NURS 356- Somatoform

Disorders
Objectives
• Identify Nursing Assessment Criteria, for Somatoform Disorders,
based on modern day nursing practice
• Apply this knowledge to further explore the Nursing Process for these
Disorders.
Review- Definitions
• Hypochondriasis
• Conversion Disorder
• Body Dysmorphic Disorder
Nursing Assessment – Somatoform Disorders

History
• Clients usually provide a lengthy and detailed account of previous
physical problems, numerous diagnostic tests, and perhaps even a
number of surgical procedures.
• Clients may express anger or dismay at the Health Care System
( “ Why can't they figure out what is wrong with me?” ).
• Client’s with conversion disorder may show lack of emotion, when
detailing history of lack of medical diagnosis.
Somatoform Disorders- Physical Assessment
• The Nurse must investigate physical health status thoroughly to
ensure there is no underlying pathology requiring treatment.
• Clients may walk slowly or with an unusual gait because of the pain
or disability caused by the symptoms.
• They may exhibit a facial expression of discomfort or physical distress.
• Clients with somatization disorder usually describe their complaints in
colorful, exaggerated terms but often lack specific information.
Somatoform Disorders- Assessment
Mood and Affect
• Mood is often labile, shifting from seeming depressed and sad when
describing physical problems to looking bright and excited when
talking about how they had to go to the hospital in the middle of the
night by ambulance.
• Emotions are often exaggerated, as with reports of physical
symptoms.
• Clients describing a series of personal crises related to their physical
health may appear pleased rather than distressed about these
situations.
Somatoform Disorders- Assessment
Thought Process and Content
• Do not usually present with disordered thoughts or perceptions.
• Content of thoughts are usually exaggerations of physical symptoms
• May talk about dying and planning of funeral
• Unlikely to respond affirmatively to emotional assessment or feelings
• Preoccupation with physical symptoms and bodily functions , which
may interfere with psychological examination
Somatoform Disorders – Assessment
Sensorium and Intellectual Processes
• Clients are alert and oriented. Intellectual functions are unimpaired.
Somatoform Disorders –Assessment
Judgement and Insight
• Exaggerated responses to their physical health may affect clients'
judgment.
• They have little or no insight into their behavior.
Somatoform Disorders- Assessment
Self Concept
• Focus is on their physical characteristics.
• Clients usually have a low self esteem, due to perceived debilitating
illness
• Lack confidence and struggle with work and daily life issues.
Somatoform Disorders – Assessment
Roles and Relationships
• Clients often lose jobs because of excessive absenteeism or inability to
perform work tasks
• They may quit voluntarily due to perceived inability to be physically/
psychologically productive.
• Being preoccupied with seeking medical care, they often have difficulty
fulfilling family roles
• They have few friends, and may refuse social activities due to the risk of
being extremely ill.
• Most socialization occurs at the level of the Health Care facility.
Somatoform Disorders- Assessment
Roles and Relationships ( Cont’d)
• Clients may report lack of family support
• Family members may tire of the ceaseless complaints and the client's
refusal to accept the absence of a medical diagnosis.
• Family members may report family life to be chaotic and
unpredictable
Somatoform Disorders- Assessment
Physiological and Self Care.
• Clients who somatize often have sleep pattern disturbances, lack basic
nutrition, and get no exercise.
• Clients may be taking multiple prescriptions for pain or other
complaints. The nurse must consider the possibility of withdrawal
symptoms ( Analgesics and Anxiolytics)
Critical Thinking
• Based on symptoms and assessment findings, what may be some of
the applicable Nursing Diagnosis, for this class of disorders?
Homework
• Ineffective Coping
• Ineffective Denial
• Impaired Social Interaction
• Anxiety
• Disturbed Sleep Pattern •
• Fatigue
• Pain