E.b) Somatic Symptom and Related Disorders (Week 4/Ch. 24)
An actor has prepared extensively for his first stage production. On the morning of the opening of the play, the actor awakens with laryngitis. The actor is most likely suffering from which of the following? A) Acute upper respiratory infection B) Conversion disorder C) Hysteria D) Somatization disorder
B
Somataform Disorder
a mental disorder marked by physical symptoms for which there is no apparent physical cause
Sleep Latency
amount of time it takes a person to fall asleep (normal is 15-30 minutes.)
Soma =
body
When does the first REM sleep occur? - what does a more rapid rem onset suggest?
Second hour of sleep - depression or narcolepsy (normally takes 70-100 mins for healthy people to go from stage 1 through rem. = 5 cycles in one night)
A patient is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the patient was laid off 4 months ago from her job. Which of the following statements made by the nurse would most strongly suggest a somatoform disorder? A) "I have been having a hard time lately. It's hard not working like I'm used to." B) "I seem to have more pain now that I got laid off" C) "I probably just over-exerted myself working around the house. It's hard to slow down." D) "I'm sure they will figure out what is wrong with me."
B
In planning care for clients who somatize, an appropriate long-term outcome for treatment would be that the client will A) Assume responsibility for self-care activities B) Develop alternative coping mechanisms C) Learn new diversional recreation patterns D) Resume home maintenance activities
B
The boyfriend of a patient with body dysmorphic disorder is attending a support group for the first time. The boyfriend states to the other group members, "I am really having a hard time understanding why she doesn't think she is beautiful. She is so gorgeous to me." The group members can best help the boyfriend understand the patient's better through which of the following responses? A) "She had some traumatic experiences during childhood which make her feel unattractive." B) "She worries about her appearance as a way to avoid expressing her emotions directly." C) "She really is satisfied with her appearance, but enjoys the compliments she gets when she keeps improving her looks." D) "She is always going to feel this way, so you have to find a way to accept it."
B
The client asks the nurse, "What does having psychosomatic symptoms mean?" The best reply by the nurse is A) "It means you're not physically sick." B) "It means that stress and/or emotions are causing your symptoms." C) "It means that you'll be well when you get your life in order." D) "It means that your symptoms are a product of your imagination."
B
The husband of a patient with hypochondriasis has accompanied his wife to the follow-up doctor's visit. While waiting for the doctor, the husband expresses to the nurse his frustration with his wife's obsession over illness. He asks the nurse, "What can I do?" The best response by the nurse would be: A) "Try ignoring her complaints and they should subside." B) "Try finding an activity you enjoy doing together to help her feel better overall." C) "Try to be patient and understand that she is worried that she is sick." D) "Try to give her some sort of reward when she resists complaining about her illnesses."
B
The husband of a wife with a somatoform disorder asks the nurse why the doctors can't find anything wrong with her. The nurse's best response would be: A) "She is not really experiencing the symptoms. She is making them up to get attention." B) "There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it." C) "She controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent." D) "There is a physical cause. It just has not been detected yet."
B
The primary gain associated with developing physical symptoms in response to stress is to A) Accept dependency B) Decrease anxiety C) Experience attention D) Suppress anger
B
Which of the following statements by the client indicates an understanding of somatization disorder? A) "As soon as my symptoms go away, I'll be my old self again." B) "How I handle stress and emotions can affect my physical health." C) "I have to avoid stress all my life to avoid getting sick again." D) "Taking medication won't help my pain since it's caused by stress."
B
A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." The nurse's best response is A) To give the client some privacy and time to calm down B) To say nothing and sit quietly with the client. C) "The pain in your head is very real." D) "Well, that's not what your doctor thinks."
C
The family of a patient with somatoform disorder reports to the nurse that every time they invite the patient to join in an activity the patient declines, saying things like, "I wish I could, but I feel so terrible." They nurse suggests that the family respond using which of the following approaches to encourage activity? A) "What does you pain feel like right now?" B) "You are fine, the doctor said so. Let's go." C) "I know this is difficult, but exercise is important. It will be a short walk." D) "I'll let you rest. Let me know when you feel better."
C
The nurse is planning care for a patient with somatization disorder. Which of the following does the nurse plan to reassess on a daily basis? A) Sensory deficits experienced by the patient B) Character of pain reported by the patient C) Frequency of generalized somatic complaints D) Signs of possible neurologic disorders
C
The patient states, "I can't go to group today. I have a very upset stomach this morning." The most appropriate response by the nurse would be: A) "You have to go to group. The doctor has ordered it." B) "Okay, you can miss this time." C) "I know you don't feel well, but it's important for you to participate in therapy." D) "You aren't really feeling nauseous. It is part of your illness."
