Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
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Outline
Lesson Objectives for Somatic Symptom Disorder (SSD)
- Definition and Understanding:
- Define and understand Somatic Symptom Disorder (SSD) as a mental health condition characterized by excessive and distressing physical symptoms.
- Differentiate SSD from other somatic disorders and medical conditions.
- Diagnostic Criteria:
- Familiarize learners with the diagnostic criteria for SSD as outlined in recognized classification systems (e.g., DSM-5).
- Explore the key features, duration, and impact on daily functioning that contribute to the diagnosis.
- Etiology and Contributing Factors:
- Examine the multifactorial nature of SSD, including psychological, social, and cultural factors that may contribute to its development.
- Understand the relationship between stress, emotional distress, and the manifestation of physical symptoms.
- Assessment and Diagnosis:
- Learn the essential components of assessing individuals with suspected SSD, including a comprehensive psychiatric evaluation and consideration of comorbid conditions.
- Understand the challenges in diagnosing SSD and the importance of ruling out underlying medical conditions.
- Treatment Approaches:
- Explore evidence-based treatment approaches for SSD, encompassing psychotherapy, cognitive-behavioral therapy (CBT), and collaborative care involving mental health professionals and primary care providers.
- Understand the role of education, support, and therapeutic interventions in managing SSD symptoms.
Pathophysiology of Somatic Symptom Disorder (SSD)
- Central Nervous System Involvement:
- Somatic Symptom Disorder is associated with alterations in central nervous system processing. Dysregulation in the processing of sensory information and heightened attention to bodily sensations contribute to the manifestation of somatic symptoms.
- Neurotransmitter Imbalance:
- Imbalances in neurotransmitters, such as serotonin and norepinephrine, play a role in the development of SSD. Changes in these neurotransmitter levels may influence mood, perception of physical symptoms, and the overall experience of distress.
- Brain-Body Interaction:
- There is a complex interplay between psychological factors and physiological processes. Emotional distress, unresolved psychological conflicts, or trauma may manifest as physical symptoms, emphasizing the mind-body connection in SSD.
- Cognitive Processes:
- Cognitive processes, including attention, memory, and interpretation of bodily sensations, contribute to the maintenance of somatic symptoms. Patients with SSD may have heightened attention to physical sensations and tend to interpret them as indicative of serious illness.
- Stress Response System Activation:
- Chronic stress and unresolved emotional issues can activate the body’s stress response system, leading to physiological changes. This can result in a variety of symptoms, ranging from pain to gastrointestinal disturbances, as the body responds to perceived threats.
Etiology of Somatic Symptom Disorder (SSD)
- Psychological Factors:
- Psychological factors, such as unresolved trauma, chronic stress, or personality traits, contribute to the development of Somatic Symptom Disorder. Individuals with a history of adverse life events or difficulty coping with stress may be more susceptible.
- Genetic and Biological Factors:
- There may be a genetic predisposition to somatic symptom disorders, suggesting a hereditary component. Additionally, alterations in neurotransmitter levels and the functioning of the central nervous system could have a biological basis in some cases.
- Early Childhood Experiences:
- Adverse experiences during childhood, including neglect, abuse, or inconsistent caregiving, can influence the development of SSD. These early experiences may shape a person’s coping mechanisms and response to stressors later in life.
- Learned Behavior:
- Observational learning and reinforcement of illness behavior can contribute to the development and maintenance of somatic symptoms. Individuals who receive attention, sympathy, or tangible rewards for expressing physical distress may continue to exhibit such behaviors.
- Cultural and Societal Factors:
- Cultural norms and societal expectations regarding the expression of distress and seeking medical attention can influence the development of SSD. Cultural factors may shape the way individuals perceive and communicate physical symptoms.
Desired Outcome in the Management of Somatic Symptom Disorder (SSD)
- Symptom Reduction:
- Achieve a significant reduction in the intensity and frequency of somatic symptoms experienced by the individual.
- Enhance the patient’s ability to cope with stressors without manifesting distressing physical symptoms.
- Improved Functioning:
- Enhance daily functioning by addressing the impact of somatic symptoms on occupational, social, and interpersonal activities.
- Promote the individual’s engagement in meaningful activities and responsibilities.
- Psychosocial Well-being:
- Improve psychosocial well-being by addressing emotional distress and promoting adaptive coping strategies.
