Trauma and Stressor-Related Disorders: Exam 2 Flashcards
Immediate and Longer-term Individual Responses to Trauma and Stressors: Characteristics
-Experiences that are extraordinary in intensity or severity.
-Stressors well beyond the stress of daily life.
Immediate and Longer-term Individual Responses to Trauma and Stressors: Risk factors
- Individual trauma/stressors: abuse and illness
- Group trauma/stressors: war (WWI,WWII), terrorist attacks (911 Twin Towers), and natural disasters (Hurricane Katrina).
Immediate and Longer-term Individual Responses to Trauma and Stressors: Manifestations
All persons may experience anxiety, insomnia, difficulty coping, grief. Most work through experiense. Return to usual levels of coping.
Some individuals have problems coping, managing stress and emotions, or resuming daily activities and may develop:
-Adjustment disorder
-Acute Stress Disorder
-PTSD
-Dissociative Disorder
Traumatic events/stressors should be _______ to disrupt events in individuals lives, not just people with ________ _______ issues.
Expected
Mental Health
Enhanced Coping =
Positive Outcome
Disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with a traumatic event(s). (Ex: natural disasters, combat, assault, etc.) The event posed actual or threatened death or serious injury and resulted in: Intense fear, helplessness, and terror.
Post-Traumatic Stress Disorder (PTSD)
Acute Stress Disorder happens…
2 days - 4 weeks after a traumatic event.
PTSD symptoms occur…
3 months or more after the traumatic event
PTSD symptoms:
- Feels emotional numbness, feels detached from others.
-Irritable
-Hyper-arousal
-On-Guard personality
Major elements of PTSD:
Subcategories of Symptoms:
-Re-experiencing the trauma: dreams, intrusive/recurrent thoughts
-Avoidance
-Negative cognition
-Being on Guard
-Onset can be delayed for months or even years
-Chronic in nature but symptoms can fluctuate in intensity and severity.
Acute Stress Disorder has similar types of symptoms but last _______ up to _________.
3 days
1 month
_____________ are more likely to develop PTSD than children and adults.
Adolescents
PTSD can occur at any age. Approximately ____ % of people are at risk. Complete recovery occurs within ___ months for about 50% of people. 1/4 of all physical assault victims develop ____. Rape victims have one of the highest rates at _____%.
50%
3 months
PTSD
70%
Factors in the likelihood of developing PTSD:
- Severity and duration of trauma
- Proximity of person to the event
Risk factors for PTSD:
-Causative trauma
-Associated with even exposure rather than personal characteristics
-Increased risk: lack of social support, Peri-trauma dissociation (dissociation during the event), previous psychiatric history, and personality factors.
Increase incidence related to the following in adolescents:
age
gender
type of trauma
repeated trauma
Adolescents with PTSD have increased risk for the following:
suicide
substance abuse
poor social support
academic problems
poor physical health
Treatment options for PTSD:
Counseling and therapy
Medications
Cognitive-behavioral therapy
Exposure therapy
Relaxation techniques
Adaptive disclosure
Cognitive processing therapy
Community-based care
Mental health promotion
One of the ________ ___________ ways of avoiding pathological responses to ________ is effectively dealing with trauma after it occurs. Do this by having the person ________ what they have witnessed or experience. If the person is _________ to share, they are more likely to ignore theur importance or their ____-______ and can put them at an increased risk for future problems such as _________.
Most Effective
Trauma
Describe
Reluctant
Self-Worth
PTSD
A subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory
Dissociation
Have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception
Dissociative Disorders
What does dissociative disorders often interfere within a person’s life?
- personal relationships
- ability to function in daily life
- ability to cope with the realities of the abusive or traumatic event.
Dissociative disorders =
“Who shall I be today?”
Types of Dissociative Disorders:
Dissociative Amnesia
Depersonalization/ Derealization disorder
Dissociative Identity Disorder
the client cannot remember important personal information and includes a fugue experience where the client suddenly moves to a new geographic location with no memory of past (assumes a new identity)
Dissociative amnesia
the client has a persistent or recurrent feeling of being detached from his or her mental processes or body or they have the sensation of being in a dream-like state in which the environment seems foggy or unreal
Depersonalization/ derealization disorder
the client displays 2 or more distinct identities or personality states that recurrently take control of his or her behavior and is accompanied by the inability to recall important personal information
Dissociative identity disorder
Treatment Options for Dissociative Disorder:
Individual therapy
Group therapy
the focus in therapy is on reassociation
Medications
Goals of Treatment for Dissociative Disorder:
Improve quality of life
Improve functional abilities
Reduce symptoms
Assessment of the Nursing Process includes:
-General appearance: hyper-alert, discomfort with physical closeness, and anxious or agitated
-Mood and affect: can range from
1. passive to angry
2. Frightened, agitated, hostile
-Thought process/content:
1. Experiences nightmares, flashbacks, intrusive thoughts
2. Hallucinations, self-destructive thoughts, fantasies
-Sensorium and intellectual processes:
1. Oriented to reality except during flashbacks
2. Memory gaps
3. Intrusive thought/ideas of self-harm
-Judgement and insight
1. May report little idea of relationship between trauma and symptoms
2. Others may be quite knowledgeable
3. Decision making ability may be impaired
-Self-Concept
1. Low-self esteem
2. See self as worthless
-Roles and Relationships
1. Problems with authority
2. Close relationships difficut or impossible
-Physiological concerns:
1. Difficulty sleeping
2. Change in appetite
3. Substance use/abuse
Common nursing diagnoses:
Risk of suicide/self-harm
Ineffective coping
Powerlessness
Disturbed sleep pattern
Social isolation
Outcomes: “The Client Will…”
Remain physically safe
Distinguish ideas of self-harm vs acting
Demonstrate healthy, effective stress management
Display nondestructive expression of emotion
Develop and utilize social support system
Interventions:
- Grounding techniques and validation theory
- Journalism
- Distraction and relaxation techniques
-Education to promote prevention and early intervention
Education to promote prevention and early intervention:
- Explain how identifying triggers can assist with flashbacks
- Discuss ways to promote self-esteem
- Address prevention by finding support people or activities in the community
- Discuss developing problem-solving skills
Refer to the client as a ______ and not a _________, because why?
Survivor
Victim
Because it makes the client see themselves as stronger than their problem that they are facing right now or have faced in the past!
Self-Evaluation Issues Include: Look at us as nurses, how do we see stress and trauma events?
-Dealing with your own personal feelings about traumatic events, abuse, and natural disasters
-The ability to convey empathy
-Remaining nonjudgmental
In patients with PTSD, Dissociative Disorder, Abused, etc. make sure to be ________ and or to avoid touch. Make sure to assess each clients _________. Get __________ before touching a client!
Cautious
Comfort
Permission/Consent
