trauma and stressor-related disorders

Question 1

Extremely distressing experience that causes severe emotional shock

Answer 1

trauma

Question 2

Reaction to extreme trauma, which is likely to cause pervasive distress to almost anyone

Answer 2

Posttraumatic stress disorder (PTSD)

Question 3

epidemiology of trauma

Answer 3

More than half of all individuals will experience a traumatic event
Less than 10% will develop PTSD

Question 4

etiology of PTSD

Answer 4

PTSD is more common in women than in men
Adjustment disorders are more common in women, unmarried individuals, and adolescents

Question 5

charateristic symptoms of PTSD and ASD

Answer 5

Re-experiencing the traumatic event
Sustained high level of anxiety or arousal
General numbing of responsiveness
Intrusive recollections or nightmares
Amnesia to certain aspects of the trauma
Depression
Survivor’s guilt
Substance use disorders
Anger and aggression
Relationship problems

Question 6

PTSD onset of symptoms

Answer 6

May begin within the first 3 months after the trauma
May be a delay of several months or even years

Question 7

ASD onset of symptoms

Answer 7

Symptoms are time limited
Up to 1 month following the trauma
If symptoms last longer than 1 month, diagnosis is PTSD

Question 8

trauma informed care

Answer 8

Recognizes widespread impact of trauma
Recognizes various paths for recovery
Recognizes the signs and symptoms of trauma in clients, families, and staff
Responds by fully integrating knowledge about trauma in policies, procedures and practices
Seeks to actively resist retraumatization

Question 9

nursing diagnosis for trauma-related disorders

Answer 9

Posttrauma syndrome
Complicated grieving

Question 10

the client outcomes for trauma related injury

Answer 10

Can acknowledge the traumatic event and the impact it has had on his or her life
Verbalizes that they experience fewer flashbacks, intrusive recollections, and nightmares than he or she was on admission
Can demonstrate adaptive coping strategies
Can concentrate and has made realistic goals for the future
Verbalizes no ideas or intent of self-harm

Question 11

ACE study

Answer 11

Kaiser Permanente 1995-1997
Adverse Childhood Experiences are common
The ACE score: used to assess cumulative childhood stress
Study findings:
Graded dose-response relationship between ACEs and negative health and well-being outcomes

Question 12

ACE pyramid conception to death

Answer 12

adverse childhood experiences
disrupted neurodevelopment
social, emotional, cognitive impairment
adoption of health risk behaviors
disease, disability, social problems
early death

Question 13

Nursing care of the client with a trauma-related disorder

Answer 13

Reassurance of safety
Decrease in maladaptive symptoms
Demonstration of more adaptive coping strategies
Adaptive progression through the grieving process

Question 14

evaluation for client with trauma related disorder

Answer 14

Can client discuss the traumatic event without experiencing panic anxiety?
Does client voluntarily discuss the traumatic event?
Can client discuss changes that have occurred in his or her life because of the traumatic event?
Does client verbalize that they have “flashbacks?”
Can client sleep 6-8 hours without medication?
Has client demonstrated new, adaptive coping strategies?

Question 15

adjustment disorders to trauma

Answer 15

Maladaptive reaction to identifiable stressors
Results in development of clinically significant emotional or behavioral symptoms
Symptoms occur within 3 months of the stressor and last no longer than 6 months

Question 16

types of adjustment disorders

Answer 16

Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed anxiety and depressed mood
Adjustment disorder with disturbance of conduct
Adjustment disorder with mixed disturbance of emotions and conduct
Adjustment disorder unspecified (impaired functioning)

Question 17

nursing diagnoses of adjustment disorders

Answer 17

Complicated grieving
Risk-prone health behavior
Anxiety

Question 18

outcomes of client with adjustment disorders

Answer 18

Verbalizes acceptable grieving behaviors
Demonstrates a reinvestment in environment
Accomplishes activities of daily living independently
Demonstrates ability to function adequately
Solves problems and sets realistic goals for the future

Question 19

planning for client with an adjustment disorder

Answer 19

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

Question 20

evaluation of questions for adjustment disorders

Answer 20

Does the client verbalize understanding of the grief process and his or her position in the process?
Does client recognize adaptive and maladaptive behaviors associated with the grief response?
Does the client demonstrate evidence of progression along the grief response?
Can the client accomplish activities of daily living independently?

Question 21

treatment for trauma related disorders

Answer 21

Cognitive therapy
Prolonged exposure therapy
Group/family therapy
Eye movement desensitization and reprocessing
Psychopharmacology

Question 22

psychopharmacology for trauma related disorders

Answer 22

Antidepressants: SSRIs first line
Anxiolytics
Antihypertensives
Other Medications: carbamazepine, valproic acid, and lithium carbonate

Question 23

treatment for adjustment disorders

Answer 23

Individual psychotherapy
Family therapy
Behavior therapy
Self-help groups
Crisis intervention
Psychopharmacology