Row 1
Ch. 17
Somatic Disorders
Ch. 17
Somatic Disorders
Learning card (no points)
Treatment: behavioral management strategies
■Behavioral contract
■Counseling : usually 1:1
■Modeling : imitating
■Role playing : learn & reinforce new skills
■Planned ignoring
■Physical distance or touch control
■Redirection : Guide patient to different activity such as playing outside or gym
■Positive feedback
■Clarification : “You are safe here”
■Restructuring
■Limit setting
■Simple restitution
■Physical restraint : If patient is danger to self or others – dangerous aggression
Nursing process:
(1) What are some screening tools we use for alcohol use disorder?
(2) What is our assessment entail?
(3) What are some interventions for these pts?
(4) What are some therapies for these pts?
(400 points added)!
(1) CIWA, CAGE
(2) Codependence
(3) Safety, sleep, nutrition, hydration, self-care, monitor VSs, therapeutic communication
(4) CBT, motivational interviewing, AA support groups
Types of crisis:
(1) What is maturational?
(2) What is Situational?
(3) What is Adventitious?
(400 points added)!
(1) leaving the home for the first time, marriage, birth of child, retirement, and death of parent (think about how the pt can mature through this time of crisis).
(2) job loss or change, death of a loved one, change in financial status, divorce, and psychiatric or physical illness (pt not sure if they can make it through this crisis).
(3) epidemics, floods, fires, earthquakes, rape, murder, acts of terrorisms, wars, riots, shootings, bombings
What does factitious disorder imposed on another mean?
--Caregiver deliberately fakes an illness upon a dependent
-- Signs of abuse: anorexia, traumatic alopecia, underweight/low BMI
(1) What is pyromania?
(2) What is Kleptomania?
(problems related to impulse control disorder)
(1) repeated deliberate fire setting.
- Tension or excitement before setting a fire. Fascination with or unusual interest in fire and its contexts, such as matches. There is pleasure or relief in setting a fire, witnessing a fire, or participating in the aftermath of a fire.
- The fire setting is done solely to bring this relief and/or pleasure and not for other reasons, such as to conceal a crime.
(2) repeated failure to resist urges to steal objects
-Associated with other impulse control disorders and impulse control--related problems, such as impulse buying.
Alcohol use complications:
(1) What is Wernicke-Korsakoff Syndrome? What are the characteristics of this syndrome? What do we need to give?
(2) What is fetal alcohol syndrome?
(3) Name some medical complications in general from alcohol abuse.
(400 points added)!
(1) Thiamine deficiency caused by poor nutrition or malabsorption.
-Characterized: altered gait, confusion, ocular motility abnormalities
-GIVE LARGE DOSES OF IV THILAMINE 2-3 TIMES DAILY TIMES 1-2 WEEKS.
(2) Alcohol during pregnancy (Intellectual disability, short stature)
(3) Peripheral neuropathy, alcoholic myopathy, alcohol cardiomyopathy, esophagitis, gastritis, pancreatitis, alcoholic hepatitis, liver cirrhosis, leukopenia, thrombocytopenia, cancer
Learning card! (No points)!
Assessment:
--General: SAFETY!! Suicide risk assessment, anxiety level
-- Assess perception of the precipitating event: ASK: "What leads you to seek help?" How does this situation affect your life?"
-- Assess situational support: ASK:"Is there anyone you would like to be involved with your care?"
-- Assess coping skills:
-Effective: Talking to trusted people, journaling, physical activity
- Ineffective: Overeating, drinking, smoking, withdrawing, yelling, and fighting
-ASK: "What has helped you through difficult times in you past?"
--Self assessment: Debriefing, countertransference
What is factitious disorder imposed on self mean?
--voluntary; pretend to be ill for their emotional needs to be met
-- Malingering--disability compensation, fraud against insurance companies, obtaining prescription meds, evading military service, or reducing a prison sentence.
What is conduct disorder? Name some comorbidities, risk factors, and treatments.
(200 points added)
--Rights of others are violated, and societal norms and rules are disregarded; aggressive behaviors leading to destruction of property or physical injury; callousness and lack of remorse/empathy.
-- Comorbidities: ADHD, oppositional defiant disorder, depression, anxiety, substance use disorder, bipolar disorder
-- Risk factors:
- Neurobiological: less dense gray matter in the prefrontal cortex region of the brain
- Environmental: Neglect, chaotic home life, inconsistent parenting and harsh discipline
--Treatment: Behavioral management strategies, Family therapy
Alcohol use disorder (withdrawal)
(1) How long can withdrawal from alcohol last?
(2) What are the s/s for mild to moderate withdrawal?
(3) A pt can have a withdrawal seizure 12-24 hrs. after last drink, what are you going to give them?
(4) A pt can have withdrawal delirium (medical emergency) within the first 72 hours of withdrawal, what are you going to give them?
(300 points added)!
