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Difficulty: HardMental Health Concepts

A nurse is planning care for a client newly diagnosed with conversion disorder. The client developed sudden bilateral lower extremity paralysis shortly after witnessing a severe motor vehicle collision. Extensive diagnostic testing has ruled out any physiological etiology. Which of the following nursing interventions are appropriate to include in the plan of care? Select all that apply.

  1. Acknowledge the client's physical symptoms without giving them excessive attention.Answer
  2. B
    Explain to the client that the paralysis is a psychological manifestation and they must attempt to walk.
  3. Promote independence by encouraging the client to perform self-care activities within their current functional ability.Answer
  4. D
    Confront the client with the negative diagnostic test results to demonstrate the absence of physiological illness.
  5. Explore the emotional distress surrounding the precipitating traumatic event when the client demonstrates readiness.Answer
  6. F
    Assign the unlicensed assistive personnel (UAP) to evaluate the client's coping mechanisms and readiness to discuss the trauma.

Answer

The appropriate interventions include acknowledging the physical symptoms without excessive focus, promoting independence in daily activities, and exploring the underlying emotional trauma when the client is ready.
In conversion disorder, the client's physical symptoms are real to them and stem from unconscious psychological conflict rather than a physical illness. Acknowledging the symptoms builds therapeutic trust, but the nurse must avoid excessive focus to prevent reinforcing secondary gain. Promoting independence helps maintain functional ability and self-esteem. Exploring the underlying emotional distress addresses the root psychological cause when the client is emotionally prepared.

Step-by-Step Solution

1
Analyze the client's diagnosis and symptom presentation.
The client has conversion disorder with paralysis, meaning the physical symptoms are real to the client but stem from an unconscious psychological conflict rather than a physical pathology.
Understanding the unconscious nature of conversion disorder is critical to avoid mistaking it for malingering (intentional faking).
2
Determine the optimal therapeutic communication approach.
The nurse should acknowledge the symptoms to build trust, avoid confrontation or logical arguments about test results, and wait for the client to demonstrate readiness before probing into the precipitating trauma.
Confrontation or invalidation will increase the client's anxiety and reinforce the psychological need for the physical symptom.
3
Identify appropriate milieu management and delegation strategies.
The nurse must encourage independence to prevent secondary gain, limit excessive attention to the symptom, and retain all evaluation and assessment tasks rather than delegating them to a UAP.
Promoting independence fosters recovery, and evaluating psychological readiness requires registered nursing judgment.

Key Concept

Management of Conversion Disorder (Functional Neurological Symptom Disorder)
Estimated Time:2m 0s
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Topics

Mental Health Concepts

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