Mental Health Exam 3 Concept Guide (Modules 7, 8, 9)

Document Content and Description Below

Mental Health Exam 3 Concept Guide (Modules 7, 8, 9) Chapter 12- Somatoform disorders Potential Nursing diagnoses for dissociative disorders: Disturbed personal identity- Amnesia or fugue related t... o a traumatic event Disturbed body image- Symptoms of depersonalization; feeling of unreality or body image distortions Ineffective coping- Alterations in consciousness, memory, or identity Ineffective role performance- Abuse of substances related to dissociation Ineffective coping/ ineffective family coping- disorganization or dysfunction in usual patterns of behavior (absence from work, withdrawal from relationships, changes in role function) Interrupted family processes- disturbances in memory and identity Impaired parenting/ ineffective impulsive control- Interrupted family processes related to amnesia or erratic and changing behavior Anxiety- feeling of being out of control of memory, behaviors, and awareness Spiritual distress/ risk for other-directed violence / risk for self-directed violence- inability to explain actions or behaviors when in an altered state Death anxiety- obsessive fear of contracting or having a serious or terminal illness Somatization-  the process of experiencing and communicating psychological distress through physical symptoms  symptoms may or may not have a medical basis that can be identified  key identifying feature is disproportionate and excessive distressful reaction to the physical symptoms which causes life impairment.  Unconscious process Dissociation-  The hallmark of dissociative disorders is a disturbance in the normally well-integrated continuum of consciousness, memory, identity, and perception. It is an unconscious defense mechanism to protect the individual against overwhelming anxiety related to past trauma, and ranges from minor to severe. Pts have intact reality testing- meaning they are NOT delusional or hallucinating.  Healthy dissociation- Daydreaming, fantasizing, and zoning-out; used to solve problems and relax  Severe dissociation- caused by major trauma. o Depending on severity of impact, person may be:  Unable to recall a specific event  feel unreal/ unattached for short to long periods of time  most severe: develop more than 1 personality to help carry the load of extremely severe trauma or abuse Somatic Symptom Disorder- NON INTENTIONAL  people with this disorder are extremely persistently preoccupied with and distressed by their perceived health issues  demand unnecessary tests, noncompliant with provider recommendations  significant life impairment, preoccupation and high anxiety  “doctor shopping” when they do not receive the answers from physicians, undergo unnecessary surgeries, invasive diagnostic procedures & drug trials  usually diagnosed with depressive and/or anxiety disorders Somatoform Disorder Nursing Interventions  offer explanations and support- reduces anxiety (don’t reinforce illness)  avoid further reinforcement- direct focus away  observe and record frequency and intensity of somatic symptoms- establishes baseline  DO NOT imply symptoms are not real (they are real to pts)  Assess secondary gains  Use straightforward approach- avoid power struggle  Reinforce pts strengths and problem-solving abilities- contributes to positive self esteem  Stress reduction- provides alternative coping strategies and reduces need for meds Secondary Gains (for somatoform disorders)  Benefits derived from the symptoms alone. Ex: in the sick role, patient is not able to perform normal family, work, and social functions and receives extra attention from loved ones. If pts derives personal benefit from the symptoms, relinquishing the symptoms is more difficult.  Approach to identifying presence of secondary gains is to ask questions such as: o What abilities have you lost since the development of your symptom(s) ? o How has this problem affected your life? Are there things you can no longer do? o Depending upon the individual patient and your rapport, the nurse might gently approach whether there is anything positive obtained because of the disorder. Hypochondria’s (Illness anxiety disorder) Prominent health anxiety  Preoccupied with having or eventually developing a serious illness  May or may not present with somatic symptoms, and if so- usually mild. o Unintentional and not under conscious control o Significant distress or dysfunction  Preoccupied with belief of having a devastating sickness or disease  Inability to function in personal, social, and occupational roles are often impaired Conversion disorder- (also called Functional Neurobiological Symptom Disorder)  Presents with one or more symptoms of impaired motor or sensory function  Incompatible or exaggeration of recognized neurological conditions, not explained by another mental or medical disorder  Causes significant distress to the patient and impaired social or occupational functioning  Symptoms: (episodes are typically brief but may become chronic) o weakness or paralysis o abnormal movement o swallowing or speech difficulties o seizures or attacks o sensory loss or anesthesia o symptoms involving the senses (blindness or loss of smell)  symptoms are not voluntarily controlled or created.  