Trauma and Stressor-Related Disorders: Exam 2

Question 1

Immediate and Longer-term Individual Responses to Trauma and Stressors: Characteristics

Answer 1

-Experiences that are extraordinary in intensity or severity.
-Stressors well beyond the stress of daily life.

Question 2

Immediate and Longer-term Individual Responses to Trauma and Stressors: Risk factors

Answer 2

1. Individual trauma/stressors: abuse and illness
2. Group trauma/stressors: war (WWI,WWII), terrorist attacks (911 Twin Towers), and natural disasters (Hurricane Katrina).

Question 3

Immediate and Longer-term Individual Responses to Trauma and Stressors: Manifestations

Answer 3

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

Question 4

Traumatic events/stressors should be _______ to disrupt events in individuals lives, not just people with ________ _______ issues.

Answer 4

Expected
Mental Health

Question 5

Enhanced Coping =

Answer 5

Positive Outcome

Question 6

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.

Answer 6

Post-Traumatic Stress Disorder (PTSD)

Question 7

Acute Stress Disorder happens…

Answer 7

2 days - 4 weeks after a traumatic event.

Question 8

PTSD symptoms occur…

Answer 8

3 months or more after the traumatic event

Question 9

PTSD symptoms:

Answer 9

• Feels emotional numbness, feels detached from others.
  -Irritable
  -Hyper-arousal
  -On-Guard personality

Question 10

Major elements of PTSD:

Answer 10

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.

Question 11

Acute Stress Disorder has similar types of symptoms but last _______ up to _________.

Answer 11

3 days
1 month

Question 12

_____________ are more likely to develop PTSD than children and adults.

Answer 12

Adolescents

Question 13

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 _____%.

Answer 13

50%
3 months
PTSD
70%

Question 14

Factors in the likelihood of developing PTSD:

Answer 14

1. Severity and duration of trauma
2. Proximity of person to the event

Question 15

Risk factors for PTSD:

Answer 15

-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.

Question 16

Increase incidence related to the following in adolescents:

Answer 16

age
gender
type of trauma
repeated trauma

Question 17

Adolescents with PTSD have increased risk for the following:

Answer 17

suicide
substance abuse
poor social support
academic problems
poor physical health

Question 18

Treatment options for PTSD:

Answer 18

Counseling and therapy
Medications
Cognitive-behavioral therapy
Exposure therapy
Relaxation techniques
Adaptive disclosure
Cognitive processing therapy
Community-based care
Mental health promotion

Question 19

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 _________.

Answer 19

Most Effective
Trauma
Describe
Reluctant
Self-Worth
PTSD

Question 20

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

Answer 20

Dissociation

Question 21

Have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception

Answer 21

Dissociative Disorders

Question 22

What does dissociative disorders often interfere within a person’s life?

Answer 22

1. personal relationships
2. ability to function in daily life
3. ability to cope with the realities of the abusive or traumatic event.

Question 23

Dissociative disorders =

Answer 23

“Who shall I be today?”

Question 24

Types of Dissociative Disorders:

Answer 24

Dissociative Amnesia
Depersonalization/ Derealization disorder
Dissociative Identity Disorder

Question 25

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)

Answer 25

Dissociative amnesia

Question 26

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

Answer 26

Depersonalization/ derealization disorder

Question 27

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

Answer 27

Dissociative identity disorder

Question 28

Treatment Options for Dissociative Disorder:

Answer 28

Individual therapy Group therapy the focus in therapy is on reassociation Medications

Question 29

Goals of Treatment for Dissociative Disorder:

Answer 29

Improve quality of life Improve functional abilities Reduce symptoms

Question 30

Assessment of the Nursing Process includes:

Answer 30

-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

Question 31

Common nursing diagnoses:

Answer 31

Risk of suicide/self-harm Ineffective coping Powerlessness Disturbed sleep pattern Social isolation

Question 32

Outcomes: "The Client Will..."

Answer 32

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

Question 33

Interventions:

Answer 33

- Grounding techniques and validation theory - Journalism - Distraction and relaxation techniques -Education to promote prevention and early intervention

Question 34

Education to promote prevention and early intervention:

Answer 34

1. Explain how identifying triggers can assist with flashbacks 2. Discuss ways to promote self-esteem 3. Address prevention by finding support people or activities in the community 4. Discuss developing problem-solving skills

Question 35

Refer to the client as a ______ and not a _________, because why?

Answer 35

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!

Question 36

Self-Evaluation Issues Include: Look at us as nurses, how do we see stress and trauma events?

Answer 36

-Dealing with your own personal feelings about traumatic events, abuse, and natural disasters -The ability to convey empathy -Remaining nonjudgmental

Question 37

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!

Answer 37

Cautious Comfort Permission/Consent