(1) 6 hrs.- 3days after last drink
(2) agitation, anxiety, N/V, tremors, diaphoresis, insomnia
(3) GIVE DIAZEPAM IV
(4) GIVE LORAZEPAM IV ASAP, MAY GIVE DIAZEPAM OR CHLORDIAZEPOXIDE--SECLUSION MAY BE REQUIRED--IV HYDRATION
Learning card! (No points)!
Crisis intervention guidelines:
--Assess for sucidal and homicidal thoughts or plans
-- take steps for pt to feel safe and less anxious
-- Therapeutic communication and active listening. This is where we are getting their perspctive.
-- Identify needed social supports
-- Identify needing coping skills
-- Involve the pt in identifying realistic interventions
-- Plan regular follow-ups to assess condition
What are some important tx guidelines nurses follow to help these types of pts?
--Establish a therapeutic relationship with therapeutic communication, use of self-lonely, low self-esteem.
-- Encourage expression of feelings, coping skills, relaxation techniques
-- Educate about the disorder and tx
-- focus on the development of self-compassion
-- Encourage a healthy lifestyle (sleep-hygiene, regular exercise, positive thinking, assertiveness techniques, hobbies).
-- Assess secondary gains
-- Avoid unnecessary tests
-- SSRI and CBT (AVOID OPIODS AND BENZODIAZIPINES).
What is Intermittent Explosive disorder? Name some comorbidities, risk factors, and treatments.
(100 points added)
-- Inability to control impulses; characterized by rage then remorse; impairment in functioning and interpersonal relationships; emotional dysregulation
--Comorbidities: ADHD, depression, anxiety, substance use disorder, antisocial, borderline personality disorder (BPD), oppositional defiant disorder, conduct disorder.
--Risk factors:
-Environmental: associated with trauma, conflict and violence in the family of origin
- Physiological: higher than normal levels of the inflammatory markers C-reactive protein and interleukin-6
--Treatment: Therapy, Medications (SSRIs and Mood Stabilizers, AVOID BENZODIAZEPINES (MAY REDUCE INHIBITIONS).
Alcohol use disorder (Intoxication)
(1) What can a BAL of 0.08g/dl cause the body to do? What about BAL 0.15g/dL, BAL 0.20g/dL, BAL 0.30g/dL, BAL 0.40g/dL?
--BAL 0.08g/dL (alterted speech, imparied judgement, poor self-control)
--BAL 0.15g/dL (vomiting, major loss balance)
--BAL 0.20g/dL (memory blackouts, N/V)
--BAL 0.30g/dL (Decreased body temp, decreased BP, RR, sleepiness, amnesia
--BAL 0.40g/dL (impaired VSs and possible death)
(1) What is somatic symptom disorder (name some symptoms).
(2) what is illness anxiety disorder?
(3) What is conversion disorder (name some symptoms)?
(200 points added)
(1) Involuntary symptoms; rooted in untreated depression, anxiety, and/or trauma (Symptoms: abd pain, HA, back pain, fatigue
(2) Extreme worry and fear about possibly have a disease
(3) (functional neurological disorder) Deficits in voluntary motor or sensory fxs: paralysis, numbness, blindness
What is Oppositional defiant disorder (ODD)? Name some comorbidities, risk factors, and tx options.
--Emotional outbursts, vindictiveness, argumentative/defiant behaviors
--Comorbidities: ADHD, depression, anxiety
-- Risk factors:
-Neurobiological: less dense gray matter in the prefrontal cortex region of the brain
-Environmental: insecure attachment
--Treatment: Behavioral management strategies, Family therapy
Opioid Use Disorder
(1) what are signs of intoxication?
(2) What are signs of withdrawal?
(3) What do you do when an overdose occurs (think nurses priority).
(4) what drugs are used for withdrawal tx?
(5) What is the maintenance for opioid use disorder?
(6) What therapies can be used?
(300 points added)
(1) Bradycardia, hypotension, hypothermia, sedation, pinpoint pupils, slowed movement
(2) Tachycardia, HTN, hyperthermia, dilated pupils, hyperreflexia, diaphoresis, piloerection (goosebumps), increased RR, rhinorrhea (runny nose), yawning, muscle spasms, anxiety, bone pain, N/V/D
(3) Maintain airway and administer Naloxone
(4) Clonidine, methadone, buprenorphine
(5) Naltrexone or Vivitrol (IM monthly)
(6) CBT, Family therapy, NA support groups
Levels of Prevention: Crisis interventions are directed toward 3 levels of prevention (How to work with or prevent a crisis----The goal is to return to the pre-crisis level of functioning)!
(1) Primary level (explain)
(2) Secondary level (explain)
(3) Tertiary level (explain)
(1) To decrease incidence of crisis---Teach coping skills, assist pt to minimize major life changes, evaluate the pts experience of the stressful life events.
(2) During crisis to prevent prolonged anxiety---Ensure safety of the pt, assess the pts problem, support systems, and coping styles
(3) After the crisis to provide long-term support---Facilitate optimal level of functioning and prevent further emotional disruptions, encourage support groups and community resources (critical incident stress debriefing is an example of Tertiary prevention).