Mod. 10 ch. 20, 27, 29, 32, 33

Question 1

Somatic symptom and related disorder include;

Answer 1

somatic symptom disorder

illness anxiety disorder

conversion disorder

factitious disorder

psychological factors affecting medical conditions

Question 2

Somatic symptom disorder

Answer 2

anxiety and depression are often comorbidities

Question 3

Somatic symptom disorder risk factors

Answer 3

+ first-degree relative with somatic symptom disorder
+ decreased level of neurotransmitters: serotonin and endorphins
+ depressive disorder, personality disorder, anxiety disorder
+ childhood trauma, abuse, neglect
+ learned helplessness

Question 4

Somatic Symptom disorder assessment tool

Answer 4

Patient Health Questionnaire 15 (PHQ-15): used to identify presence of the 15 most common manifestations

Question 5

PHQ-15 manifestations

Answer 5

1. abdominal pain
2. back pain
3. pain in extremities/ joints
4. menstrual problems or cramps
5. headaches
6. chest pain
7. dizziness
8. fainting
9. heart pounding or racing
10. dyspnea
11. problems or pain with sexual intercourse
12. problems with bowel elimination (constipation/ diarrhea)
13. nausea, indigestion, gas
14. lethargy
15. problems sleeping

Question 6

Reattribution treatment for somatic disorder: 4 stages

Answer 6

Stage 1: Feeling understood

Stage 2: Broadening the agenda: provide acknowledgment of concerns but provide feedback of assessment findings

Stage 3: Making the link: acknowledge lack of physical cause but maintain client’s self-esteem

Stage 4: Negotiating further treatment: treatment plan

Question 7

What to encourage in somatic symptom disorder

Answer 7

encourage independence in self-care
encourage verbalization of feelings
educate on alternative coping mechanisms
educate on assertiveness techniques
encourage daily physical exercise

Question 8

Conversion Disorder

Answer 8

functional neurologic disorder; exhibits neurologic manifestations in the absence of neurologic dx. Transmit emotional/ psychological stressors into physical manifestations.
- neuro. manifestations can cause extreme anxiety and distress or lack of emotional concern (la belle indifference)

• neuro. manifestations cause significant impairment in multiple aspects of life
• deficits in voluntary motor or sensory functions (blindness, paralysis, seizures, gait disorders, hearing loss)

Question 9

Bereavement

Answer 9

includes both grief and mourning as a person deals with the death of a significant individual.

Question 10

Types of loss

Answer 10

• necessary loss
• actual loss
• perceived loss
• maturational loss
• situational loss

Question 11

Maturational loss

Situational loss

Answer 11

Maturational loss- losses normally expected due to the developmental processes of life

Situational loss- unanticipated loss caused by an external event.

Question 12

necessary loss

Answer 12

part of cycle of life, anticipated, but can still be intensely felt

Question 13

Kubler-Ross: Five stages of grief

Answer 13

1) Denial- difficulty believing a terminal diagnosis or loss
2) Anger
3) Bargaining- client negotiates for more time or a cure
4) Depression
5) Acceptance

Question 14

Bowlbly: FOUR stages of grief

Answer 14

observed in clients as young as 6 months of age

1. Numbness or protest: is in denial over the reality, experiences shock
2. Disequilibrium: focuses on the loss and has intense desire to regain what was lost.
3. Disorganization and despair: feels hopelessness which impacts ability to carry out tasks of daily living.
4. Reorganization: reaches acceptance of the loss.

Question 15

Engel: FIVE stages of grief

Answer 15

1- shock and disbelief: numbness and denial over loss

2- Developing awareness: becomes aware of reality of the loss resulting in intense feelings of grief. Begins within hours of loss.

3- Restitution: carries out cultural/ religious rituals following loss

4- Resolution of the loss: preoccupied with the loss. Over about 12 month time period this preoccupation gradually decreases

5- Recovery: moves past preoccupation and forward with life

Question 16

Worden:

4 tasks of mourning

Answer 16

completion of four active tasks empowering mourner to resolve grief

task 1: accepting the reality of the loss

task 2: processing pain of grief. Client uses coping mechanisms to deal with the emotional pain of the loss.

task 3: adjusting to the world. Client changes environment to accommodate the absence of the deceased.

task 4: finding an enduring connection with the lost entity in midst of embarking on a new life. Moving forward.

Question 17

Complicated grief

Answer 17

~ Delayed or inhibited grief
~ Distorted or exaggerated grief response
~ Chronic or prolonged grief
~ Disenfranchised grief

Question 18

Types of Crises

Answer 18

Situational/ external: unanticipated life events ( divorce/ job change)

Maturational/ internal: achieving new developmental stages (getting married, retiring)

Adventitious: natural disasters, crimes, or national disasters

Question 19

Phases of a Crisis (4)

Answer 19

Phase 1: escalating anxiety from a threat activates defense responses

Phase 2: anxiety continues escalating as defense responses fail, functioning becomes disorganized, and client resorts to trial-and-error attempts to resolve anxiety

Phase 3: trial-and-error methods of resolution fail, and client’s anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors

Phase 4: experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative findings, depression, confusion, violence.

Question 20

Primary, Secondary, Tertiary Care for a crisis

Answer 20

Primary- identify potential problems; instruct on coping mechanisms; assist in lifestyle changes

Secondary- identify interventions while in an acute crisis that promote safety

Tertiary- provide support during recovery from severe crisis that include; outpatient, rehab., crisis stabilization centers, short-term residential services, and workshops.

Question 21

Cycle of violence

Answer 21

Tension-building phase

Acute battering phase

Honeymoon phase

Periods of escalation and deescalation

Question 22

Types of Violence (5)

Answer 22

Physical
Sexual
Emotional
Neglect
Economic

Question 23

Emotional violence

Neglect

Answer 23

Emotional violence- behavior that minimizes and individual’s feelings of self-worth or *humiliates, *threatens, or *intimidates a family member.

Neglect- failure to provide;

• physical care (feeding)
• emotional care (interaction/ stimulation)
• education
• necessary health or dental care

Question 24

Nursing Care in an abused client

Answer 24

Must report

• document subjective and objective data
• provide basic care for injuries
• make appropriate referrals
• help client develop a safety plan, identify situations that might trigger violence, provide info on safe places to live
• use crisis intervention techniques where violence has been devastating

Question 25

common substances involved in Rape

Answer 25

!!! gamma-hydroxybutyrate: “G” or “liquid extasy”
!!! flunitrazepam: “roofies” or “club drug” or “roachies”
!!! ketamine: “black hole” or “kit kat” or “special k”

Question 26

Rape-trauma syndrome

Answer 26

Initial emotional (or impact) reaction: expressed or controlled reaction

following initial response, clients can experience emotional reactions; embarrassment, desire for revenge, guilt, anger, fear, anxiety, denial.

Somatic reaction can occur later; muscle tension, headaches, sleep disturbances.
GI manifestations, abdominal pain
Genitourinary manifestations (pain)

Question 27

Compound rape reaction

Answer 27

mental health disorders: depression or substance use disorder

physical disorders: manifestations of a prior physical illness

Question 28

Silent rape reaction

Answer 28

survivor does not tell anyone of the assault

• abrupt changes in relationships
• nightmares
• increased anxiety during interview
• marked changes in sexual behavior
• sudden onset of phobic reactions
• no verbalization of occurrence of sexual assault

Question 29

SANE

Answer 29

sexual assault nurse examiner