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EAQ's ch 17 somatic system disorders
Terms in this set (25)
An anxious patient has frequent abdominal cramps and believes it is because of some underlying serious illness. What is the possible diagnosis for this condition?
a. Factitious disorder
b. Conversion disorder
c. Illness anxiety disorder
d. Somatic symptom disorder
Illness anxiety disorder is an exaggeration of a negligible health symptom. The minor changes experienced physically by the patient at a stressful time are magnified into a serious illness. In the case of a factitious disorder, the patient consciously pretends that he or she is in need of medical help. The patient does this to gain something or to attain the status of a "patient." Patients with conversion disorder have symptoms of neurological disorders, but examination by a neurologist often does not reveal any neurological diagnosis. In cases of somatic symptom disorder, the distressing symptoms and health concerns that the patient experiences are baseless, with no physical findings or medical diagnosis.
What techniques are offered by the Nursing Interventions Classification (NIC) to care for patients with somatization disorders?
a. Reality testing
b. Assertiveness training
c. Self-esteem enhancement
d. Family involvement promotion
c. Professional skill enhancement
b, c, d
The Nursing Interventions Classification (NIC) offers effective coping strategies to help the overall functioning of a patient with somatization disorder. Assertive communication can help in developing positive ways to meet needs and reducing the need for manipulation or a feeling of helplessness. Self-esteem enhancement reduces dependency. This reduces the need to use illness for secondary gains. Family involvement is encouraged so that the risk of loneliness can be overcome. Reality testing to let the patient verify that the symptoms are not real is not needed. The strategies are developed to address the root psychiatric problem so that the symptoms do not exist at all. Patients suffering from somatization disorders do not need professional skill development training. Rather, the nurses who care for patients with somatization disorders need to develop professional skills to be able to care for such patients.
A nurse assesses a patient diagnosed with conversion (functional neurologic) disorder. Which comment is most likely from this patient?
a. "I have severe abdominal bloating. I think I might have colon cancer."
b. "I have the sensation of needles sticking in my feet. I think there are demon forces that are causing it."
c. "For most of my life, I've had a sensitive gastrointestinal tract. Sometimes it's very bad but it usually gets better without seeing a doctor."
d. "Since losing my job last week, I've been unable to maintain my balance and coordination. It's probably just a little nerve irritation."
Patients with conversion disorder channel emotional distress into physical symptoms of a neurologic nature. Many patients show a lack of emotional concern about the symptoms (la belle indifférence). In this scenario, the patient describes symptoms of a neurologic disorder that began after a significant stressor, but then discounts the symptoms. Somatic symptom disorder has a chronic and relapsing course. Illness anxiety disorder (hypochondriasis) results in the misinterpretation of physical sensations as evidence of a serious illness.
A nurse is caring for patients with somatic symptoms. Which strategies does the nurse incorporate in the plan of care to facilitate effective recovery?
a. Provide continuity of care.
b. Avoid physical examination.
c. Set reasonable treatment goals.
d. Conduct a physical examination each time.
e. Conduct laboratory investigations related to each symptom.
a, c, d
Providing continuity of care is essential for ensuring effective patient relationships and treatment. Setting reasonable treatment goals in spite of ongoing symptoms helps the patient to be positive about treatment and recovery. Physical examination should always be conducted to evaluate the symptoms and for patient satisfaction. Laboratory tests and procedures should be ordered only when necessary.
Which nursing diagnosis should be investigated for patients with somatoform disorders?
a. Self-care deficit
b. Ineffective coping
c. Deficient fluid volume
d. Delayed growth and development
Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms.
A nurse is assessing a patient who complains of a headache. Which behaviors of the patient will make the nurse suspect factitious disorder?
a. The patient demands specific treatments.
b. The patient cooperates with the heath care team.
c. The patient feels better with negative test results.
d. The patient describes the complaints dramatically.
e. The patient is unwilling to interact with the family.
a, d, e
A patient with factitious disorder can be demanding about specific treatments and procedures. To gain more attention, the complaints are exaggerated and described dramatically by the patient. As the illness is factitious, the patient is often not willing to interact with the nurse or the family members. The patient is often demanding and may get angry if the demands are not met; hence it is not likely that the patient cooperates with the health care team. The patient may often feel worse after negative test results, and new complaints may appear as the patient has the goal of assuming a sick role in factitious disorder.
