Human Behavior: Burns Flashcards by Megan Foggia

What are the three stages of recovery for burn victims?

Resuscitative or critical stage
Acute stage
Long term rehabilitation stage

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T/F: Different stages of recovery have different psychological characteristics and treatment issues

True

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In stage 1, or the resuscitative stage, the patient is in the ICU. What are some psychosocial issues the patient may experience?

stressors of the ICU
cognitive challenges: drowsiness, confusion, disorientation
delirium and brief psychotic reactions can result from infections, drugs, withdrawal from alcohol, or metabolic complications
intubation may limit communication
pain
sleep disturbance
family is anxious or distressed

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Treatment issues in resuscitative/critical stage: What is the primary goal? What can be used to cope with ICU stressors? What can be used to manage pain? What things should be done with patient and family members?

primary goal is physical survival; use existing defense mechanisms/coping skills to cope with the ICU stressors; use medications and non-pharm methods like hypnosis and relaxation; comfort patient and educate/support family members

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In stage 2, or the acute stage, what is the medical focus on? Two types of pain.

restorative care; resting and procedural pain

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T/F: Treatment in the acute stage can be painful and retraumatizing.

True

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In the acute stage, patients are starting to understand the impact of their injuries. What kinds of psychosocial issues might arise?

guilt/anger
grief around losses
may involve loss of faith
depression
generalized anxiety
sleep disturbance
premorbid psychopathology
acute stress disorder and PTSD

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What percentage of burn patients experience depression? What is the severity of depression correlated with?

23-61%

Severity correlated with level of resting pain and with level of social support

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What percentage of burn patients experience generalized anxiety?

13-47%

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Exposure to trauma
Event involved threat of harm
Response involved intense fear, helplessness, or horror
3 or more dissociative symptoms
Numbing, detachment, absence of emotional responsiveness
Reduction in awareness of surroundings
Derealization
Depersonalization
Dissociative Amnesia
Reexperiencing (recurrent thoughts, images, dreams, flashbacks; distress on exposure to reminders of trauma)
Lasts 2 days – 4 weeks after traumatic event

acute stress disorder

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Exposure to trauma
Event involved threat of harm
Response involved intense fear, helplessness, or horror (disorganization and agitation in children)
1 or more intrusion symptoms
1 or more symptoms of avoidance of stimuli (internal or external)
2 or more symptoms of negative alterations in cognitions and mood
2 or more symptoms of increased arousal and reactvity
Lasts more than one month

PTSD

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How long does ASD last compared to PTSD?

ASD lasts 2 days - 4 weeks

PTSD lasts more than 1 month

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How many intrusion symptoms must a patient experience to have PTSD? Symptoms of avoidance of stimuli? Symptoms of negative alterations in cognitions and mood? Symptoms of increased arousal and reactivity?

1 or more; 1 or more; 2 or more; 2 or more

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Acute stage treatment issues:

Psychoeducation that symptoms resolve on their own
Psychotherapy for depression, anxiety, anger, grief, pain
Pharmacotherapy for sleep, depression, anxiety, pain
Social support is important
Premorbid psychopathology should be treated thru referral to therapy after discharge

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Psychoeducation that symptoms often resolve on their own should be used especially if there is no (blank)

premorbid psychopathology

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Do ASD symptoms always turn into PTSD?

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What can be used for pain management in the acute stage?

drugs
relaxation
imagery
hypnosis
distraction thru visual reality
CBT

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Active coping should be encouraged rather than avoidance. What’s an example of this?

repeatedly talk about the event rather than avoiding reminders

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Stage 3 is long term rehabilitation. When does this occur? What does it involve?

occurs after discharge from hospital; involves attempt to reintegrate into society; may involve continued outpatient treatment (procedures, treatment, physical rehab)

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Psychological issues in stage 3

Adjusting to practical limitations of injury
Physical: itching, limited endurance, decrease in function, amputations, disfigurement
Consider developmental issues
Depression, anx, grief PTSD

