Psychiatric Mental Health Nursing by Videbeck

Data Analysis

Nursing diagnoses commonly used when working

with clients who somatize include the following:

• Ineffective Coping


• Ineffective Denial


• Impaired Social Interaction


• Anxiety


• Disturbed Sleep Pattern


• Fatigue


• Pain
  Clients with conversion disorder may be at risk
  for disuse syndrome from having pseudoneurologic
  paralysis symptoms. In other words, if clients do not
  use a limb for a long time, the muscles may weaken
  or atrophy from lack of use.

Outcome Identification

Treatment outcomes for clients with a somatoform

disorder may include the following:

• The client will identify the relationship
  between stress and physical symptoms.


• The client will verbally express emotional
  feelings.


• The client will follow an established daily
  routine.


• The client will demonstrate alternative ways
  to deal with stress, anxiety, and other feelings.


• The client will demonstrate healthier behav-
  iors regarding rest, activity, and nutritional
  intake.

Intervention

PROVIDING HEALTH TEACHING

The nurse must help the client to establish a daily rou-

tine that includes improved health behaviors. Ade-

quate nutritional intake, improved sleep patterns,

and a realistic balance of activity and rest are all areas

with which the client may need assistance. The nurse

should expect resistance including protests from the

client that she or he does not feel well enough to do

these things. The challenge for the nurse is to validate

the client’s feelings while encouraging her or him to

participate in activities.

Nurse: “Let’s take a walk outside for some fresh

air.”(encouraging collaboration)

Client: “I wish I could, but I feel so terrible, I just

can’t do it.”

Nurse: “I know this is difficult, but some exercise

is essential. It will be a short walk.”(validation, en-

couraging collaboration)

The nurse can use a similar approach to gain

client participation in eating more nutritious foods,

getting up and dressed at a certain time every morn-

ing, and setting a regular bedtime. The nurse also can

19 SOMATOFORMDISORDERS 467

SELF-CONCEPT

Clients focus only on the physical part of themselves.
They are unlikely to think about personal character-
istics or strengths and are uncomfortable when asked
to do so. Clients who somatize have low self-esteem
and seem to deal with it by totally focusing on physi-
cal concerns. They lack confidence, have little success
in work situations, and have difficulty managing
daily life issues, which they relate solely to their phys-
ical status.

ROLES AND RELATIONSHIPS

Clients are unlikely to be employed, although they
may have a past work history. They often lose jobs
because of excessive absenteeism or inability to per-
form work; clients may have quit working voluntar-
ily because of poor physical health. Consumed with
seeking medical care, they have difficulty fulfilling
family roles. It is likely that these clients have few
friends and spend little time in social activities. They
may decline to see friends or to go out socially for fear
that they would become desperately ill away from
home. Most socialization takes place with members
of the health care community.
Clients may report a lack of family support and
understanding. Family members may tire of the
ceaseless complaints and the client’s refusal to accept
the absence of a medical diagnosis. The illnesses
and physical conditions often interfere with planned
family events such going on vacations or attending
family gatherings. Home life is often chaotic and
unpredictable.

PHYSIOLOGIC AND SELF-CARE CONCERNS

In addition to the multitude of physical complaints,
these clients often have legitimate needs in terms of
their health practices (Box 19-2). Clients who soma-
tize often have sleep pattern disturbances, lack basic
nutrition, and get no exercise. In addition, they may
be taking multiple prescriptions for pain or other
complaints. If a client has been using anxiolytics or
medications for pain, the nurse must consider the
possibility of withdrawal (see Chap. 17).

Box 19-2

➤ CLINICALNURSEALERT

Just because a client has been diagnosed with a so-

matoform disorder, do not automatically dismiss all fu-

ture complaints. They should be completely assessed

because the client could at any time develop a physi-

cal condition that would require medical attention.