Somatic Symptom Related Disorders Interdisciplinary Treatment Providing longterm

Somatic Symptom & Related Disorders.

Interdisciplinary Treatment • Providing long-term general management of the chronic condition • Conservatively treating comorbid psychiatric and physical problems • Providing care in special settings, including group treatment

Nursing Management: Biologic Domain • Assessment: – – Review of systems Assessment of pain Physical functioning Pharmacologic • Usually taking a large number of meds • Self-medicate and provider shop – Health attitude survey – Review clinical vignette • Nursing Diagnoses – Fatigue, pain, disturbed sleep

Biologic Nursing Interventions • Spend time with physical complaints • Help patient establish a daily routine • Continually monitor medication • Pain management – need multiple approaches • Activity enhancement • Nutrition regulation • Relaxation

Pharmacologic Interventions • There is no medication for somatization disorder. • Treat the comorbid disorders. – Depression: antidepressants - MOAI – Anxiety: Avoid benzodiazepines. • Monitor closely. • Observe for drug-drug interactions.

Nursing Management: Psychological Domain Assessment Nursing Diagnoses • Mental status usually normal • Anxiety • Appearance may be flamboyant, exaggerated • Ineffective sexuality patterns • Preoccupied with personal illness (may keep a copy of record), series of personal crisis. • Emotional reactions to life stressors • Labile mood • Impaired social interactions • Ineffective coping • Ineffective management of therapeutic regimen

Psychological Nursing Interventions • Maintaining nurse-patient relationship • Counseling • Problem solving • Health teaching

Nursing Management: Social Domain Assessment • How much time seeking medical care and treating illnesses? • Extent of disability? • Employment status? • Social network? Do they see their friends as providers? • Family members – Tired of all the complaints? – Alcoholism is common. Nursing Diagnosis • Caregiver role strain, risk • Ineffective community coping • Disable family coping • Social isolation

Nursing Diagnosis • • Fatigue Pain Sleep pattern disturbance Altered sexuality patterns, anxiety Ineffective coping Impaired social interactions Ineffective management of therapeutic regimen

Social Nursing Interventions • Problem-solving groups • Assertiveness groups • Family interventions

Continuum of Care • Inpatient care – very rare • Emergency care – mostly for physical problems, except when depressed • Community treatment – Spend lifetime in health care system – Most care delivered as outpatient

Factitious Disorders • Factitious disorder (Munchausen’s syndrome) – Different than malingering (has other motivations) – Injure themselves covertly – Produce physical symptoms • Factitious disorder NOS (by proxy) – Injure others in order to gain attention (mother hurting child)

Nursing Management Assessment • Chronology of medical/psychological illnesses • Early childhood experiences (abuse, neglect, role of selfinjury) • Family assessment • • • Nursing Diagnosis Risk for trauma Risk for selfmutilation Ineffective individual coping Low self-esteem

Nursing Intervention • Goal: To replace dysfunctional, attentionseeking behaviors with positive behaviors • Accept and value patient. • Encourage long-term psychotherapy. • Confrontation is effective if patient feels supported.