A nurse is caring for a young widow and suggests community resources available to help her cope with the loss. Why is this intervention important?
a. To identify anxiety
b. To identify a support system
c. To assess suicidal tendency
d. To build a relationship with the patient
Community resources can provide support systems that can aid in dealing with stressful life events. Identifying anxiety will help in reducing distress and managing self-care behavior. Suicidal tendency is assessed to help in planning patient safety from self-harm. Building a relationship with a patient will help in planning and tracking behavior change.
A nurse is developing a care plan for a patient with cancer. Which holistic therapies does the nurse apply to support medical management?
c. Massage therapy
d. Type A modification
e. Psychological counseling
b, c, e
Visualization helps cancer patients relax and create positivity about treatment and cure. Massage therapy helps in relieving anxiety and depression and reducing physical and mental stress. Psychological counseling helps in opening up the mind and reducing anxiety and stress. Biofeedback helps to alter gastric acidity and is more appropriate for managing peptic ulcers, not cancer. Type A modification helps to reduce stress in type A personalities and is more helpful in managing coronary heart disease, not cancer patients.
p. 318, Table 17.
Which statement concerning somatic symptom disorder is true?
a. Patients typically experience high levels of functional impairment.
b. Chest pain, dizziness, and headache commonly are reported symptoms.
c. Incidences of the disorder are diagnosed equally between males and females.
d. Medical and psychosocial histories are vital to achieving an accurate diagnosis.
e. The health care provider's perception of the patient is a factor in the diagnosis process.
a, b, d, e
Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis. Patients' suffering is authentic and they typically experience a high level of functional impairment. Somatic symptom disorder is difficult to distinguish from physical disorders with organic causes, and the patient's history is extremely important for accurate diagnosis. The most common symptoms for visits to primary health care providers are chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. Studies show that the strongest predictor of misdiagnosing somatic disorders is the primary health care provider's dissatisfaction with the clinical encounter. The predominance of women with somatization is significant.
A member of the military service prepares for discharge. Just before the exit physical examination, this person consumes large amounts of caffeine to increase blood pressure in an effort to qualify for disability benefits. Which term is most applicable to this individual's behavior?
Malingering is a consciously motivated act to deceive based on the desire for material gain. It involves fabricating an illness or exaggerating symptoms to become eligible for disability compensation, commit fraud against insurance companies, obtain prescription medications, evade military service, or receive a reduced prison sentence. Resilience refers to the capacity to adapt to and cope with severe stress. Somatization refers to the expression of psychological stress through physical symptoms. Hypochondriasis is an older term for illness anxiety disorder.
The nurse uses reattribution treatment when caring for a patient with somatic symptom disorder. Which action does the nurse perform to broaden the agenda as part of the treatment?
a. Acknowledging the patient's distress
b. Creating a treatment plan that includes regular follow-up visits
c. Using empathetic listening skills when taking the patient's physical history
d. Using patient cues to give an empowering explanation of the symptoms to the patient
Reattribution treatment is a structured intervention that is used to provide a simple explanation of the somatic symptoms to the patient. There are four stages of this treatment: feeling understood; broadening the agenda; making the link; and negotiating further treatment. Within the broadening the agenda phase, the care provider acknowledges the patient's distress. Using empathetic listening skills when taking the patient's history happens in stage 1, feeling understood. Creating a treatment plan happens in stage 4, negotiating further treatment. Using patient cues to give empowering explanations to the patient happens in stage 3, making the link.
During an assessment the nurse notes that a patient has a "crisscrossed" abdomen. In which illness or disorder is a crisscrossed abdomen commonly seen?
c. Anorexia disorder
d. Factitious disorder
A crisscrossed or "railroad-track" abdomen is commonly seen in a patient with factitious disorder. This happens due to scars from numerous exploratory surgeries. Patients with factitious disorder often have several invasive investigations done to investigate a proper cause of the symptoms they experience. Diarrhea, constipation, and anorexia are common symptoms often reported by patients with somatization disorders, but they do not have any physical causes behind them.
A nurse interviews a patient diagnosed with conversion disorder. Which comment is most likely from this patient?
a. "I get big lumps in my throat and can't swallow when I eat. I'm afraid I might have cancer."
b. "Since getting a divorce, I've had crushing chest pain, but I don't think it really means anything."
c. "Sexual intercourse is so painful that I avoid it. I'm afraid that's going to destroy my marriage."
d. "I have daily problems with nausea and vomiting. I think I'm getting seriously dehydrated."
