Somatoform and Sleep Disorders Nursing 201 characterized physical

Somatoform and Sleep Disorders Nursing 201

characterized • physical symptoms suggesting medical disease but without 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

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.

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

Nursing Diagnosis • Assessment

Outcomes

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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.

• 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)

• Theory of family dynamics – “Pain games” – Tertiary gain • Neurophysiological theory – Afferent pain fibers – Serotonin/endorphins

Nursing Diagnosis • Assessment

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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.

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.

• 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.

Nursing Diagnosis • Assessment

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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.

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

• Transactional Model of Stress/Adaptation – The etiology of conversion disorder is most likely influenced by multiple factors.

Nursing Diagnosis • Assessment

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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

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.

Nursing Diagnosis • Assessment

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Evaluation

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

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

• 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

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.

Nursing Diagnosis • Assessment

Outcomes

Planning/Implementation

Client/Family Education

Treatment Modalities • Somatoform disorders – Individual psychotherapy – Group psychotherapy – Behavior therapy – Psychopharmacology Sleep disorders – Relaxation therapy – Biofeedback – Pharmacotherapy

• 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