Chapter 10 Trauma & Stress-Related and Dissociative Disorders

Question 1

Yuck factor
Exposed to extremely dangerous and life threatening situations. Experiencing something way beyond the norm
Sxs. Usually begin first 3 months after the trauma-however there may be a delay of months - not start right away; anytime after trauma potential exists
Diagnosed any age group
Any time a trauma occurs, the potential to develop PTSD exists
Really starting to study following the Vietnam war - came home not as heroes but as abused veterans

Answer 1

PTSD

Question 2

Increased arousal
Hyper alertness
Numbing of emotions - not feel
May see aggressive or bizarre behaviors
Startled response
Nightmares
Drug/alcohol use - self-med and numb self
May experience flashbacks-re-experience the event
Usually ongoing

Answer 2

PTSD symps

Question 3

As a result of:
Intrusive symptoms
Dissociative symptoms - avoid things creating stress; daydream: mild end
Avoidance symptoms
Arousal symptoms
By definition, acute stress disorder resolves within 1 month - symp not ongoing; work through in short-period time; therapy needed but short term

Answer 3

Acute stress disorder (ASD)

Question 4

Witnessing or experiencing a violent or gruesome death of or by an intimate
HCP, paramedics, police officers
Repeated exposure to aversive details of the event
Example: First responders who collect body parts, or police officers repeatedly exposed to details of child abuse

Answer 4

As a result of: - Acute stress disorder (ASD)

Question 5

Similarity: Same triggers (violent events or repeatedly witnessing violent or traumatic events); same or similar manifestations
Difference: Only acute stress disorder (ASD) resolves within 1 month

Answer 5

PTSD vs ASD - Compare and contrast the differences between posttraumatic stress disorder (PTSD) and acute Stress disorder (ASD)

Question 6

Seek out supportive person
Vent strong emotions - vomit them out helpful and imp
Think through one’s options and use px.-solving techniques
Perform physical activities and exercise to release energy - large motor type activity helpful
Use Relaxation techniques - depends on person

Answer 6

Coping strategies

Question 7

Listening to music, taking warm showers or baths, meditating, performing imagery or visualization exercises,using progressive muscle relaxation
Thought Stopping - snap rubberband to bring back to reality
Journaling
Cognitive therapy: replace worried self statements with + self statements
Grounding techniques - brings back to reality

Answer 7

Use Relaxation techniques - depends on person - Coping strategies

Question 8

Anxiety part PTSD
Decrease client’s anxiety
Cognitive therapy
Present positive & hopeful attitude
Assure client they are not going crazy
Help client identify anxieties and decrease via therapeutic activities
Teach relaxation techniques and help focus on solving one problem at a time
Group & 1:1 therapy

Answer 8

Nursing objectives for anxiety

Question 9

Individual Psychotherapy
Cognitive Therapy
Behavior: (desensitization (slowly introduce things that causing anxiety), flooding)
Group Therapy (esp. Helpful with PTSD)
Psychopharmacology (not med - med depending on symp)

Answer 9

Treatment modalities

Question 10

Compassion Fatigue and Secondary Trauma - healthcare set-up for it; self-awareness; awareness PTSD and this part life; sooner recognize this and sooner seek help better; need help in life; reach out if need help
The makeup of the nurse can potentiate compassion fatigue.
Recognize it in others before recognize in self

Answer 10

Care for the caregiver

Question 11

Examples of nurses who are at high risk include those who work in the following departments and disciplines:
Hospice
Pediatrics
Emergency
Oncology
Forensics
Psychiatric

Answer 11

Compassion Fatigue and Secondary Trauma - healthcare set-up for it; self-awareness; awareness PTSD and this part life; sooner recognize this and sooner seek help better; need help in life; reach out if need help - Care for the caregiver

Question 12

Benzodiazepines (Xanax, Ativan, Valium) act directly on GABA. Effects are felt quickly. BuSpar takes up to 2-4 weeks to show results-works on serotonin-it has a lower potential for dependency and abuse
Antidepressants (i.e. Prozac, Paxil, Zoloft): SSRI’s effective with panic disorders
Antihypertensives: (beta blockers)-most effective in treatment of acute situational anxiety-test anxiety

Answer 12

Psychopharmacology

Question 13

Disturbances in a normally well-integrated continuum of consciousness, memory, identity, and perception.
Dissociation
Intact reality testing
Includes amnesiac states.

Answer 13

Dissociative disorders hallmark characteristics

Question 14

is the unconscious defense mechanism to protect an individual against overwhelming anxiety. Spectrum

Answer 14

Dissociation - Dissociative disorders hallmark characteristics

Question 15

is not delusional and not hallucinating.