- Facilitate the development of a positive self-concept and self-esteem.
- Effective Coping Strategies:
- Assist the individual in acquiring and utilizing effective coping strategies to manage stressors and emotional conflicts.
- Enhance resilience and adaptive responses to life challenges.
- Collaborative Care Involvement:
- Foster collaboration between the individual, mental health professionals, and primary care providers to ensure comprehensive care.
- Encourage active participation in the treatment process and shared decision-making.
Somatic Symptom Disorder (SSD) Nursing Care Plan
Subjective Data:
- Pain
- Fatigue
- Shortness of breath
- Nausea
- Chest pain
- Vision problems
- Amnesia
- Food intolerance
- Sexual dysfunction
- Headaches
- Anxiety
- Dysphagia
Objective Data:
- Unremarkable imaging (X-ray, CT, MRI, ultrasound)
- Lab tests are WNL
- Vomiting
- Paralysis
Nursing Assessment for Somatic Symptom Disorder (SSD)
- Comprehensive Psychiatric Evaluation:
- Conduct a thorough psychosocial assessment to gather information on the nature and history of somatic symptoms.
- Explore the patient’s perception of symptom severity and the impact on daily life.
- Psychosocial History:
- Collect a detailed psychosocial history, including information on recent stressors, life changes, and emotional conflicts.
- Identify any patterns of symptom exacerbation related to psychosocial factors.
- Medical and Family History:
- Obtain a detailed medical history to rule out underlying medical conditions contributing to physical symptoms.
- Explore family history for any patterns of somatic symptoms or psychiatric disorders.
- Cognitive and Emotional Assessment:
- Assess cognitive processes and patterns of thinking, particularly related to health concerns and illness beliefs.
- Evaluate emotional states, including anxiety, depression, and other mood disturbances.
- Collaborative Communication:
- Establish open and collaborative communication with the patient, validating their experience while exploring the potential psychological contributors to somatic symptoms.
- Use therapeutic communication techniques to build rapport and trust.
- Functional Impact Assessment:
- Evaluate the functional impact of somatic symptoms on the individual’s daily activities, work, relationships, and overall quality of life.
- Identify areas of impairment and challenges in functioning.
- Coping Mechanisms:
- Explore the patient’s current coping mechanisms and strategies for managing stress and emotional distress.
- Assess the effectiveness of existing coping mechanisms and identify areas for improvement.
- Collaborative Care Planning:
- Collaborate with the healthcare team, including mental health professionals and primary care providers, to develop a comprehensive care plan.
- Involve the patient in setting realistic goals and objectives for symptom management and overall well-being.
Implementation for Somatic Symptom Disorder (SSD)
- Psychoeducation:
- Provide psychoeducation to the individual and their support system about the nature of SSD, emphasizing the mind-body connection.
- Educate on the role of stress and emotions in somatic symptoms and the potential for symptom improvement with psychological interventions.
- Cognitive-Behavioral Therapy (CBT):
- Facilitate access to individual or group CBT sessions, targeting maladaptive thought patterns and behaviors associated with somatic symptoms.
- Collaborate with mental health professionals to implement CBT interventions tailored to the patient’s specific needs.
- Stress-Reduction Techniques:
- Introduce and teach stress-reduction techniques such as mindfulness, relaxation exercises, and deep breathing.
- Encourage regular practice of these techniques to help manage emotional distress and reduce the occurrence of somatic symptoms.
- Collaborative Care Coordination:
- Foster communication and collaboration between mental health professionals, primary care providers, and other healthcare team members.
- Ensure a coordinated approach to care that addresses both psychological and physical aspects of health.
- Medication Management:
- Collaborate with the healthcare team to assess the potential role of medications, such as antidepressants or anxiolytics, in symptom management.
- Monitor medication adherence and side effects, providing education on their purpose and expected outcomes.
Nursing Interventions and Rationales
- Perform complete nursing assessment with vital signs
Get baseline information and determine if there is a physical or explained cause of symptoms.
- Perform neurological assessment daily or per facility protocol
Determine if client is having other neurological symptoms that may help determine treatment options.
- Assess if client is having suicidal or homicidal ideations or potential substance abuse
Maintain client’s safety and the safety of others
- Assess pain per appropriate scale
Pain is subjective and must be managed according to what the client feels and reports.
