Trauma

Question 1

Trauma

Answer 1

A lasting emotional response that can happen because of living through a distressing event

Experiencing a traumatic event can harm a person’s sense of safety, sense of self, & ability to regulate emotions & navigate relationships

Adverse Childhood Experiences (ACEs)

Question 2

Life Events Checklist

Question 3

Coping & Trauma

Answer 3

Events may induce anxiety, grief, insomnia, & difficulty coping
- Some people work through the experience & return to their normal state
- Some may continue to have problems coping, managing emotions, & resuming normal ADLs

May develop:
- Adjustment disorder
- Acute stress disorder
- PTSD
- Dissociative disorder

Question 4

Acute Stress Disorder

Answer 4

Occurs after a traumatic event & is characterized by reexperiencing, avoidance, & hyperarousal that occur from 3 days–4 weeks following a trauma
- CAN BE A PRECURSOR TO PTSD

CBT involving exposure & anxiety management can help prevent the progression to PTSD

Question 5

Adjustment Disorder

Answer 5

A reaction to a stressful event that causes problems
- More than the expected difficulty coping w/ or assimilating the event
- Usually due to a change
Ex) Moving to another state
Symptoms may develop W/IN A MONTH, LASTING NO MORE THAN 6 MONTHs

At that time, the adjustment has been successful, or the person moves on to another diagnosis

Outpatient counseling or therapy is the most common and successful treatment

Question 6

Trauma & Brain Development

Answer 6

Research has shown that children are particularly vulnerable to trauma because of their rapidly developing brain.

During traumatic experiences, a child’s brain is in heightened state of stress and fear-related hormones are activated.

Although, stress is a normal part of life, when a child is exposed to chronic trauma, like abuse or neglect, the child’s brain remains in this heightened pattern.

Remaining in this heightened state can change the emotional, behavioral and cognitive functioning of the child to maintain and promote survival.

Over time, these traumatic experiences can have a significant impact on a child’s future behavior, emotional development, mental and physical health.

Question 7

Reactive Attachment Disorder & Disinhibited Social Engagement

Answer 7

Occur before 5 years of age in response to trauma (child abuse or neglect)

Child shows disturbed inappropriate social relatedness in most situations.

Rather than seeking comfort from caregivers to whom the child is emotionally attached, the child with RAD exhibits minimal social and emotional responses to others; lacks a positive affect; and may be sad, irritable, or afraid for no apparent reason.

They lack the hesitation in approaching or talking to strangers evident in most children their age

Question 8

Dissociative Amnesia

Answer 8

The client cannot remember important personal information (usually of a traumatic or stressful nature)

Question 9

Dissociative Identity Disorder

Answer 9

AKA Multiple Personality Disorder

The client displays two or more distinct identities or personality states that recurrently take control of their behavior.
- This is accompanied by the inability to recall important personal information.

Question 10

Depersonalization/derealization disorder

Answer 10

The client has a persistent or recurrent feeling of being detached from their mental processes or body (depersonalization) or sensation of being in a dream-like state in which the environment seems foggy or unreal (derealization).

The client is not psychotic or out of touch with reality.

Question 11

Posttraumatic Stress Disorder (PTSD)

Answer 11

When thoughts and memories of the traumatic event don’t go away or get worse, which can seriously disrupt a person’s ability to regulate their emotions and maintain healthy relationships

Question 12

PTSD DSM V-TR Criteria

Answer 12

The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see the following corresponding criteria:

Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing in person the event(s) as it (they) occurred to others.
Learning that the traumatic event(s) occurred to a close family member or a close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work-related.

Question 13

What are the 4 subcategories of symptoms in PTSD and what out of these categories would a person be diagnosed w/it?

Answer 13

1) Intrusion symptoms (one or more in this category).
2) Persistent avoidance (one or both specifiers).
3) Negative cognition or thoughts (two or more in this category).
4) Being on guard, or hyperarousal (two or more in this category

Question 14

Adverse Childhood Experiences (ACEs)

Answer 14

Underscores the impact of trauma on physical & mental health over time

The ACEs study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being

The study uses the ACE score, which is a total count of the number of adverse childhood experiences reported by respondents to assess the total amount
of stress during childhood.

The greater the number of ACEs the greater the risk for the following problems later in life including alcoholism, depression, multiple sexual partners, suicide attempts, smoking and liver disease among other negative health related issues.

Question 15

Effective Treatments for Patients w/ PTSD

Answer 15

Exposure therapy

Adaptive disclosure/Cognitive behavior therapy

Individual or group therapy with Trauma specialists

Eye Movement Desensitization Therapy

Medications for symptom management such as insomnia, anxiety, or hyperarousal.
- SSRI, SNRI are most effective, specifically fluoxetine, paroxetine, sertraline, and venlafaxine (Bisson et al., 2020).
- Evidence is lacking for the efficacy of benzodiazepines, although they are widely used in clinical practice.

A combination of meds & CBT is considered to be MORE EFFECTIVE than either one alone!!!

