Exam 4 Flashcards
Somatic Symptom Disorders
SSD, Illness Anxiety Disorder, Conversion Disorder, Psychological Factors Affecting Medical Conditions, Factitious Disorder
Somatization
Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress
Symptoms expressed in place of anxiety, depression, or irritability
Holistic Approach
Somatic Symptom Disorder
One or more distressing symptoms
Excessive thoughts, anxiety, and behaviors around symptoms, or health concerns
Without significant physical findings and medical diagnosis
Suffering is authentic
High level of functional impairment
Illness Anxiety Disorder
Misinterpretation of physical sensations
Preoccupation with having or acquiring serious illness for at least 6 months
High anxiety about health
Excessive health-related behaviors or maladaptive avoidance
May be care-seeking or care-avoidant
Conversion Disorder
Neurological symptoms in the absence of a neurological diagnosis
Presence of deficits in voluntary motor or sensory functions
Common symptoms: paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy
“La belle indifference” versus distress
Psychological Factors Affecting Medical Condition
Psychological factors that increase risk for medical diseases, magnify them, or interfere with their treatment
Depression, CV diseases, cancer
Stress
Assessment of Somatic Symptom Disordes
Psychosocial factors Coping skills Spirituality and religion Secondary gains Cognitive style Ability to communicate feelings and emotional needs Dependence on medication Self-assessment
Nursing Diagnoses for Somatic Symptom Disorders
Ineffective coping Anxiety Risk for loneliness Powerlessness, hopelessness Social isolation Pain Altered family processes Risk for suicide
Outcomes Identification for Somatic Symptom Disorders
Shared decision making
Patient participation
Outcome criteria realistic and attainable
Small steps or increments
Factitious Disorder
Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury
Goal of assuming sick role
Types of Factitious Disorders
Factitious disorder imposed on self
Factitious disorder imposed on another
Malingering
Malingering
Condition related to factitious disorder
Conscious fabrication of illness or exaggerating symptoms for secondary gain such as insurance fraud, prescription medication, avoidance of prison or military service
Etiology of Eating Disorders
Genetics, neurobiological
Psychological factors
Environmental factors
Assessment of Anorexia Nervosa
Perception of the problem, eating habits, history of dieting, methods used to achieve weight control, value attached to a specific shape and weight, interpersonal and social functioning, mental status and psychological parameters
Anorexia Nervosa Interventions
Suicidal ideation first Psychosocial interventions Pharmacological interventions Integrative medicine Health teaching and health promotion Safety and teamwork
Assessment of Bulimia Nervosa
Appear well: at or near ideal body weight
Physical signs: enlarged parotid glands, dental erosion, caries
Emotional signs: impulsivity and compulsivity, non-nurturing family relationships, familial/social instability, difficult interpersonal relationships
Bulimia Nervosa Interventions
Teamwork and safety Pharmacological interventions Counseling Health teaching and health promotion Psychotherapy
Binge Eating Interventions
Psychosocial interventions Pharmacological interventions Surgical interventions: bariatric surgery Health teaching and health promotion Teamwork and safety
Feeding Disorders
Pica
Rumination
Avoidant/Restrictive Food Intake
Pica
Eating nonfood items well past toddlerhood
Not part of other illness
Rumination
Regurgitation with rechewing, reswallowing, or spitting
No medical or mental reason
Avoidant/Restrictive Food Intake
Starts in childhood
Note: 40% of “picky” eaters resolve on their own
Low BMI
No distorted body image
Consequence of Sleep Loss
Excessive sleepiness Sleep deprivation Mental and physical problems Psychomotor impairment Increased risk for errors
Non-REM Sleep
Stage 1: transition between awake and sleep
Stage 2: deeper; occupies 45-55% of total sleep time; reduced HR and respiration
Stage 3: slow wave deep or delta sleep, further reduction in HR, respiratory rate, BP, and response to external stimuli. Restorative sleep
REM Sleep
Reduction and absence of skeletal muscle tone
Bursts of rapid eye movement
Myoclonic twitches of facial and limb muscles
Dreaming
Autonomic nervous system variability
Atonia
Regulation of Sleep
Complex interaction between homeostatic process (sleep drive) which promotes sleep, and circadian process (circadian drive) which promotes wakefulness
Sleep Latency
The time it takes to fall asleep
Sleep Architecture
Structural organization of NREM and REM sleep
Hypnogram
Graphic display of sleep architecture
Sleep Continuity
Distribution of sleep and wakefulness across the sleep period
Sleep Fragmentation
Disruption of sleep stages
Sleep Efficiency
Ratio of sleep duration to time spent in bed
Sleep Drive
Homeostatic process that promotes sleep
Circadian Drive
Process that promotes wakefulness
Zeitgebers
Exogenous factors that help set our eternal clock to a 24-hour cycle
Master Biological Clock
SC nucleus in the hypothalamus that regulates a host of functions
Basal Sleep Requirement
Amount of sleep necessary to feel fully awake and sustain normal levels of performance
Sleep Requirements
Varies from individual to individual
Most adults require 7-8 hours of sleep
Long sleepers require more than 10 hours of sleep each night
Short sleepers can function effectively on fewer than 5 hours of sleep per night
Sleep Disorders
Hypersomnia disorders Narcolepsy/hypocretin deficiency Breathing-related sleep disorders Circadian rhythm disorders Disorders of arousal Nightmare disorder REM sleep behavior disorder Restless legs syndrome Substance-induced sleep disorders Insomnia
Diagnostic Tests for Sleep Disorders
Polysomnography
Multiple Sleep Latency Test
Maintenance of Wakefulness Test
Actigraphy
Polysomnography
All-night test using electrodes to diagnose sleep-related disorders and nocturnal seizure disorders
Multiple Sleep Latency Test
Daytime nap that measures sleepiness in a sleep-conducive setting
Maintenance of Wakefulness Test
Evaluates ability to stay awake in a situation conducive to sleep
Actigraphy
Uses a tracker to record body movement over a period of time to detect sleep patterns
Insomnia Disorder
Difficulty with sleep initiation
Sleep maintenance
Early awakening
Nonrefreshing, nonrestorative sleep
Symptoms 3 times a week for at least 3 months
3P Model of Insomnia
Assesses causes, suggests interventions, and provides treatment rationales
Predisposing factors
Precipitating factors
Perpetuating factors
Hypersomnolence Disorders
Excessive daytime sleepiness
Chronic–begins in young adulthood
Excessive sleepiness impairs social and vocational functioning
Treatment: maintains regular sleep-wake schedules, pharmacotherapy
Narcolepsy
Uncontrollable need to sleep
Symptoms: irresistible attacks of refreshing sleep, cataplexy, sleep paralysis, and hypnagogic hallucinations
Do not feel rested regardless of amount of sleep
Diagnosis: measuring hypocretin levels
Treatment: lifestyle modifications and long-acting stimulant medication
Obstructive Sleep Apnea Hypopnea Syndrome
Repeated episodes of upper airway collapse and obstruction
Results in sleep fragmentation
Cannot breathe and sleep at the same time
Diagnosis: clinical evaluation and polysomnography
Treatment: CPAP therapy
Central Sleep Apnea
Cessation of breathing during sleep
Instability of respiratory control system
Related to aging, advanced cardiac or pulmonary disease, neurological disorders
Sleep-Related Hypoventilation
Sustained oxygen desaturation in sleep
No apnea or respiratory events
Associated with morbid obesity, lung parenchymal disease, or pulmonary vascular pathology
