hello future nurses this afternoon we're going to Rego over the physical problem psychological sources which is chapter 22 these are your um student learning outcomes they're a good thing to kind of study because it tells you kind of where we're going on the test so emotions in health right fight or flight health is that whole concept that embodies who a person is as a whole animals even have fight ORF flight responses that protect us during times of threats or illness anxiety and stress there's tons of different things that stress us out in life physiological stress is that biochemical fight or flight General Adaptation though is how our body is responding to stress and there's three stages right that alarm st stage your body recognizes there's stress that something's happening and It prepares to fight the stage of resistance the body if you can't adapt it goes on into the stage of exhaustion in the stage of exhaust exhaustion this is when illness can occur and it can affect any body system multiple or just one the immune system is affected by stress more so because when we're exhausted it's just not going to function right our immune system is going to be tired too if we're not eating right our body doesn't have the nutrients to fight off whatever it is that's affecting us physically and psychologically the psychological aspect of an individual having a St that sentence is weird in my head the psychological aspects of an individual have a strong impact on the ability to identify and successfully cope with stress so whatever we have going on mentally that is going to affect how we cope these are breaking up into three different types of disorders seator psychosomatic and psychophysical disorders anxiety and stress children right we've talked about children repeatedly children learn how to perceive and respond to stress from the world around around them how do their parents act how do their friends at school act you know if they act a certain way what is everyone's reactions to them children who come from an unstable home environment are going to have in general just exaggerated hormonal mechanisms how they respond to stress is going to be maladaptive families who emotionally support and encourage their children and teach them how to cope with stress are going to have fewer physical complaints so this is at box 22.1 in your book take a look at okay lots of conditions are affected psychobiologic right I will tell you over and over again the more I study and the more I do the more stress I get the more migraines I get um pain is a big one GI system most of our serotonin is made in our gut and serotonin is going to affect mood impotence is a big one for guys PMS in females even hyperthyroidism diabetes because of how hormones get pulled into it common psychophysical problems stress related right the body system experiences stress and you get it you feel it in the GI track you know that's the butterflies in the stomach a kid who has a test the next day and their stomach hurts psychophysical theories there's a stress response Theory theory that says we're just biochemically patterned to react to stress Carl Jung I honestly wouldn't worry about him symbolism is a attached to a symptom or an illness whatever is wrong we can deep down read it that it's something else going on we will psychophysical that's Eric fro certain personalities are prone to develop certain illnesses some people are just more anxious and those people who are more anxious might be more prone to develop you know GI issues than someone else the organic weakness Theory says that one body system and each person is going to be more sensitive than others so somata form disorders somatization is a feeling of physical symptoms in the absence of a disease or if a disease is present out of proportion to an ailment right that's that man flu guy gets sick and he has the slight sniffles and the world is ending it is out of proportion to the ailment 80% of healthy people have a sematic symptom in any given week so that's most of us signs and symptoms of the illness could be a way of coping with stress and emotional stress is going to deplete the body of energies which affects the immune function which can make a person more susceptible to illness and disease cultural influences culture comes into play table 22.1 in your book Compares three culturally related semantization orders it's good to look at we need to make sure we're aware of our clients culture how it affects their um physical and emotional health and we need to make sure we're learning about other cultures to have a seaform disorder there has to be no medical condition that explains it the disorder is going to disrupt or impact someone's functioning and the client has to be unaware or is unable to express his or her emotional distress right so especially in children we're children are huge with somat formform disorders right it's difficult because they can't necessarily Express the emotions they might not know what they're feeling however when the physical symptoms are present and a child's functioning deteriorates after a time of significant stress we have to consider samator disorder thematic symptom disorder briquette syndrome or old school known as hysteria it's polysymptomatic so there's many signs and symptoms genetic environmental factions factors can contribute to the risks of developing it clients are going to see multiple physicians at a time and most importantly it's going to be involuntary so this sematic symptom disorder someone has a pain and we have done all the tests in the world