NUR2200 WK5 GREEN BANK Q’s ONLY

Definition: Somatic Symptom Disorders affect individuals across the lifespan, not limited to a specific age group. They can occur in the elderly, particularly due to co-morbidities and chronic conditions.
Clinical Challenge: These disorders are often underdiagnosed or overlooked in older adults.
Nurse Teaching Interventions:
  - Relaxation Techniques:
    - Deep breathing exercises.
    - Guided imagery.
  - Manifestations: Patients may experience mental conditions resulting in symptoms such as back pain, chest pain, or abdominal pain.

Methadone: Used in the treatment of opioid withdrawal.
Disulfiram: Utilized for alcohol sobriety, serves as a deterrent; it can cause severe nausea and vomiting if alcohol is ingested (
- Note: Even touching alcohol based products, e.g., hand sanitizer, can induce nausea/vomiting).
Risperidone: Antipsychotic medication for bipolar disorder and schizophrenia.
Lithium: Employed in acute management of bipolar disorder and mania.
Diazepam: A benzodiazepine, prescribed for alcohol withdrawal, helps prevent seizures and alleviate anxiety; appropriate for use during life-threatening alcohol withdrawal emergencies.

Signs and Symptoms (S/S):
  - Central Nervous System (CNS) stimulation leading to:
    - Dilated pupils.
    - Insomnia.
    - Euphoric feelings.

Nutritional Deficiencies:
- Individuals with chronic alcohol use disorder often exhibit deficiencies in vitamins, particularly Vitamin B6; a common treatment involves a vitamin bag (banana bag).
Tolerance Development:
- Chronic exposure to alcohol leads to physical tolerance, requiring increased amounts to achieve the same effect.
- Risks of dependence due to decreased response from repeated use, necessitating increased substance intake.
Withdrawal Risks:
  - Two substances with potential fatal withdrawal effects are:
    - Benzodiazepines.
    - Alcohol.
  - Stopping either cold turkey after prolonged use can lead to seizures and death.
Opioid Withdrawal Symptoms:
- Symptoms include shivering, shaking, and severe flu-like manifestations, fostering suicidal thoughts.

Examples:
- Eszopiclone (Lunesta)
- Zolpidem (Ambien)
Note: These medications can cause seizures and are primarily utilized for insomnia treatment.

Onset: Occurs within hours of the last drink, with intensifying symptoms over 1-3 days.
CNS Effects: Chronic alcohol use depresses CNS function, and withdrawal evokes an autonomic response resulting in anxiety and diaphoresis.
Early Signs:
  - Anxiety.
  - Sweating/diahporesis.
  - Irritability.
  - Mood swings.
  - Tremors.
  - Dilated pupils.
  - Hypertension.
Priority Intervention: Immediate assessment to determine suicide risk, especially regarding:
- Depression + alcohol issues + withdrawal experiences.
- Recent personal losses (e.g., job loss, divorce).

Definitions and Examples:
  - Regression: Adopting child-like behaviors in stress situations (e.g., an adult sucking on a bottle).
  - Reaction Formation: Acting nice to someone the individual dislikes.
  - Splitting: Viewing people in all-or-nothing terms, typical in Borderline Personality Disorder.
  - Denial: Refusing to accept reality or facts.

Key Points:
  - Substance abuse disorders are not influenced by ethnicity or gender.
  - Common factors include:
    - Family history of addiction.
    - Low self-esteem.
    - Existing personality disorders (e.g., borderline).
  - BOWTIE Method:
    - Techniques for managing antisocial behaviors include:
      - Addressing bad behavior without ignoring it.
      - Positive reinforcement for good behavior.
      - Maintaining a low-stimuli environment when agitated.

Schizotypal Personality Disorder:
- Considered a precursor to schizophrenia, marked by odd beliefs and behaviors, such as the belief in magical thinking.
Anti-Social Personality Disorder:
- Characterized by disregard for laws and the rights of others, with a history of criminal behavior and lack of empathy.
Paranoid Personality Disorder:
- Exhibiting pervasive distrust and suspicion of others.
Avoidant Personality Disorder:
- Excessive shyness and avoidance of social situations; often dependent on others.
Narcissistic Personality Disorder:
- Exhibits grandiosity, a need for admiration, and can’t maintain functional relationships.
Histrionic Personality Disorder:
- Characterized by attention-seeking behaviors and exaggerated emotional expressions.

Clinical Approach:
  - Do not employ flooding or desensitization techniques; focus on providing reassurance and empathy.
  - Avoid confrontation regarding the reality of their symptoms.
  - Collaborate with the patient to help them manage their symptoms through therapy, guided imagery, and deep breathing exercises.
  - Treatment aims to alleviate the preoccupation with their health; note that having these disorders does not imply a co-existing bipolar condition, nor does it manifest solely as anxiety-related symptoms.