- Provide accommodation for client and make them more comfortable (ie., pillows, temperature, positioning, etc.)
This can help client feel accepted and develop rapport and trust. This can allow the client to feel more comfortable and express their feelings and emotions more readily to the healthcare team.
- Encourage behavior modification such as praising client and offering more attention when symptoms improve
Change the focus from what’s wrong to what’s right. Helps client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms.
- Provide teaching and demonstrations of relaxation techniques including progressive muscle relaxation and deep breathing exercises
This can help relieve acute pain and distress that the client may feel, but also helps them learn to control many symptoms through focus and calming the mind.
- Provide education about feared or actual medical condition
Helps client understand the condition in a more realistic light and helps alleviate fear and anxiety about a particular health concern.
- Administer medications and decrease dosage as appropriate
- Pain relievers / analgesics
- Antidepressants
- Anti-anxiety medications
- Antiemetics
Perceived pain and symptoms are to be treated appropriately, but as circumstance allows, decrease medication and continue offering praise for improvement of symptoms to encourage continuing positivity.
- Discuss symptoms with client and when they began, what makes them better or worse and how they have been managing these symptoms
This helps make a more definitive diagnosis and help determine how to best treat client. Helping the client determine the etiology of symptoms helps them to recognize and avoid situations that make symptoms worse.
- Encourage client to keep a journal of symptoms and the events or factors that lead up to the development of symptoms and their resolution
This is a technique of cognitive behavior therapy that helps the client understand what factors (usually stress) that prompt the onset of symptoms. It can also help the client determine a pattern of emotions surrounding the symptoms.
- Encourage client to involve family members in their care. Discuss signs and symptoms and what triggers those symptoms
Help the family to be aware and understand the reality of the client’s condition. This can be helpful in long-term management if client’s family is willing to provide realistic feedback and support.
Evaluation for Somatic Symptom Disorder (SSD)
- Symptom Monitoring:
- Regularly assess and monitor changes in the frequency and intensity of somatic symptoms.
- Use standardized assessment tools to quantify symptom severity and track progress over time.
- Functional Improvement:
- Evaluate improvements in the individual’s daily functioning, including their ability to engage in work, relationships, and recreational activities.
- Assess any enhancements in overall quality of life.
- Adherence to Interventions:
- Evaluate the individual’s adherence to recommended interventions, including attendance at therapy sessions, participation in stress-reduction activities, and medication compliance.
- Identify and address any barriers to treatment adherence.
- Coping Strategies Utilization:
- Assess the utilization and effectiveness of coping strategies learned during psychoeducation and therapy sessions.
- Explore the individual’s ability to apply adaptive coping mechanisms in response to stressors.
- Collaborative Care Effectiveness:
- Evaluate the effectiveness of collaborative care coordination in addressing both the psychological and physical aspects of SSD.
- Assess the patient’s satisfaction with the collaborative approach and make adjustments to the care plan as needed.
Regular and ongoing evaluation is essential for refining the care plan, optimizing treatment strategies, and promoting the individual’s long-term well-being. Adjustments to interventions can be made based on the evaluation results to achieve the desired outcomes in managing Somatic Symptom Disorder.
References
- https://www.aafp.org/afp/2007/1101/p1333.html
- https://www.psychiatry.org/patients-families/somatic-symptom-disorder/what-is-somatic-symptom-disorder
- https://medlineplus.gov/ency/article/000955.htm
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Transcript
This is a nursing care plan for somatic symptom disorder. Somatic symptom disorder also previously known as somatoform disorder is a mental illness and it causes unexplained physical symptoms such as pain, and it’s very distressing and it disrupts the patient’s normal functioning. While there may not be a physical reason for the symptoms, the patients oftentimes are upset because it’s real to them. There may not be an explanation, but the distress and pain that the client feels is very real. These are a few of the conditions that make up somatic symptom disorder. So first we have some somatization disorder that just involves physical symptoms. Then there’s a conversion disorder. That’s when there are motor or sensory function disorders, there’s a pain disorder and they have a strong feeling of pain with strong physiological involvement. There’s body dysmorphic disorder when they are preoccupied with an image or an imagined physical deficit.