Question 16

Eye Movement Desensitization & Reprocessing Therapy (EMDR)

Answer 16

EMDR is a structured therapy that encourages the patient to focus briefly on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.

EMDR therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and PTSD symptoms.

Ongoing research supports positive clinical outcomes showing EMDR therapy as a helpful treatment for disorders such as anxiety, depression, OCD, chronic pain, addictions, and other distressing life experiences

EMDR therapy has even been superior to Prozac in trauma treatment (Van der Kolk et al., 2007). Shapiro and Forrest (2016) share thatmore than 7 million peoplehave been treated successfully by 110,000 therapists in 130 countries since 2016.

Question 17

Care of Clients w/ PTSD

Answer 17

Reveals that the client has a history of trauma or abuse.

It may be abuse as a child or in a current or recent relationship.
- It is generally not necessary or desirable for the client to detail specific events of the abuse or trauma; rather, in-depth discussion of the actual abuse is usually undertaken during individual psychotherapy sessions.

Question 18

Care of Clients w/ PTSD: General Appearance & Motor Behavior

Answer 18

Client often appears hyperalert and reacts to even small environmental noises with a startle response.

They may be uncomfortable if the nurse is too close physically and may require greater distance or personal space than most people

May appear anxious or agitated and may have difficulty sitting still, often needing to pace or move around the room
- Sometimes, the client may sit very still, seeming to curl up with arms around knees

Question 19

Care of Clients w/ PTSD: Mood & Affect

Answer 19

Nurse must remember that a wide range of emotions is possible, from passivity to anger.
-The client may look frightened or scared or agitated and hostile depending on their experience.

When the client experiences a flashback, they appear terrified and may cry, scream, or attempt to hide or run away.

When the client is dissociating, they may speak in a different tone of voice or appear numb with a vacant stare
- The client may report intense rage or anger or feeling dead inside and may be unable to identify any feelings or emotions

Question 20

Care of Clients w/ PTSD: Thought Processing & Content

Answer 20

Clients who have been abused or traumatized report reliving the trauma, often through nightmares or flashbacks
- Intrusive, persistent thoughts about the trauma interfere with the client’s ability to think about other things or to focus on daily living

Some clients report hallucinations or buzzing voices in their heads

Self-destructive thoughts and impulses as well as intermittent suicidal ideation are also common
- Some clients report fantasies in which they take revenge on their abusers.

Question 21

Care of Clients w/ PTSD: Sensorium & Intellectual Processes

Answer 21

During assessment of sensorium and intellectual processes, the nurse usually finds that the client is oriented to reality except if the client is experiencing a flashback or dissociative episode.
- Client may not respond to the nurse or may be unable to communicate at all.

The nurse may also find that clients who have been abused or traumatized have memory gaps, which are periods for which they have no clear memories.
- These periods may be short or extensive and are usually related to the time of the abuse or trauma.

Intrusive thoughts or ideas of self-harm often impair the client’s ability to concentrate or pay attention.

Question 22

Care of Clients w/ PTSD: Judgement & Insight

Answer 22

The client’s insight is often related to the duration of their problems with dissociation or PTSD

Early in treatment, the client may report little idea about the relationship of past trauma to their current symptoms and problems

Other clients may be quite knowledgeable if they have progressed further in treatment

The client’s ability to make decisions or solve problems may be impaired

Question 23

Care of Clients w/ PTSD: Self-Concept

Answer 23

The nurse is likely to find these clients have low self-esteem.
- They may believe they are bad people who somehow deserve or provoke the abuse

Many clients believe they are unworthy or damaged by their abusive experiences to the point that they will never be worthwhile or valued.

May believe they are going crazy and are out of control with no hope of regaining control

Clients may see themselves as helpless, hopeless, and worthless

Question 24

Care of Clients w/ PTSD: Roles & Relationships

Answer 24

Clients generally report a great deal of difficulty with all types of relationships.

Problems with authority figures often lead to problems at work, such as being unable to take direction from another or have another person monitor performance.

Close relationships are difficult or impossible because the client’s ability to trust others is severely compromised.
- Often the client has quit work or has been fired, and they may be estranged from family members.
- Intrusive thoughts, flashbacks, or dissociative episodes may interfere with the client’s ability to socialize with family or friends, and the client’s avoidant behavior may keep them from participating in social or family events

Question 25

Care of Clients w/ PTSD: Physiological Considerations

Answer 25

Most clients report difficulty sleeping because of nightmares or anxiety over anticipating nightmares.

Overeating or lack of appetite is also common.

Frequently, these clients use alcohol or other drugs to attempt to sleep or to blot out intrusive thoughts or memories

Question 26

The Nurse’s Response to Trauma & Stress

Answer 26

Evaluate your own experiences, feelings, attitudes, and beliefs about responses to trauma & stress
- Reflective practice

How can you take care of yourself?

Community Resiliency Model (CRM)

Resiliency Zone

Question 27

Resourcing Skill