Mod. 10 ch. 20, 27, 29, 32, 33 Flashcards
Somatic symptom and related disorder include;
somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
psychological factors affecting medical conditions
Somatic symptom disorder
anxiety and depression are often comorbidities
Somatic symptom disorder risk factors
+ 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
Somatic Symptom disorder assessment tool
Patient Health Questionnaire 15 (PHQ-15): used to identify presence of the 15 most common manifestations
PHQ-15 manifestations
- abdominal pain
- back pain
- pain in extremities/ joints
- menstrual problems or cramps
- headaches
- chest pain
- dizziness
- fainting
- heart pounding or racing
- dyspnea
- problems or pain with sexual intercourse
- problems with bowel elimination (constipation/ diarrhea)
- nausea, indigestion, gas
- lethargy
- problems sleeping
Reattribution treatment for somatic disorder: 4 stages
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
What to encourage in somatic symptom disorder
encourage independence in self-care encourage verbalization of feelings educate on alternative coping mechanisms educate on assertiveness techniques encourage daily physical exercise
Conversion Disorder
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)
Bereavement
includes both grief and mourning as a person deals with the death of a significant individual.
Types of loss
- necessary loss
- actual loss
- perceived loss
- maturational loss
- situational loss
Maturational loss
Situational loss
Maturational loss- losses normally expected due to the developmental processes of life
Situational loss- unanticipated loss caused by an external event.
necessary loss
part of cycle of life, anticipated, but can still be intensely felt
Kubler-Ross: Five stages of grief
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
Bowlbly: FOUR stages of grief
observed in clients as young as 6 months of age
- Numbness or protest: is in denial over the reality, experiences shock
- Disequilibrium: focuses on the loss and has intense desire to regain what was lost.
- Disorganization and despair: feels hopelessness which impacts ability to carry out tasks of daily living.
- Reorganization: reaches acceptance of the loss.
Engel: FIVE stages of grief
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
Worden:
4 tasks of mourning
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.
Complicated grief
~ Delayed or inhibited grief
~ Distorted or exaggerated grief response
~ Chronic or prolonged grief
~ Disenfranchised grief
Types of Crises
Situational/ external: unanticipated life events ( divorce/ job change)
Maturational/ internal: achieving new developmental stages (getting married, retiring)
Adventitious: natural disasters, crimes, or national disasters
Phases of a Crisis (4)
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.
Primary, Secondary, Tertiary Care for a crisis
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.
Cycle of violence
Tension-building phase
Acute battering phase
Honeymoon phase
Periods of escalation and deescalation
Types of Violence (5)
Physical Sexual Emotional Neglect Economic
Emotional violence
Neglect
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
Nursing Care in an abused client
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
common substances involved in Rape
!!! gamma-hydroxybutyrate: “G” or “liquid extasy”
!!! flunitrazepam: “roofies” or “club drug” or “roachies”
!!! ketamine: “black hole” or “kit kat” or “special k”
Rape-trauma syndrome
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)
Compound rape reaction
mental health disorders: depression or substance use disorder
physical disorders: manifestations of a prior physical illness
Silent rape reaction
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
SANE
sexual assault nurse examiner
