Exam 5 Flashcards
the concept of ___-___ response was known as shell shock, battle fatigue, accident neurosis, or posttraumatic neurosis.
post-trauma
the DSM-IV-TR described trauma that precedes ___ as an
event outside the range of usual human experience
Rape, war, physical attack, torture, or natural/manmade disaster
PTSD
Less than __% of trauma victims will develop PTSD
10
true or false: PTSD is more common in women than in men.
TRUE
Individuals who have difficulties with stress reactions to more “normal” events may be diagnosed with ____ disorder.
adjustment
adjustment disorders are more common in what demographics but can occur at any age
- women
- unmarried persons
- adolescents
Extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects
Trauma
A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or manmade disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes
PTSD
PTSD symptoms may begin within the first __ months after the trauma
May be a delay of several months or even years
3
The full symptom picture of PTSD must be present for more than __ month and cause significant interference with social, occupational, and other areas of functioning
1
similar to PTSD in terms of precipitating traumatic events and symptomatology.
Symptoms are time limited.
Up to 1 month following the trauma
If symptoms last longer than 1 month, the diagnosis is PTSD.
Acute stress disorder (ASD)
Seeks to explain why some individuals exposed to massive trauma develop PTSD while others do not
psychosocial theory
variable of the psychosocial theory include characteristics
1.
2.
3.
- traumatic experience
- the individual
- the recovery environment
specific characteristics have been identified as crucial in the determination of an individual’s long term response to stress
- stress and duration of stressor
- anticipatory grief
- exposure to death
- numbers affected by life threat
- amount of control over recurrence
- location where the trauma was experienced
the traumatic experience
variables that are considered important in determining an individual’s response to trauma include
- degree of ego-strength
- effectiveness of coping resources
- presence of preexisting psychopathology
- outcomes of previous experiences with stress and trauma
- temperament
- current psychosocial developmental stage
- demographics
the individual
the quality of the environment in which the individual attempts to work through the traumatic experience is correlated with the outcome
the recovery environment
Negative reinforcement leads to the reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior.
Avoidance behaviors
Psychic numbing
learning theory
these models consider the cognitive appraisal of an event and focus on world assumptions an individual makes about the world
cognitive theory
3 fundamental beliefs that people construct within a personal theory of reality (cognitive theory)
When there is some disequilibrium then we call on these fundamental beliefs to deal with the trauma
The world is benevolent and a source of joy.
The world is meaningful and controllable.
The self is worthy.
Dysfunctions in the ___-pituitary-adrenal axis have been linked to psychiatric illnesses including PTSD, depression, Alzheimer’s disease, and substance.
hypothalamic
studies have shown ___ administered shortly after exposure to a trauma reduced the incidence of PTSD
opioids
____, dopamine, and benzodiazepine receptors are other neurotransmitters believed to be dysregulated in individuals with PTSD.
norepinephrine
describes a philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care
trauma-informed care
trauma informed care
___ the widespread impact of trauma and various paths for recovery
___ the signs and symptoms of trauma in clients, families, staff, and all those involved with the system
___ by fully integrating knowledge about trauma in policies, procedures, and practices
___ to actively resist traumatization
realizes
recognizes
responds
seeks
Nursing diagnoses for trauma-related disorders
- postrauma syndrome
- complicated grieving
Defined as “a sustained maladaptive response to a traumatic, overwhelming event”
post trauma syndrome
Defined as “a disorder that occurs after death of a significant other in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment”
complicated grieving
these are ___ __ goals for post-trauma syndrome
the client will begin a healthy grief resolution initiating the process of psychological healing
the client will demonstrate ability to deal with emotional reactions in an individually appropriate manner
short-term
short term goal for complicated grieving diagnosis
client will verbalize feelings (guilt, anger, self-blame, hopelessness) associated with the trauma
this a ___-term goal for complicated grieving diagnosis
client will demonstrate progress in dealing with stages of grief and will verbalize a sense of optimism and hope for the future
long
Characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms
adjustment disorders
adjustment disorder symptoms occur within __ months of the stressor and last no longer than __ months
3
6
perceptions, emotions, anxieties, interpersonal, social, or economic events that are considered threatening to ones physical health, personal safety, or well being
stress
This category is the most commonly diagnosed adjustment disorder.