In conversion disorder, the individual may be expressing a forbidden thought or wish by converting it into physical symptoms that are more appropriate and acceptable, and which also provide sympathy, care, and attention from others. Individuals exhibit one or more symptoms that affect voluntary motor or sensory function. These symptoms appear to be related to a neurologic or general medical condition but are not caused by a general medical condition, or the direct effects of a substance, or a culturally sanctioned behavior or experience. The symptom is not intentionally produced and is not limited to pain or sexual dysfunction. The conversion symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Common symptoms are blindness, paralysis, deafness, seizures, anesthesia, or abnormal motor movements
When a pregnant woman is brought to a health care facility with a suspected ruptured amniotic sac, the nurse suspects Munchausen by proxy. What is the most appropriate statement about the disorder?
a. The patient has ruptured the sac with her fingernails.
b. The agony will be less if legal intervention is avoided.
c. The disorder may lead to harmful medical procedures.
d. The family has ruptured the sac to receive insurance money.
Munchausen by proxy disorder results in unnecessary medical visits. It may sometimes cause serious complications or sepsis that leads to harmful medical procedures. The patient does not cause harm to self. The harm is caused by a caregiver to the vulnerable and dependent patient. The family does not feign illness of the patient to receive insurance money or other rewards. They do it to attract attention and cause excitement. The caregiver may also do this so that the dependent remains a "patient" and the relationship of the dependent with the primary health care providers is maintained. Legal interventions may be necessary depending on the severity of the cases because some cases may become fatal due to such feigning.
The nurse is caring for a 45-year-old patient who presents with nonassertive behavior and speaks poorly about him- or herself. When discussing the patient's background and health history, the patient consistently seeks the nurse's reassurance. Based on the nurse's nursing diagnosis as "chronic low self-esteem," what is the best outcome the nurse should plan for this patient?
a. Verbalizes positive sense of self; maintains strong decision-making abilities
b. Displays ability to stand up for one's self; finds more positive coping patterns
c. Finds more positive social system to support sense of self; describes self as successful
d. Identifies support system to assist with self-esteem issues; recognizes ways of being more successful
For the patient with nonassertive behavior who displays negative self-talk and has a nursing diagnosis of chronic low self-esteem, the best outcome is for the patient to verbalize a positive sense of self and maintain strong decision-making abilities. Identifying a support system, recognizing ways of being successful, finding more positive social systems, describing self as successful, displaying the ability to stand up for oneself, and finding more positive coping patterns are outcomes that can be planned once the patient has first achieved a positive sense of self and strong decision-making.
Which therapeutic intervention is included for a patient with a somatoform disorder?
a. Encouraging the patient to use benzodiazepines liberally
b .Steering the conversation away from the patient's feelings
c. Conveying an interest in the patient rather than in the symptoms
d. Encouraging the patient to rely on the nurse to meet the patient's needs
When the nurse focuses on the patient rather than on the symptoms, the patient's self-worth and coping skills are enhanced.
When caring for patients with somatic symptom disorders, what cultural considerations does the nurse keep in mind?
a. Men in the United States are commonly seen to have somatization disorders.
b. West Indians (Caribbean) attribute somatic symptoms to suppressed anger or rage.
c. People in North America sense worms in the head more often than people in Africa.
d. People in southern Asia feel ants under the skin more often than those in North America.
The type and frequency of somatic symptoms may be different in different cultures. People in southern Asia and Africa may complain of a sensation of ants under their skin more often than those in North America. Men in the United States are rarely seen to have somatization disorders. It is more common in Greek and Puerto Rican men. West Indians (Caribbean) believe somatic symptoms are due to chronic overwork and irregular lifestyles rather than due to suppressed anger or rage. People in Africa express a sensation of worms in the head more often than people in North America.
When discussing somatic disorders from a cultural perspective, which of the following is true?
a. Somatic disorders rarely are observed in males
b. Somatic symptoms vary widely from culture to culture
c. Secondary gain is seldom a factor in somatic disorders
d. Underdeveloped countries rarely tolerate somatic disorders
The type and frequency of somatic symptoms vary across cultures.