C
Which of the following statements would lead the nurse to suspect body dysmorphic disorder? A) "I can't possibly go to work with all this pain." B) "I don't know why I'm so sick when I'm so young." C) "My hair is so thin that I always wear a hat." D) "This cough is terrible; I know I have pneumonia."
C
factitious disorder
Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick.
A client with somatization disorder tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. This is an example of a A) Dysfunctional family unit B) Primary gain C) Role reversal D) Secondary gain
D
A patient is seen in the primary care clinic complaining of headaches. The patient appears extremely distressed and insists that she must have a brain tumor. Which of the following diagnoses is most probable for this patient? A) Conversion Disorder B) Pain Disorder C) Brain cancer D) Hypochondriasis
D
A patient with a somatoform disorder asks what is causing her physical symptoms. The nurse includes which of the following in the explanation of somatoform disorders? A) Physical symptoms can be attributed to an organic cause B) Physical symptoms are deliberately expressed in order to benefit in some way C) Physical symptoms are independent of the amount of patient's psychic distress D) Physical symptoms are an involuntary way of dealing with psychic conflict
D
The nurse has suggested to a patient with a somatoform disorder to keep a journal. The main purpose of journaling in this patient's treatment is which of the following? A) Assist the nurse in controlling external stressors that trigger the patient's physical symptoms B) Assist the nurse in assessing the onset of physical symptoms C) Assist the patient in learning to express emotions privately D) Assist in connecting external factors to the occurrence of physical symptoms
D
The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." The nurse suspects that the client is A) A hypochondriac B) Exhibiting somatization disorder C) Having a conversion reaction D) Malingering
D
The nurse is working with the patient to develop emotion-focused coping strategies. Which of the following would the nurse include as an emotion-focused coping strategy? A) Problem-solving B) Assertiveness techniques C) Role playing D) Deep breathing techniques
D
The nurse performs a thorough physical examination for patient being admitted for a somatoform disorder. Which of the following is the best rationale for the physical exam? A) Ease the patient's mind that the nurse is looking for physical illness B) Physical disorders underlie somatic disorders C) Physical exams are reimbursed by third party payers D) Underlying pathology should be ruled out
D
The primary gain for a client with conversion disorder is which of the following? A) Emotional detachment B) Emotional support from family C) Identification of anxious feelings D) Relief from emotional conflict
D
Malingering
Deliberate faking illness to get something
Somatic Symptom Disorder DSM5 criteria: ______________response to a somatic symptom - Diagnosis is only considered if the symptom is: _____________________________________________________________________________________________
- Abnormal - found to be interfering with the patient's quality of life, social interactions, or other areas of functioning
Somatic Symptom syndrome Comorbidity - Occurs most commonly with what? - these pts have been treated for fibromyalgia and what else?
- depression and anxiety - IBS, Ovary disease, other somatic syndromes
Illness Anxiety Disorder The exclusion of ____________________________ from theDSM5 has brought about the emergence of illness anxiety as a new DSM disorder Experience excessive anxiety and preoccupation with having or acquiring a serious _____________ Physical symptoms, if present, are ______________ aspect of this diagnosis Persistent _________________ regarding illness invades multiple aspects of the person's life Will spend hours researching suspected illnesses and continuously examine the body for signs of illness Impacts quality of life Potentially limits activity of daily living and can result in inability to go to work or school - Occurs same for men and women with unknown cause (its said may be a childhood ilness or abuse precursor)
- hypochondriasis - illnes - major - worry
Conversion Disorder Females experience conversion disorder 2 to 3 times more than men Symptoms do not follow neurologic pathways but rather the individual's ___________________ of the problem The nurse must understand that the physical sensation is real for the patient ________________ of a relationship between childhood trauma (sexual abuse) or stressful life events (war) and conversion disorder Nurse treats the conversion symptom as a real symptom that may have distressing psychological aspects The nurse intervene by acknowledging the pain and helps the patient deal with it
- idea - evidence
Social Domain Assessment of Somatization disoders?
- identify both good and bad relationships in pts life - Fmily members are weary of pts complaims - the social dynamics, like stress or a crazy famly, may contribute to the sterss - Routine changes or major life events may rpeciptate symptoms (like before leaving for vacation)
Factitious Disorder Patients will __________________________ illness or injury to receive the attention of heath care workers Motivated solely by the desire to become a patient and develop a dependent relationship with health care providers Factitious Disorder, Imposed on Self : __________________________ Factitious Disorder, Imposed on Another: ___________________________________
- intentionally cause an - Manchausens syndrome - manchausen by proxy
Sleep has tw stages. REM and NREM What are stages of NREM?
