOCS at week 6 and week 12, and her hand skin, school arrival time and shower length are tracked as daily signs of progress. A total of 10 or less would mark remission.
Conclusion
Gabriela has contamination OCD with a CY-BOCS of 27. The POTS trial supports starting with combined exposure therapy and sertraline, and the later trial shows that real exposure therapy, not brief advice, rescues a partial response. With a detailed ladder, a family that steps back from the rituals and measured follow-up, she has a strong chance of getting back to school, her cousins and healthy skin.
References
Franklin, M. E., Sapyta, J., Freeman, J. B., Khanna, M., Compton, S., Almirall, D., Moore, P., Choate-Summers, M., Garcia, A., Edson, A. L., Foa, E. B., & March, J. S. (2011). Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: The Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. JAMA, 306(11), 1224-1232. https://doi.org/10.1001/jama.2011.1344
Pediatric OCD Treatment Study Team. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA, 292(16), 1969-1976. https://doi.org/10.1001/jama.292.16.1969
Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., Cicchetti, D., & Leckman, J. F. (1997). Children's Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844-852. https://doi.org/10.1097/00004583-199706000-00023
Reading the NUR 7641 Module 4 assignment instructions
Psychotherapeutic modalities for young patients are named in the NUR-7641 catalog description, and with no public syllabus from TESU, this module applies them to obsessive-compulsive disorder. Expect a case analysis that rates severity with the CY-BOCS from child and parent reports, explains the cycle of fear and ritual to the family, chooses between CBT alone and combined treatment from trial data, writes an exposure ladder with real tasks, describes how parents step back from rituals and plans for a partial response. Some sections assign a case with tics or a sudden onset after infection instead. Check whether your directions want SSRI doses written out. Address any physical harm the rituals cause.
How the NUR 7641 Module 4 example is put together
Gabriela's forty daily washes and cracked hands open the paper, with what her mother does to help. Her CY-BOCS of 27 is explained with the scale's testing and the gap between informants. The cycle that keeps OCD going is set out in plain words. POTS remission rates for each arm appear in a table. The plan pairs sertraline, raised slowly, with a written exposure ladder and skin care. Her parents learn a set reassurance phrase, and the POTS II results guide what happens after a partial response. Ratings at the sixth and twelfth weeks and a conclusion close the paper. Moisturizer and limited washing let her skin heal.
Where the marks sit in the NUR 7641 Module 4 rubric
Pediatric OCD cases are graded on a severity score from a validated scale, an accurate account of how rituals keep fear going, an evidence-based first treatment, a concrete exposure ladder and a plan for family accommodation. Mentors look for remission figures reported correctly and for the reason combined treatment was chosen. A ladder with specific tasks and ratings shows the student understands exposure and response prevention. A plan for partial response based on trial evidence, rather than an early medicine switch, is often credited. Physical harm from rituals, such as cracked skin, should be addressed. All three papers belong in the APA reference list. Involving both parents so they respond the same way is often credited.
NUR 7641 Module 4 help: mistakes that cost marks
Students often write "start CBT" without describing exposure. Write the ladder with tasks and ratings. Another common gap is ignoring what the family does to calm the child; name the accommodation and how it will stop. Do not treat OCD doses and timelines like depression; note that higher doses and longer waits are common. Report remission figures, not only response. Address skin damage from washing. If she responds only partly, show that complete exposure therapy comes before a medicine change. The desk writes a first draft of your own OCD case at no cost when you send the directions. Involve both parents in stepping back from rituals, and tell siblings what is happening in simple words.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7641 Module 4 questions, answered
Where can I find a free NUR 7641 Module 4 sample paper?
Everything in Gabriela's case is printed here: her CY-BOCS rating, the exposure ladder and the family plan.
What is the CY-BOCS?
A clinician-rated scale for obsessions and compulsions in children, scoring time, interference, distress, resistance and control, with a total from 0 to 40.
What did the POTS trial find?
After 12 weeks, remission was reached by 54 percent on CBT plus sertraline, 39 percent on CBT alone, 21 percent on sertraline alone and 4 percent on placebo.
What if an SSRI only partly helps a child's OCD?
Add full exposure-based CBT; in POTS II it raised response to 69 percent, while brief CBT tips from the prescriber did no better than medicine alone.
How should parents respond to reassurance seeking in OCD?
Step back in a planned way: answer once with an agreed phrase, stop doing rituals for the child and praise brave practice.