Nursing Care Plan for Somatic Symptom Disorder (SSD)

Pathophysiology

Somatic Symptom Disorder (SSD), previously known as  somatoform disorder, is a mental illness that causes unexplained physical symptoms such as pain that are distressing or disrupt the client’s normal functioning. When no physical cause for their symptoms can be found,clients often become upset and experience even more symptoms, or the symptoms may change. While there may be no explanation for the symptoms, the distress that the client feels is very real. These are the conditions that make up SSD:

  • Somatization disorder – involves physical symptoms in multiple systems
  • Conversion disorder – voluntary motor or sensory function symptoms
  • Pain disorder – pain with a strong psychological involvement
  • Body dysmorphic disorder -client is preoccupied with a real or imagined physical defect
  • Hypochondriasis – fear of having a life-threatening illness

Etiology

Diagnostic Criteria:

The diagnosis is made based on the amount of distress the client experiences.

  • Symptoms must be distressing or cause a disruption in the client’s daily life
  • Excessive thoughts, feelings or behaviors are exhibited by at least one of the following:
  • Disproportionate and ongoing thoughts about the seriousness of the symptoms
  • Ongoing high level of anxiety about the client’s general health or their symptoms
  • Excessive time and energy are spent on the symptoms or health concern
  • At least one symptom is constantly present for more than six months; other symptoms may come and go

Desired Outcome

Client’s pain will be managed;client will have optimal control of recognizing and managing symptoms related to psychological factors;client will have improved independence and functioning of daily activities

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 Interventions and Rationales

  1. Perform complete nursing assessment with vital signs

  2. Get baseline information and determine if there is a physical or explained cause of symptoms.

  3. Perform neurological assessment daily or per facility protocol

  4. Determine if client is having other neurological symptoms that may help determine treatment options.

  5. Assess if client is having suicidal or homicidal ideations or potential substance abuse

  6. Maintain client’s safety and the safety of others

  7. Assess pain per appropriate scale

  8. Pain is subjective and must be managed according to what the client feels and reports.

  9. Provide accommodation for client and make them more comfortable (ie., pillows, temperature, positioning, etc.)

  10. 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.

  11. Encourage behavior modification such as praising client and offering more attention when symptoms improve

  12. 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.

  13. Provide teaching and demonstrations of relaxation techniques including progressive muscle relaxation and deep breathing exercises

  14. 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.

  15. Provide education about feared or actual medical condition

  16. Helps client understand the condition in a more realistic light and helps alleviate fear and anxiety about a particular health concern.

  17. Administer medications and decrease dosage as appropriate

    • Pain relievers / analgesics
    • Antidepressants
    • Anti-anxiety medications
    • Antiemetics
  18. 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.

  19. Discuss symptoms with client and when they began, what makes them better or worse and how they have been managing these symptoms

  20. 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.

  21. Encourage client to keep a journal of symptoms and the events or factors that lead up to the development of symptoms and their resolution

  22. 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.

  23. Encourage client to involve family members in their care.

    Discuss signs and symptoms and what triggers those symptoms

  24. 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.


References

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