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A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note what patient characteristic?
- A. Readily sees a relationship between symptoms and interpersonal conflicts.
- B. Rarely derives personal benefit from the symptoms.
- C. Has little difficulty communicating emotional needs.
- D. Has unmet needs related to comfort and activity.
Correct Answer: D
Rationale: The patient diagnosed with a somatic system disorder frequently has altered comfort and activity needs. In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic system disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.
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A patient with a diagnosis of somatic symptom disorder is being assessed. What assessment questions are appropriate and therapeutic in nature?
- A. "Would you consider yourself to be mentally ill?"
- B. "Do you have periods of depression or extreme sadness thinking?""
- C. "Have you ever been told that your symptoms are not real?"
- D. "Are you able to care for yourself and meet your own basic needs?"
- E. "How do the members of your immediate family react to your illness?"
Correct Answer: B,D,E
Rationale: The assessment should address possible comorbid conditions like depression, the ability for a patient to be able to self-feed their basic needs independently, and the dynamics of feeding himself to the existence. The remaining options are likely to cause increased stress and foster anger, either of which would not be therapeutic.
A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. What is an appropriate outcome for this patient?
- A. Assumes roles and functions of the other family members.
- B. Demonstrate a resumption of former roles and tasks.
- C. Focuses energy on problems occurring in the family.
- D. Relies on family members to meet personal needs.
Correct Answer: B
Rationale: The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and the resumption of former roles are necessary to change this pattern. The distractors are inappropriate outcomes.
A patient diagnosed with somatic symptom disorder says, "I have pain from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to conduct what focused assessment?
- A. Mood
- B. Cognitive style
- C. Secondary gains
- D. Identity and memory
Correct Answer: C
Rationale: Secondary gains should be assessed. The patient's dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient's diagnosis has been established.
A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?
- A. Functional neurological (conversion) disorder
- B. Illness anxiety disorder (hypochondriasis)
- C. Derealization disorder
- D. Dissociative amnesia with fugue
Correct Answer: B
Rationale: Patients with illness anxiety disorder (hypochondriasis) have fears of serious medical problems such as cancer or heart disease. These fears persist, despite medical evaluations, and interfere with daily functioning. No complaints of pain are made, and no evidence of dissociation or conversion exists. Derealization disorder involves recurrent periods of feeling unreal, detached, outside of the body, numb, dreamlike, or a distorted sense of time or visual perception.
A patient reporting stomach pain says, "I have seen 10 different health care providers but all of them tell me I don't have stomach cancer." Which term might be appropriate in describing this report?
- A. Somatic symptom disorder
- B. Factitious disorder
- C. Illness anxiety
- D. Malingering
Correct Answer: C
Rationale: Individuals with illness anxiety disorder are preoccupied with having or eventually developing a serious illness. The patient is apprehensive of a particular illness despite continuous negative medical evaluations and assurances. Malingering is intentionally faking or exaggerating symptoms for an obvious benefit such as money, housing, medications, avoiding work, or criminal prosecution. Malingering is a behavior and not a psychiatric disorder. "Somatization," defined as a process by which psychological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impairment with or without a known general medical disease. The essential feature of factitious disorder is intentionally faking symptoms in order to assume the sick role, that is, to be a patient. In addition, there are no obvious external benefits such as financial gain or avoiding work or criminal prosecution.