HB-burn victims Flashcards
What are the 3 stages of recovery for burn victims?
- Resuscitative or Critical Stage
- Acute Stage
- Long Term Rehabilitation Stage
What are the psychological issues associated w/ the resuscitative or critical stage? Where is the patient at this point?
Patient in the ICU. Stressors of the ICU (under or overstimulation) Hallucinations or psychotic issues Cognitive Challenges Intubation Pain Sleep Disturbance Family Anxiety
What are the cognitive challenges associated w/ the critical stage?
drowsiness
confusion
disorientation
What are some causes of hallucinations or psychotic reactions during the critical stage?
infections
drugs
alcohol withdrawal
metabolic complications
Why might intubation be a problem?
b/c you can’t speak, say “I love you” to his loved ones.
Why is a particularly big problem that family members are anxious?
b/c this response from family members fosters the same response in the patient. Comfort & calm is vital.
What is the primary goal during the critical stage?
physical survival
What treatment issues are there during the critical stage?
pts will use defense mechanisms to deal w/ ICU stressors
use meds for pain
use hypnosis or relaxation methods to handle pain
family members need to be educated
comfort patient!!
T/F If a patient is in denial, they should be discouraged from using this defense mechanism during the critical stage.
False. People should use whichever defense mechanisms they want to…just want them to survive & keep fighting!!
What should you educate the family members about?
you should let them know that they need to be comforting rather than anxious b/c that will transmit to the patient.
You should also let them know what to expect w/ burn issues.
What is the focus of the acute stage?
focus is on restorative care
What is the patient experiencing during the acute stage?
resting & procedural pain (cleaning of wounds-retraumatizing; skin grafts)
What are the psychosocial issues during the acute stage?
patients begin to process what has happened to them
patient & family members start to feel guilt & anger
grief sets in
spiritual struggles: how could God have this happen?
depression
anxiety
sleep disturbance
premorbid psychopathology
acute stress disorder
Many burn victims are children who experienced ___ ____.
parental neglect
Explain the grief that patients might feel during the acute period.
perhaps the fire came from a car accident or house fire: could have lost close friends or pets or other things…
T/F Mental health professionals should not be used in the acute stage as patients still need to process through things themselves.
False: Mental health professionals are quite helpful during this stage.
What are examples of premorbid psychopathology? Burn victims often have higher rates of this. What are the implications of this?
Substance use disorders
Personality disorders
**these patients cope in more dysfunctional ways & have longer hospitalizations
What percentage of burn victims experience depression? What does the severity of this depression depend on?
23-61%
Level of resting pain & level of social support
What percentage of burn victims experience generalized anxiety?
13-47%
What is the difference between acute stress disorder & post traumatic stress disorder?
Acute: lasts less than 30 days involves dissociate symptoms flashbacks of trauma PTSD: lasts more than one month negative alterations to cognition intrusion symptom avoidance symptom increased arousal
T/F ASD always turns into PTSD.
False. It doesn’t always remain & progress to that.
What should be involved in terms of psychoeducation during the acute stage treatment?
tell patients that often symptoms can resolve on their own (things such as anxiety, ASD…)
premorbid psychopathology can be more challenging…
What would psychotherapy be used to treat during the acute stage treatment?
depression anxiety anger grief pain
What are the pain management techniques that are taught during psychotherapy in the acute stage?
drugs relaxation imagery hypnosis virtual reality CBT
Which coping strategies should be encouraged? Which should be discouraged?
Encouraged: active coping strategies
Discouraged: avoidance coping strategies
What might pharmacotherapy help to treat during the acute stage?
sleep
depression
anxiety
pain
What is the most important factor for recovery?
Social Support!!
How is virtual reality used in treatments?
when a person is getting a painful procedure involving their burns…they play a virtual reality game in the snow….it distracts from the pain & is the opposite of what they’re feeling.
What is stage 3? When does it begin & what does it involve?