A patient diagnosed with a somatic disorder asks what kind of psychotherapy will be prescribed. What is the nurse's response?
a. "A combination of antianxiety and antidepressant therapy is the most effective therapy."
b. "Aversion therapy often is used because in effect you are punishing yourself by not being able to walk."
c. "As you see desired behaviors modeled by the therapist, you also will be able to achieve the expected outcome."
d. "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders."
Cognitive behavioral therapy (CBT) is the most consistently supported treatment for the full spectrum of somatic disorders. A combination of antianxiety and antidepressant therapy, aversion therapy, and emulating desired behaviors are incorrect and do not describe the most used and effective therapy for this disorder.
What does the nurse include in the assessment of a patient with a potential somatic symptom disorder?
a. Asking about the abuse of drugs or other substances
b. Asking about family and community support systems
c. Identifying any biological needs that need to be addressed
d. Assessing the ability to problem-solve and work through complex thoughts
e. Finding out when the patient's symptoms began and how long they've lasted
a, b, c, e
Assessment guidelines for somatic symptom disorder include screening the patient for misuse of drugs or other substances; exploring the patient's support systems; asking about the onset and duration of symptoms; and identifying any biological needs that must be met. Assessment guidelines for somatic symptom disorder do not include assessing problem-solving abilities or how well the patient is able to work through complex thoughts.
The nurse practices cognitive behavioral therapy (CBT) while caring for a patient with somatization disorders. What is the advantage of using CBT for such patients?
a. Provides a consistent supported treatment by a general medical nurse
b. Helps to reframe the patient's thoughts and gain control of the situation
c. Builds a self-fulfilling cycle of pain, despair, and health-seeking behaviors
d. Initiates psychiatric consultation without need for the primary health care provider
In cognitive behavioral therapy (CBT), the nurse helps the patient to reframe his or her thoughts of exaggeration of symptoms and health-seeking behaviors. This helps the patient to gain control of the situation and break the cycle of pain, despair, and health-seeking behaviors. CBT is a consistent supported treatment method that cannot be managed by general medical nurses. An advanced practice psychiatric nurse provides CBT. An advanced practice nurse works with the patient, keeping the primary health care provider in the loop. An advanced practice nurse initiates the psychiatric consultation if needed.
The nurse includes stress management interventions when developing a plan of care for a patient with which disorder?
a. Factitious disorder
b. Conversion disorder
c. Illness anxiety disorder
d. Somatic symptom disorder
Patients with illness anxiety disorder experience stress or extreme worry and fear about the possibility of having a disease. Hence, with stress management the fear and worry is brought under control. Factitious disorder can be resistant to treatment and may require management rather than cure or legal interventions. Conversion disorder can be managed with behavior therapy, hypnosis, or antianxiety drugs. Somatic symptom disorder can be managed with cognitive behavioral therapy.
p. 327, Table 17.5
Which patient is most likely to initially demonstrate behaviors suggesting a somatic disorder?
The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals.
Which statement concerning conversion disorder is true?
a. A commonly reported symptom is chronic diarrhea.
b. Patients tend to experience symptom remission as they age.
c. Childhood abuse plays a role in the development of the disorder.
d. Comorbid conditions include posttraumatic stress disorder (PTSD).
e. Conversion disorders can be the exaggeration of existing medical conditions.
b, c, d, e
Childhood physical or sexual abuse is common in patients with conversion disorder, and comorbid psychiatric conditions include depression, anxiety, posttraumatic stress disorder, other somatic disorders, and personality disorders. There are also cases in which a comorbid medical or neurologic condition exists, and the conversion disorder is an exaggeration of the original problem. Conversion disorder is marked by the presence of deficits in voluntary motor or sensory functions. Chronic diarrhea is not a characteristic sign of this disorder.
The nurse is caring for a patient from Africa with a somatic symptom disorder. Which finding does the nurse expect from this patient?
a. Denying having any symptoms
b. Reporting the sensation of ants under the skin
c. Telling the nurse that the symptoms are food-related
d. Explaining that the symptoms are related to a spell that was cast on the patient
It is important to understand cultural implications for patients with somatic symptom disorders. Burning hands and feet or the sensation of ants under the skin or worms in the head are common in patients with somatic symptom disorders who are from Africa and southern Asia. The nurse knows that it is less likely that this patient will deny having any symptoms, say the symptoms are food-related, or attribute the symptoms to a spell.
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