Answer 15

Intact reality testing - Dissociative disorders hallmark characteristics

Question 16

Characterized by the presence of multiple, real, and/or physical symptoms for which no evidence of medical illness is revealed
Accompanied by abnormal thoughts, feelings and reactions to these symptoms
Phys issue cannot find a cause but cannot move arm, talk, not hear; psychological response in life

Answer 16

Somatic Symptom Disorders

Question 17

Characterized by mental detachment from conscious awareness in reaction to abuse
Involve a disruption in the consciousness with a significant impairment in memory, identity, social functioning, or perceptions of self
Detached from conscious awareness - dissociative identity disorder - one few things some sort abuse in background

Answer 17

Dissociative Disorders

Question 18

Depersonalization/Derealization Disorder
Dissociative Amnesia
Dissociative Amnesia with Fugue
Dissociative Identity Disorder (DID)

Answer 18

Dissociative disorders

Question 19

Forgetting - not remember
Not know who are or where belong
Psychologically induced memory loss and inability to recall important personal information after severe stressor
Scenario: Bob’s vehicle hits an improvised explosive device (IED). He and his friend are thrown onto the sand. Bob’s friend dies. A convoy passes 2 hours later. Bob is sitting by his friend, staring into space, and is unable to state who or where he is. Bob states that he does not remember the explosion.

Answer 19

Dissociative Amnesia

Question 20

Sudden, unexpected travel from a customary locale, and the inability to recall one’s identity after a traumatic event
Traveled somewhere else but not know who are or where belong
Scenario: Lin, 19 years old, is admitted to the psychiatric unit after police found her wandering in a Louisiana shopping mall parking lot. Lin does not recall who she is or where she lives. It is later found that Lin lives in Oregon, where her fiancé had cancelled their wedding 2 weeks earlier.

Answer 20

Dissociative Amnesia with Fugue

Question 21

Trauma: abuse (phys/sexual)
Diff personalities protect them in anxious states; diff purposes for indivs; facial expression and whole identity changes; treatment: recognize alternative indivs (alternates) doing and helping them with - intense therapy on when bring them out
Formerly known as multiple personality disorder, which is the presence of two or more personality states that control behavior.
Each alternate personality (alter) has its own pattern of perceiving, affect, cognition, behavior, and memories.
Severe sexual, physical, and/or psychologic trauma in childhood predisposes an individual to DID.
Scenario: The psychiatric nurse practitioner who visits a women’s free health center notices that Taylor, 23, dresses, acts, writes, and speaks in extremely different ways at each visit and has lapses of memory in time, unable to remember the previous visits.

Answer 21

Dissociative identity disorder (DID)

Question 22

Communication Guidelines:
Health Teaching and Health Promotion:
Milieu Therapy:
Psychotherapy:
Pharmacologic:

Answer 22

Implementation: dissociative disorders

Question 23

Gentle, supportive, slowly build rapport

Answer 23

Communication Guidelines: - Implementation: dissociative disorders

Question 24

Coping skills, stress management; techniques to interrupt a dissociative episode; journal to identify triggers

Answer 24

Health Teaching and Health Promotion: - Implementation: dissociative disorders

Question 25

safe; quiet, structured, supportive

Answer 25

Milieu Therapy: - Implementation: dissociative disorders

Question 26

most effective treatment (special training required)

Answer 26

Psychotherapy: - Implementation: dissociative disorders

Question 27

mostly for co-morbid symptoms - depends on disorder

Answer 27

Pharmacologic: - Implementation: dissociative disorders

Question 28

Patient will verbalize clear sense of personal identity - diff alters and what do to them; how lower anxiety and stress levels
Patient will report decrease in stress (using a scale of 1 to 10)
Patient will report comfort with role expectations
Patient will plan coping strategies for stressful situations
Patient will refrain from injuring self - high risk for injury

Answer 28

Outcomes: dissociative disorders - hoping

Question 29

Patient safety has been maintained - SAFETY
Anxiety has been reduced and the patient has returned to a functional state. - other ways to cope so not dissociating
Conflicts have been explored.
New coping strategies have permitted the patient to function at a better level.
Stress is handled adaptively, without the use of dissociation.

Answer 29

Evaluation: dissociative disorders

Question 30

Which of the following is an appropriate expected outcome when working with a patient with DID?
A.Patient will verbalize clear sense of personal identity.
B.Patient will express feelings verbally rather than through the development of physical symptoms.
C.Patient will experience no symptoms as a result of psychologic distress.
D.Patient will understand the distinction between true physical pain and imagined pain.

Answer 30

Answer: A
A - (Recovery from DID can take long-term therapy to address the abuse, dissolve the amnesic barriers between alter personalities leading to integration, and develop healthier coping skills.)
B - (This is an appropriate goal for a somatization disorder, rather than a dissociative disorder.)
C - (Some symptoms will probably always exist.)
D - (No clear distinction exists for the patient or health care provider.)