and we can find there's nothing wrong with them someone is compl compling of you know GI upset and diarrhea and we can scope in every direction we can test and culture stool we can do everything however everything is coming back that every test is normal does the patient have the pain does the patient have the GI upset yes but there's not a physical reason or physical cause for this we watch this video where it talked about the censes remember we had the little boy who was getting hooked up to that EEG and then all of a sudden they asked about school and he passed out school was stressing him out and as a reaction his body would just give up and he would pass out how to differentiate somatization disorder from a medical problem if there is multiple organ system involved it's most likely a somatization disorder if there's an early onset and it's chronic condition but there is no change over time most likely a sematic symptom disorder right chronic conditions are mostly going to get worse over time so if this person has had this one condition and it does not change in characteristics we need to question it and lab values and testing are so important if we run cat skins and pet scans and MRIs and eegs and everything and nothing's coming up that everything is normal we need to look at what's going on psychologically too conversion disorder takes sematic disorders a step step further these are also involuntary symptoms but they're neurological this is that person who wakes up one day and they're unable to walk or they're blind or deaf right some type of neurological deficit that comes on suddenly watch this video about this guy who just woke up and couldn't walk one day there thought to result from emotional conflict one of the biggest things to look for with this is that label indifference lack of concern or indifference about signs or symptoms if I woke up one day and I couldn't walk I would be raising hell and I would be like fighting to try to figure out what is wrong you will run every test on me because there has to be something wrong these people wake up and it's like oh hey guess what I can't walk today signs and symptoms are keeping more in line with what the individual's idea of what the problem should be not necessarily what we think illness anxiety disorder is formerly known as hypochondriasis these are your hypochondriacs right 25th doctor's visit where's the proof like they want proof that something's wrong with them there just is no proof intense fear or preoccupation with having a serious disease or medical condition based on misinterpreting their body signs so there could be symptoms present but they're just taking it a step further the clients are going to doctor shop because if you don't tell them what they want to hear they are going to find a doctor that does if can begin at any age and it's difficult to treat because they're just not going to accept what you say right hey this is what's wrong with you not this they're basically going to leave AMA and tell you they don't care five criteria the client must meet to get the diagnosis of hypochondriasis or illness anxiety disorder preoccupation with fear serious disease the preoccupation is not delusional the preoccupation persists despite negative diagnosing testing results the preoccupation causes significant distress or impairment in activities of daily living and it has to be present for at least six months watch this video she is certain she has cancer right she's like but I feel it there's this lump it moves around inside of me and the doctor's like we've done all the tests you don't have cancer and she's so certain she has cancer factitious disorders and mingering factitious disorders and mingering differ from some mform disorders and that the signs and symptoms are produced intentionally these symptoms are voluntary the clients are not actually sick they want some type of gate factitious disorder by proxy is what was known as Munch Housen by proxy right we watched that Gypsy Rose video today gypsy's Rose mother told her she was sick gave her all these meds she dealt with all these side effects and then eventually she killed her mom mom had Munch housin by proxy gain primary gain and mingering come into play with this factitious disorders and mingering usually happen because the person wants to get something out of it right it could be you know primary that they're trying to mass their inner to turmoil they're upset they're anxious about something and being sick just makes them feel better secondary gain right if I get sick I can go to bed and sleep for a few days and make my husband deal with the kids so I don't have to or you want special attention right in that Dr Phil interview with Gypsy Rose they talked about you know her mom got money they got this house you know you got to make a wish trip to Disney different things happen malingerers the individuals producing the symptoms to mean a recogniz a bur goal we see this a lot in the veteran population because if you're sick the VA gives you money these patients have lots and lots and lots of emergency room visits they're going to be very knowledgeable about medicine they are going to going to leave if that you tell them hey this is right or this is wrong in some inst instances they're the kids really are sick right so in the six sense the kids were sick because the mother was poisoning them these are parents who when you walk out of the room they're going to take feal matter and stick it in an IV to get make their kids septic so we have to watch out for signs and symptoms frequent ER