Somatoform autonomic dysfunction
▪
The patient presents the
symptoms as if they were due to a physical disorder of a system or organ that
is largely or completely under autonomic control
▪
Heart and cardiovascular
system:
q Cardiac
neurosis
q Da
Costa’s syndrome
q Neurocirculatory
asthenia
▪
Upper gastrointestinal
tract:
q Gastric
neurosis
q Psychogenic
aerophagy
q Hiccough
q Dyspepsia
q pylorospasm
▪
Lower gastrointestinal
tract:
q Psychogenic
flatulence
q Irritable
bowel syndrome
q Diarrhoea
▪
Respiratory system:
q Psychogenic
forms of cough and hyperventilation
▪
Genitourinary system:
q Psychogenic
increase of frequency of micturition and dysuria
Persistent somatoform pain disorder
▪
The predominant complaint
is of persistent, severe and distressing pain, which cannot be explained fully
by a physiological process or a physical disorder
▪
Pain occurs in
association with emotional conflict, or psychosocial problems that are sufficient
to allow the conclusion that they are the main causative influences
Nursing Diagnosis
▪
Impaired adjustment
related to fear of assuming adult responsibilities, as evidenced by multiple
somatic complaints
▪
Impaired adjustment
related to inability to express hostile and competitive feelings, as evidenced
by hypertension
▪
Ineffective denial
related to doubts about self worth, as evidenced by chronic, unresponsive
respiratory symptoms limiting one’s work
▪
Chronic pain related to
marital conflict, as evidenced by back problems
▪
Chronic pain related to
work pressures, as evidenced by reports of headache
▪
Disturbed sleep pattern
related to financial and familial concerns, as evidenced by difficulty falling
asleep and frequent awakening during the night
Nursing Management
▪
Continuously monitor
medical assessments, lab findings, and other report to assure absence of
organic illness
▪
Recognize that physical
symptoms are real to the client, and provide a means for meeting emotional
needs
▪
Establish an ongoing, trusting
relationship with the client
▪
Encourage expression of
feelings, and relate them to stressors and symptoms
▪
Avoid focusing on the
physical symptoms, disabilities or impairment unless the client needs
assistance
▪
Observe and record the
frequency and intensity of somatic complaints and related events
▪
Teach clients about the
relationship of mind and body, anxiety and stressors, and basic body function
▪
Teach coping skills such
as relaxation techniques, meditation and exercise
▪
Teach assertive
communication
▪
Encourage participation
in group activities
Clinical Management Tips
▪
Avoid reinforcing the
somatic symptoms by focusing on the pain or other somatic symptoms
▪
Always ask the client
what is going on emotionally when he is complaining of somatic symptoms
▪
Avoid assumptions that
all somatic complaints are invalid
▪
Avoid a punitive attitude
▪
Recognize the value of
supportive therapy that increases the client’s functional level rather than aim
for cure
COMMENTS