And there’s a hypochondria, which is the fear of having a life-threatening illness. Some nursing considerations are that we want to assess and manage pain. The pain is real for these patients. So we want to make sure that we assess that we want to determine what is causing the condition. If at all possible, we want to see any causes or alleviating factors for the pain, any potential triggers. And we want to assess suicidal ideation. The desired outcome is that this patient’s pain is going to be managed. The patient’s going to have optimal control in recognizing and managing symptoms related to the psychological factors. The client is going to have improved independence and functioning of daily activities. So when a patient comes in and they are complaining of having pain, they are going to have a list of symptoms. We’re going to list out a few of them here. So the patient’s going to have pain. They’re going to be short of breath. They may have some nausea,and maybe some vomiting. They’ll have some vision problems. They also have some amnesia depending on what type of SSD that they have. They may complain of some sexual dysfunction, some headaches and dysphasia. So, difficulty swallowing.
What we’re going to observe is we are going to see something that is unremarkable. So we’re going to see imaging. We’re going to look at the objective data and we’re going to see the x-ray and the CT. So let’s write that here. So unremarkable x-rays CTS, MRIs, ultrasounds; they’re all going to be unremarkable. And guess what else is going to be unremarkable? Their lab results. Their lab tests are going to be within normal limits. So we’re not going to see any type of disorders that are going to present via blood draws on the imagery. They may complain of paralysis. The patient may manifest with paralysis.
Again, all of these things are very real to the patient. So what are some things that we can do with this condition with a SSD? Well, the first thing that I think as a nursing intervention is we need to assess their pain. We want to assess pain. Remember pain is very, very subjective. It’s what you feel is what the patient feels. Remember, we have to manage the pain, regardless of if it’s showing on the lab or on imaging or on the vital signs. We want to make sure we assess pain. Pain is real to patients. The last thing we want to do is to discuss symptoms with the client, when they began, and what makes them better or worse? If it’s pain, that’s what we call old carts with pain.
If it’s something else is going to help us make a more definitive diagnosis, and it’s going to help determine how to best treat the client, making sure that we help the client recognize and avoid situations that make symptoms worse; those triggers. So let’s discuss triggers. We want to discuss triggers next. We want to discuss signs and symptoms. So we want to discuss signs and symptoms and what triggers actually trigger those symptoms. We want to make sure that the family is aware and that they understand the reality of the client’s condition. It can really be helpful in long-term management. That’s, that’s the key long term management of the condition. We want to make sure that the family is willing to provide realistic feedback and support. Remember, this is a condition and where these signs and symptoms are real to the patient.
They manifest real inside of the patient. So we want to make sure that we’re supporting that. We also want to make sure that we assess the client and see if they are having suicidal or homicidal ideations or potential substance abuse. We want to make sure that the safety of the client and those around them is the number one priority. So we want to make sure we assess suicidal ideation and if appropriate, we will put the client on suicide precautions as well. And then we want to provide teaching and demonstrations of relaxation techniques. We want to include progressive muscle relaxation and deep breathing exercises. These exercises are non-pharmacological and these tend to really help these patients that are presenting with SSD. It’s going to help the client relieve acute pain and distress that they may feel, but also it’s going to help them learn to control and manage the symptoms through focus and calming.
Deep breathing exercises are what’s important for these patients so they can have a sense of control. So let’s take a look at the key points. Remember, the patho of this is that this is a mental illness. SSD is a mental illness that causes unexplained physical symptoms, such as pain. And it’s very disruptive to the patient’s life. The subjective data that the patient is going to present with is that they are going to have pain. They’re going to have fatigue. They’re going to have chest pain, anxiety, and shortness of breath. However, for us, it’s going to show vomiting. They’re all remarkable. CT, x-ray MRI. They’re going to have normal lab results. They may have some paralysis that manifests from the condition. Our first and number one thing is we’re going to do a good pain assessment. We want to make sure that we are on top of their pain because, remember, pain is subjective and it must be addressed.
Whether it may not be a physical reason for pain, we must address it per the policy of your facility. Also these patients, because of all of the things that are going on, are not listened to by their healthcare team. They are at an increased risk for suicide. So we want to assess if they have a plan, if they do have a plan, maybe we want to make a suicide contract with these patients. And then this is initiate a suicide risk. I know that this was a lot of content, but you all are going to get through it. Well, we love you guys; go out and be your best self today. And, as always, happy nursing.
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