visits and children where there's really nothing wrong with them and where the parents aren't taking no for an answer we watch this video over what are factitious disorders this kind of explains each one of them right so somatic symptom disorders excessive anxiety and preoccupation with one unexplained symptom illness anxiety disorders or hypochondriacs they are so terrified of having this illness despite no symptoms and consistently negative Labs conversion disorder or neurological symptoms this is a patient who wakes up paralyzed blind deaf something along and it's an acute onset associated with stress factitious disorder is someone who is becoming sick to get something out of it or fous disorder by proxy making someone else sick so they can get the attention malingering falsification or exaggerating of symptoms for secondary gain right mingering that person who's in a minor fender bender and they're in the courtroom with the neck brace saying they can't move their neck how horrible their life is and then someone makes a noise and they turn their head well they want money from the court case it's slipping and falling at Walmart and yelling on the floor that you're so injured so you can Su Walmart lingering so implications for care providers sematic and all of these kind of psychosomatic conditions are difficult because how do you know what to believe or not to believe we have to rule out the presence of physical disease or dysfunction we have to do a complete history and physical assessment seriously even as a psych nurse I'm pulling out my stethoscope and I'm doing a head to toe I'm going to listen to your you know abdomen your four corners I'm going to do listen to every single you know lobe of your lung for the full minute to see what is true or not true we need to form a relationship with the patient right first step of Psych when we get to psych have that therapeutic relationship we have to Prior prioritize our ABC's AA breathing circulation we have to prioritize safety and we have to look at the bottom how is our patient doing physically we have to encourage our patient to talk about their feelings and emotional states rather than the physical complaints in that one practice question and we'll go over them again in the slide right we the conversion disorder patient we're not going to focus on the fact that he can't walk we're going to focus on what he can do and we need to meet the physical needs when necessary but we have to encourage Independence in the patients those practice questions we did in class which reason best accounts for the physical symptoms in a client with a sematic symptom disorder the answer was C it relieves to prevent or relieve symptoms of anxiety right anxiety and depression are common in sematic symptom disorders a delusional thinking we see in schizophrenia b symptoms allow the client to avoid unpleasant activity not be the center of attention and D that focuses on the family not the client so the answer to this one is c a client comes to the healthcare provider's office with reports of chronic pain the client's history reflects numerous visits to the healthc care to the healthcare provider for pain relief what therapies will be effective in caring for this client select all that apply which are the worst and CLE questions ever so in this patient what we're going to do is behavioral therapy relaxation techniques hypnosis even and tri cyclic anti-depressants we want to avoid lowd do narcotics because they're still narcotics right they can be habit forming and problematic when managing chronic pain disorders if long-term narcotics in needs that goes way above our heads into a pain management provider behavioral therapies can work on stress reduction and teaching coping skills relaxation techniques can just kind of help them calm down hypnosis can be used not on here they can also do acupuncture massage Chiropractics right complimentary alternative Med medicine there's tons of different things they can use tricyclic anti-depressants can also help we've talked about this previously tricyclic anti-depressants are dangerous because when patients overdose they it can kill them but neene amitryptiline all of them can help with the psychological symptoms and they are shown to help with pain too especially neuropathic pain okay okay we already kind of talked about this one a client is diagnosed with conversion disorder with paralysis of the legs what's the best nursing intervention for the nurse to use D avoid focusing on the client's physical limitations the paralysis is used as an unhealthy way of expressing unmet psychological needs we should avoid speaking about the paralysis right we want to shift the client the mental aspect um the others Focus too much on the paralysis they all Focus too much on the paralysis we need to recognize the underlying psychological motivations not just the fact that you're paral paralyzed the nurse is reviewing a nursing care plan for a client with psychophysiologic disorder nursing intervention should address which symptoms right psychophysiologic is just a nice big fancy word to say psychologic and physical combined so what interventions are we going to address with this patient the answer is C we're going to address physical symptoms psychosocial and spiritual we have to address everything even those that are not life-threatening or that really might not be in the problem our care plans need to be comprehensive okay that is the end with this chapter I'm going to pause now let me know if yall have any questions and we'll finish the rest in a few weeks