PSYCHIA CHAPTER 13

• Posttraumatic Stress Disorder

  • A disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with a traumatic event such as a natural disaster, combat, or an assault
• A person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror.
• A person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror
• Subcategories of PTSD

  • Reexperiencing Trauma
  • Avoidance
  • Negative cognition or thoughts
  • Hyperarousal
• Reexperiencing Trauma

  through memories, dreams, flashbacks, or reactions to external cues about the event and therefore avoids stimuli associated with the trauma.
• Avoidance

  He or she reports losing a sense of connection and control over his or her life.
• Negative cognition or thoughts

  The person seeks comfort, safety, and security, but can actually become increasingly isolated over time, which can heighten the negative feelings he or she was trying to avoid.
• Hyperarousal

  The victim feels a numbing of general responsiveness and shows persistent signs of increased arousal such as insomnia, hyperarousal or hypervigilance, irritability, or angry outbursts.
• Related Disorders: PTSD

  • Adjustment Disorder
  • Acute Stress Disorder
  • Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED)
• Adjustment Disorder

  • A reaction to a stressful event that causes problems for the individual.

  • The person has more than the expected difficulty coping with or assimilating the event into his or her life
• Acute Stress Disorder

  • This occurs after a traumatic event and is characterized by reexperiencing, avoidance, and hyperarousal that occur from 3 days to 4 weeks following a trauma.

  • It can be a precursor to PTSD.
• Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED)

  • RAD occur before the age of 5 in response to the trauma of child abuse or neglect, called grossly pathogenic care.

  • The child with DSED exhibits unselective socialization, allowing or tolerating social interaction with caregivers and strangers alike.
• ETIOLOGY of PTSD

  • Causative trauma or event that occurs prior to the development of PTSD.

  • In other words, the effects of the trauma at the time, such as being directly involved, experiencing physical injury, or loss of loved ones in the event, are more powerful predictors of PTSD for most people.
• Treatment: PTSD

  • Counseling or Therapy
  • CBT
  • Exposure Therapy
  • Adaptive Disclosure
  • Cognitive Processing Therapy
  • Medications: SSI’s
• • PTSD can be diagnosed at any age (Bloch, 2017).
• Traumatic events such as natural disasters are not clustered in any particular age group. Elder people who fall and fracture a hip can experience PTSD.
• In addition, the current population of elders includes veterans of World War II who experienced PTSD, though it was not recognized as such at the time
• Often, it was called combat fatigue or shell shock. PTSD was identified as a common disorder in the elderly in Europe, linked to the war, as well as the resulting occupation.
• • Veterans of the Vietnam War, now in their 60s, are among some of the first people to be diagnosed with PTSD.
• Many among the elderly population have impaired quality of life from PTSD, including a negative impact on physical functioning and general health.
• Chronic PTSD may be associated with premature aging and dementia.
• Therefore, it is essential that the elderly receive adequate treatment for PTSD (Jakel, 2018).
• Community-Based Care: PTSD

  • Ask for support from others.
  • Avoid social isolation.
  • Join a support group.
  • Share emotions and experiences with others.
  • Follow a daily routine.
  • Set small, specific, achievable goals.
  • Accept feelings as they occur.
  • Get adequate sleep.
  • Eat a balanced, healthy diet.
  • Avoid alcohol and other drugs.
  • Practice stress reduction techniques.
• Dissociative Disorder

  is a subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory.
• Dissociative Disorder

  have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception.
• Dissociative Disorder

  This often interferes with the person’s relationships, ability to function in daily life, and ability to cope with the realities of the abusive or traumatic event.
• Dissociative Amnesia:

  The client cannot remember important personal information.
• Dissociative Identity Disorder

  The client displays two or more distinct identities or personality.
• Depersonalization /Derealization disorder:

  Persistent or recurrent feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream -like state in which the environment seems foggy or unreal (derealization).
• Treatment and Interventions

  • Survivors of abuse who have dissociative disorders are often involved in group or individual therapy in the community to address the long-term effects of their experiences. Therapy for clients who dissociate focuses on reassociation, or putting the consciousness back together.
• Treatment and interventions:

  This specialized treatment addresses trauma-based, dissociative symptoms. The goals of therapy are to improve quality of life, improved functional abilities, and reduced symptoms. Clients with dissociative disorders may be treated symptomatically, that is, with medications for anxiety or depression or both if these symptoms are predominant.
• Short Hospital Treatment for Survivors of Trauma and Abuse

  Clients with PTSD and dissociative disorders are found in all areas of health care, from clinics to primary care offices. The nurse is most likely to encounter these clients in acute care settings only when there are concerns for personal safety or the safety of others or when acute symptoms have become intense or overwhelming and require stabilization. Treatment in acute care is usually short-term, with the client returning to community-based treatment as quickly as possible.
• NURSING DIAGNOSIS

  • Post trauma Syndrome: An ongoing, maladaptive pattern of behavior in response to a traumatic event that posed a threat to the well-being of the individual.
• ASSESSMENT DATA OF POST TRAUMA SYNDROME

  • Flashbacks or reexperiencing the traumatic event(s)

  • Nightmares or recurrent dreams of the event or other trauma Sleep disturbances (e.g., insomnia, early awakening, or crying out in sleep)

  • Depression

  • Denial of feelings or emotional numbness
• ASSESSMENT DATA OF POST TRAUMA SYNDROME

  • Projection of feelings

  • Difficulty in expressing feelings

  • Anger (may not be overt)

  • Guilt or remorse

  • Low self-esteem

  • Frustration and irritability

  • Anxiety, panic, or separation anxiety

  • Fears—may be displaced or generalized (as in fear of men by survivors who have been raped by men)

  • Decreased concentration
• ASSESSMENT DATA OF POST TRAUMA SYNDROME

  • Difficulty expressing love or empathy

  • Difficulty experiencing pleasure

  • Difficulty with interpersonal relationships, marital problems, and divorce

  • Abuse in relationships

  • Sexual problems

  • Substance use

  • Employment problems

  • Physical symptoms
• EXPECTED OUTCOME

  Immediate

  • The client will:

  • Identify the traumatic event within 24 to 48 hours.

  • Demonstrate decreased physical symptoms within 2 to 3 days.

  • Verbalize the need to grieve loss(es) within 3 to 4 days.

  • Establish an adequate balance of rest, sleep, and activity; for example, sleep at least 4 hours per night within 3 to 4 days.

  • Demonstrate decreased anxiety, fear, guilt, and so forth within 4 to 5 days.

  • Participate in a treatment program; for example, join in a group activity or talk with staff for at least 30 minutes twice a day within 4 to 5 days.
• EXPECTED OUTCOME

  Stabilization

  • The client will:

  • Begin the grieving process; for example, talk with staff about grief related feelings and acknowledge the loss or event.

  • Express feelings directly and openly in nondestructive ways.

  • Identify strengths and weaknesses realistically; for example, make a list of abilities and review with staff.

  • Demonstrate an increased ability to cope with stress.

  • Eliminate substance use.

  • Verbalize knowledge of illness, treatment plan, or safe use of medications, if any
• Points to Consider When Working with Abused or Traumatized Clients

  • Clients who participate in counseling, groups, and/or self-help groups have the best long-term outcomes. It is important to encourage participation in all available therapies.
• Points to Consider When Working with Abused or Traumatized Clients

  • Clients who survive a trauma may have survivor’s guilt, believing they “should have died with everyone else.” Nurses will be most helpful by listening to clients’ feelings and avoiding pat responses or platitudes such as “Be glad you’re alive,” or “It was meant to be.”