Psychosocial Aspects of Burns Flashcards
What are the three stages of recovery for burn victims?
stage 1: resuscitative or critical stage
stage 2: acute stage
stage 3: long term rehab
Different stages of recovery have different (blank) and treatment issues.
psychological characteristics
Where do we find stage 1 patients?
in the ICU : (
What are these:
stressors of ICU (over or understimulation)
delirium and brief psychiotic reactions (from infections, drugs, withdrawals or metabolic complications)
intubation may limit communication
pain
sleep disturbances
family is anxious and distressed
Psychosocial issues facing stage 1 recovery burn patients
What are the treatment issues associated with stage 1 (resuscitative or critical stage)?
physical survival coping skills pain managment comfort educate and support family membranes
What is the medical focus of stage 2 (acute stage)?
restorative care
resting and procedural pain
What is the treatment like for stage 2?
painful and can be retraumatizing
What are these: understanding impact of injuries guilt/anger grief loss of faith depression (23-61%) anxiety (13-47%) sleep disturbance premorbid psychopathology actue stress disorder (1st month) PTSD (after first month)
psychosocial issues facing stage 2 (acute stage)
So describe an individual in the acute stage (stage 2)?
angry, hurting, traumatized, sleep deprived patient who is grieving
What is AST (acute stress disorder)?
exposure to trauma
3 or more dissociative symptoms
reexperiencing
last from 2 days to 4 weeks after event
What are these: numbing, detachment, absence of emotional responsiveness reduction in awareness of surroundings derealization depersonalization dissociative amnesia
Dissociative symptoms
What is this:
event involved threat of harm
response involved intense fear, helplessness, or horror (disorganization and agitation in children)
exposure to trauma
What is PTSD?
being exposed to a traume with 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 reactivity, last more than one month
(blank) is the inability to keep memories of the event from returning. (blank) is an attempt to avoid stimuli and triggers that may bring back those memories
intrusion
Avoidance
Do ASD symptoms always turn into PTSD?
no
Using (blank), symptoms often resolve on their own (especially if there is no premorbid psychology)
pyschoeducation
What is the treatment for depression, anxiety, anger, grief, pain?
psychotherapy w/ pain managment (drugs, relaxation, imagery, hypnosis, distraction through virtual reality, CBT) and encouraging coping skills rather than avoidance.
Use (blank) for the treatment of sleep, depression, anxiety, or pain.
pharmacotherapy
(blank) support is important for recovery.
social
(blank) should be treated through referral to therapy after discharge
premorbid pyschopathology
What stage is long term rehabilitation?
stage 3
What is this:
after discharge from hospital
involves attempt to reintegrate into society (SCARED response)
May involved continued outpatient treatment (procedures, surgery, physical rehabilitation)
Long term rehabilitation (stage 3)
What is the SCARED response?
What burn victims experience after integrating with society:
Staring, curiousity, anguish, recoil, embarrassment, dread
What are these: adjusting to practical limitation of injury physical issues development issues depression, anxiety, grief, PTSD Adjustments
Psychological issues associated with stage 3
What are some physical problems associated with stage 3?
itching, limited endurance, decrease in function, amputations, disfigurement
What are these: physical appearance, body image, lowered self-esteem identity return to work/school (may need vocational rehabilitation) financial problems family strain changing roles sexual dysfunction social withdrawal versus social support
Adjustments that are made during stage (3: psychological issues)
What are the treatment issues that need to be addressed for stage 3 patients?
outpatient psychotherapy social skills training prepare burn victim's community encourage social support improve self-esteem; manage disfigurement vocational rehab address premorbid psychopathology
What do you use outpatient psychotherapy for?
adjustment, grief, depression, anxiety, PTSD
T or F
Most pediatric burn patients adjust well, with 20-50% of most samples experiencing mild-moderate difficulties
T
T or F
Approx. 30% of any given adult sample demonstrates moderate-severe psychological and/or social difficulties
T
T or F
Most burn survivors achieve a satisfying quality of life after the burn
T
Tell me about burns and children
burns are common in children, but most survive well, but they can become aggressive, depressed and axious with low self esteem and PTSD symptoms
Greater difficulties in adjustement are associated with burns on (blank) areas of skin
exposed (face, upper limbs)
Children’s reactions of burns may be mediated by reactions of their (blank) who often feel distress, guilt and can be overprotective.
mother
Younger children have (blank) psychosocial adjustment than adolescents.
better
Do adolescents who move a lot adjust better or worse to burns?
worse
Did severity of burn indicate better ability to cope in adolescents?
no
In a study by Pallua, kunsebeck, and noah, they looked into psychosocial adjustments after 5 years after burn injury, what did they find out?
Physical function was best predictor.
Location of burns was next best predictor
extend of body surface burned was less predictive
What affects all areas of quality of life with burn victims?
physical limitations and functions
(blank) burns create disadvantage in social reintegration.
visible
What did Gilboa (study) find out about long-term psychosocial adjustment after burns?
(brains good (no change in personality or IQ), job change, increased family time, may get divorced, decreased sex life : (, improved self esteem after 1 year)
IS the size of burn or length of a hospitalization a good predictor of whether or not a person will adjust well to their burns?
NO :)
(blank) account for 40% of the variance in predicting psychosocial adjustment
social factors
So all in all who are the best at adjusting to burns?
extroverts, who are hopeful :)
(blank): these traits support and enable the victim to recruit social and emotional support
personality
What should treatment reinforce? s
ocial support, positive personality traits, and effective coping mechanisms
What is this:
appraisal of situation, reaction to social environment.
coping mechanisms
Other researchers (Blakeney et al.) have emphasized that outcomes (blank) depend on: Extent of the injury Depth of the burn Total area burned/scarred Amputations
Instead, adjustment (blank) depends on:
Quality of family and social support
Patient’s willingness to take social risks, extroversion
do NOT
Do
According to blakeney, what are the guidelines for treatment of burns?
normal person will have normal recovery, but the process will be difficult and take 2 years, and adaptation will be difficult and the “family” must be included in pnt’s treatment
What three personal skills should be promoted in treatment of burns?
self-efficacy, social skills, and social risk-taking.
Therapy for burn victims involves defining a new (blank)
self-image
The new (blank) should involve more than one of “burn survivor” over time
self-image
The (blank) from burns involved different psychosocial issues and treatment needs.
stages of recovery
(blank) involves grieving what was lost and building a new life, including new identities.
psychosocial adjustment
(blank) plays a vital role in adjustment for burn victims and should be encouraged.
Social support
When patients are in the ICU and its all crazy in there how should they cope?
by any means necessary so denial or repression or whatever is encouraged
What are the most commonly used anelgesics?
opoids (if you dont want to use this you can you NO, or anxiolytics)
Both procedural pain and background are difficult to deal with, why do some patient’s prefer procedural pain?
because it has an end in sight
