trauma and stressor-related disorders Flashcards
Extremely distressing experience that causes severe emotional shock
trauma
Reaction to extreme trauma, which is likely to cause pervasive distress to almost anyone
Posttraumatic stress disorder (PTSD)
epidemiology of trauma
More than half of all individuals will experience a traumatic event
Less than 10% will develop PTSD
etiology of PTSD
PTSD is more common in women than in men
Adjustment disorders are more common in women, unmarried individuals, and adolescents
charateristic symptoms of PTSD and ASD
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
PTSD onset of symptoms
May begin within the first 3 months after the trauma
May be a delay of several months or even years
ASD onset of symptoms
Symptoms are time limited
Up to 1 month following the trauma
If symptoms last longer than 1 month, diagnosis is PTSD
trauma informed care
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
nursing diagnosis for trauma-related disorders
Posttrauma syndrome
Complicated grieving
the client outcomes for trauma related injury
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
ACE study
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
ACE pyramid conception to death
adverse childhood experiences
disrupted neurodevelopment
social, emotional, cognitive impairment
adoption of health risk behaviors
disease, disability, social problems
early death
Nursing care of the client with a trauma-related disorder
Reassurance of safety
Decrease in maladaptive symptoms
Demonstration of more adaptive coping strategies
Adaptive progression through the grieving process
evaluation for client with trauma related disorder
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?
adjustment disorders to trauma
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
types of adjustment disorders
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)
nursing diagnoses of adjustment disorders
Complicated grieving
Risk-prone health behavior
Anxiety
outcomes of client with adjustment disorders
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
planning for client with an adjustment disorder
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
evaluation of questions for adjustment disorders
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?
treatment for trauma related disorders
Cognitive therapy
Prolonged exposure therapy
Group/family therapy
Eye movement desensitization and reprocessing
Psychopharmacology
psychopharmacology for trauma related disorders
Antidepressants: SSRIs first line
Anxiolytics
Antihypertensives
Other Medications: carbamazepine, valproic acid, and lithium carbonate
treatment for adjustment disorders
Individual psychotherapy
Family therapy
Behavior therapy
Self-help groups
Crisis intervention
Psychopharmacology