The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depressive disorder (MDD).
adjustment disorder with depressed mood
the symptoms of this adjustment disorder include those such as depressed mood, tearfulness, and feelings of hopelessness, exceed what is an expected or normative response to an identified stressor.
adjustment disorder with depressed mood
Predominant features of this category of adjustment disorders include
Disturbances in mood (depression, feelings of hopelessness and sadness)
Manifestations of anxiety (nervousness, worry, jitteriness) more intense than would be expected to be a normative response to an identified stressor
adjustment disorder with mixed anxiety and depressed mood
this adjustment disorder is Characterized by conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules
Examples include truancy, vandalism, reckless driving, fighting, and defaulting on legal responsibilities.
Differential diagnosis must be made from conduct disorder or antisocial personality disorder.
adjustment disorder with disturbance of conduct
Predominant features of this category of adjustment disorders include Emotional disturbances (e.g., anxiety or depression) Disturbances of conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy, vandalism, fighting)
adjustment disorder with mixed disturbance of emotions and conduct
This subtype of adjustment disorder diagnosis is used when the maladaptive reaction is not consistent with any of the other categories.
The individual may have physical complaints, withdraw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct.
adjustment disorder unspecified
with an adjustment disorder the individual shows ___ in social and occupational functioning or exhibits symptoms that are in excess of an expected reaction to the stressor
impairment
with adjustment disorders the ___ can be almost anything but an individual’s response to a particular stressor cannot be predicted
stressor
___ theory looks into how genetic factors influence individual risk for maladaptive response to stress and Vulnerability related to neurocognitive or intellectual developmental disorders
biological
this theory views adjustment disorder as a maladaptive response to stress caused by early childhood trauma, increased dependency, and retarded ego development. Other factors that influence adjustment disorder include
Vulnerability related to neurocognitive or intellectual developmental disorders
psychosocial theories
this theory takes into consideration the interaction between the individual and the environment, the type of stressor,
situational factors, and intrapersonal factors
transactional model of stress and adaptation
what are the nursing diagnoses for adjustment disorder
- complicated grieving
- risk-prone health behavior
- anxiety
these are nursing ___ to be done on a patient with adjustment disorder
Adaptive progression through the grief process
Helping the client achieve acceptance of a change in health status
Assisting with strategies to maintain anxiety at a manageable level
interventions
nursing diagnosis
“impaired ability to modify lifestyle/behaviors in a manner that improves health status”
risk-prone health behavior
treatment for trauma related disorders includes
cognitive theory
prolonged exposure therapy
group/family therapy
eye movement desensitization and reprocessing
____
psychopharmacology
this is a treatment for trauma-related disorders
strives to help the individual recognize and modify trauma-related thoughts and beliefs.
The individual learns to modify the relationships between thoughts and feelings, and to identify and challenge inaccurate or extreme automatic negative thoughts.
Goal is to replace these negative thoughts with more accurate and less distressing thoughts, and cope more effectively with feelings such as anger, guilt, and fear.
cognitive theory
behavioral therapy similar to implosion therapy or flooding.
Conducted in an imagined or real (in vivo) situation
In the imagined situation, the individual is exposed to repeated and prolonged mental recounting of the traumatic experience
serves to neutralize the memories so that they no longer result in anxious arousal or escape and avoidance behaviors
Prolonged exposure therapy (PE)
PE has ___ parts
- Education about the treatment
- Breathing retraining for relaxation
- Imagined exposure through repeated discussion about the trauma with a therapist
- Exposure to real-world situations related to the trauma
four
Strongly advocated for clients with PTSD and has proved especially effective with military veterans
Share their experiences with empathetic fellow veterans
Talk about problems in social adaptation
Discuss options for managing aggression toward others has been emphasized
group/family therapy
Integrative psychotherapy approach with a theoretical model that emphasizes brain’s information processing system and memories of disturbing experiences as the basis of pathology
the process involves rapid eye movements while processing painful emotions
while concentrating on a particular emotion or physical sensation surrounding the traumatic event, the client is asked to focus his or her eye movements on the therapists fingers as the therapist moves them from left to right and back again
eye movement desensitization and reprocessing (EMDR)
treatment for trauma related disorders
Although some individuals report rapid results with this therapy, research has indicated that between 5 and 12 sessions are required to achieve lasting treatment effects.
Treatment encompasses an eight-phase process.
eye movement desensitization and reprocessing (EMDR)
what is the first line of treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings
SSRIs
what medication is used to treat trauma related disorders
antidepressants
anxiolytics
antihypertensive
other medications
treatment for adjustment disorders include Individual psychotherapy Family therapy Behavior therapy Self-help groups Crisis intervention
psychopharmacology
Paroxetine and Sertraline are ___ used as the first line of treatment for PTSD
SSRIs