La bella indifference: patients who are highly distressed or show lack of emotional concern.  Comorbidities include: childhood abuse, depression, anxiety and personality disorders Nursing intervention:  Behavioral therapy  Family therapy  Hypnosis  Anxiolytics- used to reduce anxiety Dissociative Fugue-  patient in a fugue state frequently relocates and assumes a new identity while not recalling previous identity or places previously inhabited. The distracters are more consistent with paranoid schizophrenia, generalized anxiety disorder, or bipolar disorder  rather lead simple lives not calling attention to themselves, as time progresses the person may remember their former identity and then become amnesic of the time in the fugue state.  USUALLY PRECIPITATED BY A TRAUMATIC EVENT  Implementation: Dissociative disorders is treated in the community, but may be admitted to a psychiatric unit when suicidal or in need of crisis stabilization  Teaching: teaching about illness and instructions in coping skills and stress management. Patients keep a daily journal to increase awareness of feelings and to identify triggers  Treatment: psychotherapy- primary and most effective treatment. Therapy needs to be flexible. Techniques include: o Psychoeducation o Processing memories and trauma through talking o Traumatic reenactment o Safety planning o Journaling, o Relaxation techniques o Hypnosis & artwork There are no specific medications for dissociative disorder, but appropriate antidepressants or anxiolytic medications are given for comorbid symptoms. Body Dysmorphic Disorder- THINK SAFETY!! HIGHEST PRIORITY (ineffective coping- nursing diagnosis)  Highly distressing and impairing disorder than ranges along the continuum from distressing to delusional severity.  Pts usually have a normal appearance, but small # show minor defects. Average age of onset is >20  Frequently concerned with face, skin, genitalia, thighs, hips and hair.  Symptoms: o DSM-5 diagnosis includes preoccupation with imagined “defective body part” o Obsessive thinking- thinking they are ugly or deformed o Compulsive behavior- mirror checking, skin picking, excessive grooming. o Impairment of normal social activities related to academic or occupational functioning o Usually shows great shame and hides/withdraws from others  Many will alter appearance their appearance with plastic surgeries (multiple) which often does not relieve the symptoms. o Pts who have plastic surgery have co-occurring disorders including:  Major depression  Substance abuse disorder  Social phobia  Higher rates of suicidal ideation, suicide attempts and completed suicides.  Disorder is usually kept secret for years and does not respond to reassurance.  Treatment: o Pharmacological agents:  SSRIs- (a second generation antipsychotic added to an SSRI may help in more severe delusional form of BDD)  Antidepressants  Clomipramine (tricyclic antidepressant) o Cognitive behavioral therapy (CBT) CHAPTER REVIEW QUESTIONS: 1. A patient at a general medical clinic tells the nurse, “I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me.” Which comment should the nurse offer next? a. “Let’s review all the medications you currently take.”  SAFETY is the first concern, one serious risk associated with doctor-shopping is medication interactions and duplicate medications b. “Tell me about allergic reactions you’ve had to medication.” c. “Selecting one primary care provider would be better for you.” d. “I’m not sure I understand how you can afford these expenses.” 2. A combat veteran from two tours of the war in Afghanistan tells the nurse, “Some guys in my unit have posttraumatic stress disorder, but I never had any problems other than my hearing is not as good as it once was.” Which explanation for this comment should the nurse consider? a. The veteran wants to demonstrate toughness and strength. b. The veteran shows indicators of derealization and depersonalization. c. The veteran may be rationalizing this reaction to memories of combat. d. The veteran may have amnesia associated with the combat experience.  The veterans comment about his peers and hearing deficit clearly indicate that he was exposed to explosives, some studies show that between 5% and 20% of veterans are amnesic for their combat experiences 3. A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse’s comment should prompt the nursing supervisor to intervene? a. “I have never taken care of a patient diagnosed with this disorder.” b. “I think this patient was misdiagnosed and probably has schizophrenia.” c. “I find myself more fascinated and engaged with this patient than others.”  The correct response presents a comment indicating that the nurse may have lost objectivity regarding the patient. Guidance from the supervisor is needed d. “I recently read an autobiographical book about someone with this problem.” 4. A nurse in an outpatient medical clinic talks t [Show More]

Last updated: 1 year ago

Preview 1 out of 21 pages