Long Term Rehabilitation
begins after discharge from the hospital
involves reintegrating into society
continued outpatient procedures & rehab
What is the response that society has when burn victims go out?
SCARED response S: staring C: curiosity A: anguish R: recoil E: embarrassment D: dread
What is the main psychological issue during stage 3?
adjusting to practical limitations of injury also: depression anxiety grief PTSD
What are some of the physical issues you deal w/ during stage 3?
itching limited endurance decrease in function amputation disfigurement
What are the main things that patients have to adjust to during stage 3?
physical appearance-self esteem identity issues returning to work or school financial problems--hospital bills family strain-changing roles sexual dysfunction social withdrawal (hopefully instead-->social support)
Describe the treatment during Stage 3.
outpatient psychotherapy: adjustment, grief, depression, anxiety, PTSD thru peer counseling, group therapy, individual therapy
counseling for premorbid psychotherapy if it is present
social skills training–deal w/ SCARED
prepare patient’s community
maybe change jobs if necessary
encourage social support
Do pediatric burn patients adjust well?
Yes. 20-50% have mild-moderate difficulties
Do some adults have trouble adjusting?
30% of adults have moderate-severe difficulties
T/F Most burn survivors achieve a satisfying quality of life after the burn.
TRUE
T/F It is rare to have children burn victims.
FALSE. It is sadly common. But they adjust well.
When children have long-term psychological it is usu what?
aggressiveness anxiety disturbed self-esteem depression PTSD
What role do mothers have in their children’s adjustment to burns?
If they feel distress & guilt & are over-protective, it is worse for the child.
T/F Having more severe burns & having burns over visible parts of the body are correlated to more difficult psychological recovery.
False.
Burns on visible parts of the body are harder to recover from.
However, more severe burns don’t correlate with the recovery difficulty.
Who does better adjusting: young children or adolescents to burns? Also…what makes it harder for adolescents to adjust?
Young children are better at adjusting.
Harder for adolescents to adjust when they move from place to place.
What is the best predictor of psychosocial adjustment? Next best?
physical functioning: affects all areas of life quality
visibility of burns
What are the 2 things that severity of depression is correlated with?
severity of functional limitations
visibility of burns
Is percentage of body surface burned a predictor of psychosocial adjustment?
Not really…
What percentage of burn victims find that they need to change their jobs?
50-60%
How are patient’s family interactions & marriages affected?
increase in family interactions
conflicting info about affect on divorce
How does being burned affect sexual satisfaction?
it decreases for women regardless of size or location of burn.
Social support predict ____ % of variance in psychosocial adjustment.
40% of variance.
Social support predict ____ % of variance in psychosocial adjustment.
40% of variance.
What are personality traits that help with adjustment?
extraversion
self control
optimism
hope
What are personality traits that help with adjustment?
extraversion
self control
optimism
hope
What are personality traits that hurt adjustment?
neuroticism
LSE
social anxiety
What are personality traits that hurt adjustment?
neuroticism
LSE
social anxiety
Blakeney & other researchers state that the 2 most important predictors of social adjustment are….?
social support
patient’s willingness to take social risks
Blakeney & other researchers state that the 2 most important predictors of social adjustment are….?
social support
patient’s willingness to take social risks
BLakeney & other researchers state that certain factors don’t predict social adjustment at all. What are these factors?
extent of injury
depth of the burn
total area burned or scarred
amputations
BLakeney & other researchers state that certain factors don’t predict social adjustment at all. What are these factors?
extent of injury
depth of the burn
total area burned or scarred
amputations
About how long is the recovery process for a burn patient? Must family be considered a biological family?
about 2 years
of course not! Friends, support group…
About how long is the recovery process for a burn patient? Must family be considered a biological family?
about 2 years
of course not! Friends, support group…
Over time self-image should be? Should not be?
as a burn survivor, but so much more
shouldn’t be: burn victim
Over time self-image should be? Should not be?
as a burn survivor, but so much more
shouldn’t be: burn victim