- intermediate 1 (drowsiness) - light stage 2 [person beleives they fell asleep] - deep stage or slow-wave (used to be 4 but now its three, 3 and 4 were combined)
Somatic Symptom Disorder Epidemiology Occurs more prevalently among individual ________ than 65 years of age ___________ significant gender differences In cultures in which stigma toward mental illness exists, the expression of psychological distress can occur through physical symptoms Cultural differences also influence how nurses recognize and manage somatization Comorbid with depression __________ exhibit more somatic symptoms than the general population
- less - no - refugees
What interventions can you do for patient with somatoform disorder int eh psychological domain?
- therapeutic relationshio - counseling - pt. education/teaching
Somatization is the term used when unexplained physical symptoms occur in the presence of psychological distress or psychiatric illness Occurs in many psychiatric disorders including depression, anxiety, and psychosis and is the ___________________ Occur when a person experiences physical symptoms causing psychological distress or abnormal patters of thought Occurs in ________________% in the general population
-Primary Symptom - 10 - 23
A 26 year old woman reports that she is very fearful of leaving the house because she fears people in public are ridiculing her appearance. She expressed distress that she cannot enjoy social functions anymore because she is certain people are staring at her. The nurse discusses the possibility that this patient may be suffering from which of the following? A) Body dysmorphic disorder B) Social phobia C) Obsessive-compulsive disorder D) Hypochondriasis
A
A graduate nurse is scheduled to take the NCLEX-RN examination in 3 days. On awakening today, the graduate cannot see anything at all but tells fellow classmates, "Oh, don't worry; it will all work out." This statement is an example of A) La belle indifference. B) Regression. C) Test-taking anxiety. D) Undoing.
A
A middle-aged woman goes to the physician falsely complaining of hip pain. Her intention is to fake chronic hip pain to apply for disability benefits from the government. Which of the following best reflects the woman's potential diagnosis? A) Malingering B) Hypochondriasis C) Factitious disorder D) Munchausen syndrome by proxy
A
A patient yells at the nurse, "You are all quacks! Can't you see I am sick?" The nurse can work most effectively with this patient if the nurse believes which of the following? A) Patient progress is expected to be very slow B) Physical illness is the root of the patient's problems C) The patient will never be free of somatic symptoms D) The nurse has done everything possible to treat the patient
A
Psychosocial theorists propose that somatoform disorders are an indirect expression of stress and anxiety through physical symptoms. The primary defense mechanism used in somatoform disorders is which of the following? A) Somatization B) Identification C) Internalization D) Repression
A
The nurse is identifying outcomes for a patient with a somatoform disorder. Which of the following is an appropriate outcome to include in the plan of care? A) The client will verbally express emotions B) The client will be free from stress C) The client will demonstrate alternative ways to avoid stressful situations D) The client will verbalize acceptance of physical symptoms
A
Psychosomatic illness refers to physical symptoms that are either created or worsened by psychic influences. Which of the following conditions are thought to be attributed to the connection between mind and body? (Select all that apply). A) Diabetes B) Arthritis C) Hypertension D) Headache E) Colitis
A,C,D,E
What are the Psychological domain nursing diagnossi?
Include anxiety, ineffective sexuality patterns, impaired social interactions, ineffective coping, and ineffective therapeutic regimen management
What is the Etiology of Somatic disorders?
Neuropathologic Theory (unknown - said there is decreased activity isn some parts of the brain - indicating hypermetabolism) Genetic (said to run in families) Biochemical Changes (something happens because it occurs with depression and anxiety, and in those chemical imbalancess are ocuring.) Psychological Theories (expressing emotion that cant be verbalaized - kid feels stomach pain when her grandma gets beat up) Social Theories (symptoms vary between cultures. Western have it but asians don't really see it as a mental illness.)
What are the common biologic nursing diagnossi seen with soamtication disorder?
fatigue, pain and disturbed sleep pattern
Nurses may feel anger toward deceits and may feel sense of betrayal with patients who have: _________________________________ The nurse must be aware of these feelings and resolve them by developing a better understanding of the underlying psychodynamic issues
fictitious disorders
Sleep hypnogram
graph that represents the stages of sleep as a function of time (be able to interpret the graph)
'dreas are a product of mind'
leibniz
Somatic Symptom Disorder
psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause
The link between stress and heart disease is best defined as what?
psychosomatic
sleep efficiency
ratio of total sleep time to nocturnal time in bed
___________________ Is a behavioral and physiologic state of temporary disconnection from the environment, characterized by Physical stillness characterized by no or few movements Stereotypical body postures (closed eyes, usually lying down) Reduced responsiveness to external stimuli Rapid reversibility between states, as compared with other states of altered vigilance like coma, hypothermia, or anaesthetized
sleep
Somatization
the term used when unexplained physical symptoms occur in the presense of psychological distress or psychiatric illness
Diversified somatizers vs asthenic somatizers?
women vs men more diverse and frequent vs less diverse and less frequent (minor illnesses)