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Adjustments in stage 3

physical appearance
body image
lowered self-esteem
identity
return to work/school
financial problems
family strain
changing roles
sexual dysfunction
social withdrawal

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Stage 3 treatment issues:

Outpatient psychotherapy for adjustment, grief, depression, anxiety, PTSD
Individual and/or group therapy
Peer counseling
Social skills training
Prepare the burn victim’s community
Encourage social support
Improving self-esteem; managing disfigurement
Vocational rehabilitation
Address premorbid psychopathology

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T/F: Most pediatric burn patients adjust well, with 20-50% of most samples experiencing mild-moderate difficulties.

True

What percent of an adult sample demonstrates moderate-severe psych and/or social difficulties?

30%

T/F: Most burn survivors achieve a satisfying quality of life after the burn.

True

Who are burns common in?

children and adolescents

T/F: Most pediatric burn survivors adjust well.

True

Types of long term psychosocial sequelae in pediatric patients:

``` aggressiveness anxiety disturbed self-esteem depression PTSD ```

T/F: Long term adjustment to pediatric burns depends on many factors

True

Children's reactions to burns may be mediated by reactions of their (blank)

mothers (mothers feel distress, guilt overprotective)

In what area of the body are there greater difficulties in adjustment following burns?

exposes areas of skin (face, upper limbs)

Do younger children or adolescents have better psychosocial adjustment?

younger children

T/F: Adolescents with multiple home moves adjust more poorly.

True

In Pallua, Kunsebeck & Noah study looking at psychosocial adjustment 5 years after burn injury, what was the best predictor of psychosocial adjustment?

physical functioning (no limitations vs moderate functional impairment vs extensive functional loss)

T/F: physical functioning affects all areas of quality of life.

True

What is severity of depression correlated with?

severity of functional limitation | visibility of burns

What was the next best predictor of psychosocial adjustment after physical functioning?

location of burns (visible vs invisible)

What was one factor that was of less predictive value in determining psychosocial adjustment?

extent of body surface burned

Do burns affect personality or IQ?

What percent of burn victims need to change their work, depending on total body SA burned?

50-60%

T/F: After burns, you tend to see an increase in interactions with family

True

After burns, there is a decline in (blank), esp with women, regardless of size/location of burn

sexual satisfaction

After a burn, (blank) tends to improve after one year (except for those burned in their youth), esp with social support

self esteem

Are objective variables (size of burn, length of hospitalization) indicators of psychosocial adjustment?

Not necessarily

Social factors account for what percent of the variance in predicting psychosocial adjustment

40%

Personality traits can also predict adjustment to burns. What are some traits that predict better adjustment? What are some traits that predict poor adjustment?

extravert, self control, optimism, hope; neuroticism, LSE, social anx

Outcomes of burn victims NOT dependent on these factors

extend of injury depth of burn total area burned/scarred amputations

Outcomes of burn victims ARE dependent on these factors

quality of family and social support | patient's willingness to take social risks, extroversion

Blakeney's Guidelines for Treatment: The patient is assumed to be a normal person who is expected to fully recover. Full recovery is a difficult process over about (blank) years. Difficulties during adaptation are normal/expected. The (blank) must be included in the patient's treatment.

2; family

Three things that should be promoted in treatment

self-efficacy social skills social risk-taking

T/F: Therapy involves defining a new self-image. The new self-image should involve more than one of “burn survivor” over time

True

T/F: The stages of recovery from burns involve different psychosocial issues and treatment needs Psychosocial adjustment involves grieving what was lost and building a new life, including new identities Social support plays a vital role in adjustment for burn victims and should be encouraged

True

During what stage does grief begin?

Acute stage

Main difference between PTSD and ASD?

acute stress disorder only lasts 30 days -- PTSD much longer

What does the SCARED response refer to in stage 3?

``` staring curiosity anguish recoil embarassment dread ```