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ch19 psyc

ch19 psyc somattoform d/o

psychosomatic connection b/t mind(psyche) & body(soma). the mind can cause the body to create physical s/s or to worsen physical illnesses
somatization transference of mental experiences & states into bodily s/s
somatoform d/o physical s/s that suggest medical condition w/out a demonstrable organic basis to account fully for them
3 central features of somatoform d/o *physical complaint suggest major medical ill but no organic basis *psychologic factor/conflict important in exsistance of s/s *magnified health concerns NOT under pt control
do pt actually experience physical symptoms? yes! as well as accompyning pain, distress, & function impairment despite neg Dx test results.
somatization d/o multiple physical s/s. begins 30yrs of age extends over several yrs. combo pain/gi, sexual & pseudoneurologic s/s
conversion d/o "conversion reaction" unexplained, sudden deficits in sensory/motor function. attitude of la belle indifference is key feature
la belle indifference seeming lack of concern or distress over conversion reaction
pain d/o pain primary s/s which is unrelieved by analgesics & greatly affected by psychologic factors in terms of onset, severity, exacerbation, & mainenance
hypochondriasis preoccupation with FEAR that one has a serious disease(disease conviction) or will GET a serious disease(disease phobia). they misinterpret bodily functions
body dysmorphic d/o preoccupation w/imagined or exaggerated defect in physical appearance
stats for d/os S d/o, pain d/o ^ in women than men. hypochondriasis & bdd equal
malingering intentional production of false or exaggerated phys/psyc s/s. motivated by external incentives(avoiding work, jail, money, drugs) CONCIOUS
factitious d/o when person intentionally produces or feigns phys/psyc s/s solely to gain attention. pts may even cause injury for attention
common term for factitious d/o Munchausen Syndrome
Munchausen Syndrome By Proxy when someone inflicts illness/injury on someone else to gain attention of emergency to be "hero". most common victim is kid c/o mother or nurse giving K+ OD to save pt life w/CPR
internalization ppl that keep stress, anxiety, or frustration inside rather than express it outwardly. can lead to somatoform d/o
primary gain direct external benifits that being sick provides, relief of cause of anxiety, conflict, or distress
secondary gain attention gained from being sick
Dhat (indian) hypochondriacal concern abt semen loss
Koro (southeast Asia) belief that penis is shrinking & will disappear into abdomen, resulting in death
falling-out episodes (southern US & carribean) sudden collapse; person cant see or move
Hwa-byung (korea) suppessed anger c/o insomnia, fatigue, panic, indigestion, general aches/pains
sangue dormido (portuguese) (sleeping blood) pain, numbness, tremors, paralysis, seizures, blindness, heart attack, miscarriage
shenjing shuariuo (china) physical/mental fatigue, dizziness, headache, pain, sleep problem, memory loss, gi prob, sex dys
biologic theories difference in way pts w/Som d/o regulate & interpret stimuli. cant sort relevent from irrelevent stimuli & respond equally to both types. found more often in relatives of pts w/som d/o
Treatmetn managing s/s & improving quality of life. show empathey & sensitivity to prevent pt from dr shopping. Therapy groups work well.
anti-dep used in Som d/o tx prozac, paxil, zoloft
history som d/o pt usually have lengthy account of past treatment & tests run & surgical procedures. may be angry with healthcare team for not giving a Dx or may have La Belle Indiffernce
general appearance/motor behavior appearance normal. may shuffle or limp depending of symptoms
mood/affect labile, from depressed when describing phys s/s to excited when talking abt going to hospital via ambulance. exaggeratedly describe s/s
thought process/content NO dosordered thought process! pt will answer ow they feel in terms of phys health. hypochondriasis focus on fear of serious illness rather than exsistance of illness
hypochoondriasis thought process preoccupied w/bodily funcitons, ruminate abt illness, fascinated w/medical info, & have unrealistic fears abt potential infection & Rx meds
sensorium & intellectual process intact. alert & oriented
judgement insihgt pts focus only on phys part of self. low self-esteem & deal by totally focusing on phys concern. lack confidence & managing daily issues.
roles relationships unlikely to be employed. consumption w.seeking med care makes family life difficult. they have few friends & dont really socialize for fear of getting sick away from home
physiologic & self care concerns pts have sleep dist, lack basic nutrition, get no exercise. may take multiple Rxs. if using anxiolytics: assess for withdrawal syptoms
Nursing Dx for Som d/o ineffctive coping, ineffective denial, impaired social interaction, anxiety, distured sleep pattern, fatigue, pain. risk for diuse syndrome if pseudoneurologic paralysis s/s
goals for Som d/o ID relationship b/t stress & phys s/s *verbally express emotional feelings *follow established daily routine *show alt ways to deal w/stress *show healthier behaviors (nutrition, rest, activity)
health teaching Som d/o establish daily routine that includes improved health behavior. adequate nutrition intake, improved sleep. validate feelings but encourage involvement!
assisting pt to express emotions teach abt relationship b/t stress & physiological s/s to teach mind-body relationship. Journaling, limiting time pts may focus on phys s/s & focus on emotional feelings. tell family to stop reinforcing the sick role
Emotion-focused coping progressive relaxation, deep breathing, guided imagery, distractions like music. this helps pt relax & reduce feelings of stress.
problem-focused coping helps resolve pt behavior or situation or manage life stressors. inculdes problem-solving methods, ID problem, role-playing interactions with others.
evaluation fewer visits to Dr b/c of phys complaints, less meds used, more positive coping skills, ^ functional ability, improved fam/social relationships
Created by: 1225581002