somatoform and sleep disorders nursing 201. characterized withoutphysical symptoms suggesting...
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Somatoform and Sleep Disorders
Nursing 201
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characterized
• physical symptoms suggesting medical disease but withoutwithout a demonstrable organic
pathological condition or a known pathophysiological mechanism to account for them.
• Somatoform disorders are more common – In women than in men– In those who are poorly educated– In those who live in rural communities– In those who are poor
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Predisposing Factors• Theory of family dynamics
– “Psychosomatic families”
– Role modeling
• Cultural and environmental factors
– Low socioeconomic, occupational, and
educational status
• Genetic factors
– Possible inheritable predisposition
• Transactional Model of Stress/Adaptation– The etiology of somatization disorder is more likely influenced by
multiple factors
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Pain Disorder: Assessment• The predominant disturbance in pain disorder is
severe and prolonged pain that causes– Clinically significant distress
– Impairment in social, occupational, or other areas of functioning
• Even when an organic pathological condition is detected, the pain complaint may be evidenced by correlation of a stressful situation with onset of symptoms.
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Nursing Process
• Assessment: A syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health care professionals.
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
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• The disorder may be maintained by:– Primary gains: the symptom enables the client to avoid
some unpleasant activity.– Secondary gains: the symptom promotes emotional
support or attention for the client.• Psychodynamic theory
– Symbolically expressing an intrapsychic conflict through the body
• Behavior theory – Negative reinforcement results when the pain behavior prevents an
undesirable phenomenon from occurring (i.e., provides relief from responsibilities for the client)
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• Theory of family dynamics
– “Pain games”– Tertiary gain
• Neurophysiological theory– Afferent pain fibers– Serotonin/endorphins
• Neurophysiological theory– Afferent pain fibers– Serotonin/endorphins
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Hypochondriasis: Assessment
• Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease
• Even in the presence of medical disease, the symptoms grossly exceed extent of pathological condition.
• Anxiety and depression are common findings, and obsessive-compulsive traits frequently accompany the disorder.
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Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
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Predisposing Factors• Psychodynamic theory
– Ego-defense mechanism– Transformation of aggressive and hostile wishes toward others into
physical complaints about self to others– Defense against guilt
• Cognitive theory– Hypochondriasis arises out of perceptual and cognitive abnormalities.
• Social learning theory– Somatic complaints are often reinforced when the sick role relieves the client of the need to deal with a stressful situation.
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• Past experience with physical illness– Previous experience can predispose to
hypochondriasis.
*Genetic influences
• Transactional Model of Stress/Adaptation– The etiology of hypochondriasis is likely
influenced by multiple factors.
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Conversion Disorder: Assessment
• A loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder
or pathophysiological mechanism• The client often expresses a relative lack of concern that
is out of keeping with the severity of the impairment. This lack of concern is termed la belle indifference and may be a clue to the physician that the problem is psychological rather than physical.
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Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
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Predisposing Factors• Psychoanalytical theory
– Emotions associated with the traumatic event that the client cannot express because of moral or ethical unacceptability are “converted” into physical symptoms.
• Familial factors– Findings suggest that conversion disorder occurs more often in
relatives of people with the disorder.
• Neurophysiological theory– Central nervous system involved. Excessive cortical arousal creating
a negative feedback loop between the cerebral cortex and the brainstem reticular formation.
• Behavioral theory– Learned through positive reinforcement from cultural, social, and interpersonal influences
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• Transactional Model of Stress/Adaptation– The etiology of conversion disorder is most
likely influenced by multiple factors.
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Body Dysmorphic Disorder: Assessment
• Characterized by the exaggerated belief that the body is deformed or defective in some specific way
• Common complaints involve imagined or slight flaws of face or head
• Symptoms of depression and characteristics associated with OCD common in people with
body dysmorphic disorder
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Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
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Predisposing Factors• Etiology unknown
– In some clients, belief is result of another more pervasive psychiatric disorder, such as
schizophrenia, major mood disorder, or anxiety disorder
– Classified as one of several monosymptomatic hypochondriacal syndromes
• Defined as the fear of some physical defect thought to be noticeable to others although the client appears normal.
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Sleep Disorders: Introduction
• About 75 percent of adult Americans suffer from a sleep problem.
• 69% of all children experience sleep problems• The prevalence of sleep disorders increases with
advancing age• Sleep disorders add an estimated $28 billion to the
national health care bill.• Common types of sleep disorders include insomnia,
hypersomnia, parasomnias, and circadian rhythm sleep disorders
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Sleep Disorders: Assessment• Insomnia
– Difficulty falling or staying sleep
• Hypersomnia (somnolence) – Excessive sleepiness or seeking excessive amounts of
sleep
• Narcolepsy: Similar to hypersomnia– Characteristic manifestation: Sleep attacks; the person
cannot prevent falling asleep
• Parasomnias – Nightmares, sleep terrors, sleep walking
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• Sleep terror disorder – Manifestations include abrupt arousal from
sleep with a piercing scream or cry
• Circadian rhythm sleep disorders– Shift-work type
– Jet-lag type– Delayed sleep phase type
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Nursing Process
• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation
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Predisposing Factors• Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and
sleepwalking.
• Various medical conditions, as well as aging, have been implicated in the etiology of insomnia.
• Psychiatric or environmental conditions can contribute to insomnia or hypersomnia.
• Activities that interfere with the 24-hour circadian rhythm hormonal and neurotransmitter functioning within the body predispose people to sleep-wake schedule disturbances.
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Treatment Modalities
• Somatoform disorders– Individual psychotherapy– Group psychotherapy– Behavior therapy– Psychopharmacology Sleep disorders– Relaxation therapy– Biofeedback– Pharmacotherapy
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• Primary hypersomnia/narcolepsy– Pharmacotherapy– CNS stimulants such as amphetamines
• Parasomnias– Centers around measures to relieve obvious stress
within the family– Individual or family therapy– Interventions to prevent injury