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Psychiatric Mental Health Nursing > Trauma, Stress-Related, and Dissociated Disorders > Flashcards

Trauma, Stress-Related, and Dissociated Disorders Flashcards

1
Q

what is a trauma?

A

events in life- extraordinary intensity or severity beyond stress of everyday life- person perceives as harmful or life threatening- causes severe emotional shock and may have long lasting psychological effects

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2
Q

what is a trauma brain?

A

traumatized brain perceives presence of danger almost everywhere

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3
Q

what is the thinking brain?

A

prefrontal cortex- personality, decisions, memory, information processing- translator of emotion- should control amygdala

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4
Q

what is the survival brain?

A

amygdala- midbrain, brain stem, and limbic system- our autopilot- breathe, heartbeat, digest food, and fight-flight-freeze-faster

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5
Q

what happens to the amygdala when trauma occurs?

A

it hyperactives it

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6
Q

what is the mediator of the brain?

A

thalamus- receives all sensory information (sights, sounds, smells, tastes, touch)- relays to both thinking and survival brain

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7
Q

what are example of trauma disorders?

A

posttraumatic stress disorder
attachment disorders
acute stress disorder
adjustment disorder

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8
Q

what are examples of attachment disorders?

A

reactive attachment disorder
disinhibited social engagement disorder

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9
Q

what is PTSD?

A

exposure to actual or threatened death, serious injury, or sexual violence- person responded with intense fear, helplessness, or horror

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10
Q

what can be brought on by indirect exposure?

A

loved ones or friends experience the trauma
EMS/police/ED nurses

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11
Q

what is a flashback?

A

feels or acts as if event recurring- physical sensations of terror

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12
Q

what happens when a person with PTSD persistently avoids stimuli associated with trauma?

A

avoid distressing memories, thoughts, feelings
avoid external reminders- peoples, places, conversations, activities, objects, situtations

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13
Q

what are the cognition issues with people with PTSD?

A

inability to recall aspects of trauma
negative beliefs of self, others, and world
blame self or others
fear, horror, anger, guilt, shame
decreased interest in usual activities
feelings of detachments, estrangement from others
restriction in feelings- can’t feel happiness, satisfcation, love

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14
Q

what are the arousal and reactivity issues with people with PTSD?

A

hypervigilance and exaggerated startle response
persistent high levels of anxiety or arousal
irritable/angry outbursts
trouble concentrating
sleep issues
guilt common

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15
Q

what are other signs and symptoms of PTSD?

A

may have dissociate symptoms
generalized numbing- feeling detached from others, empty inside
significant distress or impairment in functioning, trust a common issue; sense of foreshortened future
often present for care of somatic symptoms

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16
Q

what are the comorbidities of PTSD?

A

depression
substance abuse
anger
aggressive behavior
relationship problems

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17
Q

what is dependent on the severity of the PTSD?

A

the duration of the trauma, the knowledge/readiness to experience the trauma, and the place the trauma happened

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18
Q

what is the experience of PTSD?

A

severity and duration
extent of preparation
exposure to death; number affected
control over recurrence
location (familiar environment, home, foreign country?

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19
Q

what is the isolation defense mechanisms?

A

splitting off of emotional components of a thought
may be temporary or long-term

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20
Q

what is the repression defense mechanisms?

A

involuntary exclusion of a painful or conflictual thought, impulse, or memory from awareness

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21
Q

what is the assessment for PTSD in children?

A

reduced play
repetitive play- includes aspects of events
social withdrawal
negative emotions- fear, guilt, anger, horror, sadness, shame, confusion
negative thoughts to self- “bad person”
detachment/estrangement from others
irritable, aggressive, self-destructive behavior
sleep disturbance, problems concentrating, hypervigilance

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22
Q

what are the nursing diagnosis for the PTSD in children?

A

risk for development delay
risk for impaired attachment

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23
Q

what is reactive attachment disorder?

A

inhibited- emotionally withdrawn behavior
does not seek comfort when distressed abnormally

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24
Q

what is the cause of the attachment disorder?

A

lack of bonding with primary caregiver by age 8 months

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25
what is the disinhibited social engagement disorder?
remarkably friendly and confident no normal fear of strangers no normal boundaries with those not known unfazed by separation with adult caregivers- attaching to everyone yet not really attaching to anyone
26
what are the genetic risk factors of PTSD?
prenatal exposure to maternal stress altered DNA in brain- methylation-control production of stress hormone-prevents brain from governing response to stress protective= parental nurturing absence of nurturing= increased high risk behaviors as teens
27
what are the neurobiological risk factors of PTSD in childhood?
< age 5 trauma disrupts integration of neuronal networks in limbic system brain will dissociate- disconnection of thoughts, emotions, sensations, and behaviors- connected with the memory
28
what are the psychological factors in childhood PTSD?
attachment theory- early relationship infant- caretaker schemas- formed early
29
what are the environmental risk factors of childhood PTSD?
neuroplasticity- experiences reorganize neural pathways parent models behaviors cushion effect- family stability
30
what are adverse childhood experiences/ "The ACE effect"?
changes in neuruobiological, epigenetic, and adaptive stress hormone responses in developing brain allostatic overload of nervous system= exaggerated inflammatory respoonses
31
what happens if the score is greater than four the for the ACE effect?
increases the likelihood of developing: tobacco abuse/substance abuse & addiction obseity sedentary lifestyle depression suicide attempts multiple sex partners/STI
32
what are the comorbidities associated with adverse childhood experiences?
anxiety depression suicidal ideation PTSD independent risk factor for cardiovascular disease delayed development
33
what are the PTSD treatment in children?
stable/stabilization- safe predictable environment with structure and detailed schedule reduce arousal and regulate emotions developmental skill catch up- teach coping skills to deal with trauma widen the "Window of tolerance"- balancing arousal-help to self regulate if possible, involve the family improve relationships and connections with others therapies used: CBT and EMDR- family, group, play, therapeutic gaming, therapeutic drawing, mindfulness medications: no FDA approved- SSRI may help
34
what are the goals of therapy for treating PTSD?
manage anxiety increase self-esteem improve ability to cope
35
what are the PTSD treatment in adults?
CBT/group/self-help exposure therapy- stop avoidance behavior- regain control establish a therapeutic relationship- nonjudgmental acceptance and empathy, assist in managing arousal- safe predictable environment, and gently express that person is not responsible for what happened
36
what are some medications for the treatment of adulthood PTSD?
SSRIs- may help with anxiety and depression symptoms clonidine (catapres)- address hyperarousal and intrusive symptoms prazosin (minipress)- used for nightmares and sleep disturbances propranolol (indarel)- hyperarousal and panic new trial- MDMA- ectasy
37
what is bilateral stimulation?
used of visual, auditory or tactile external stimuli occurring in a rhythmic side-to-side pattern e.g. tapping, drawing, butterfly hug, and EMDR
38
what does EMDR stand for?
eye movement desensitization and reprocessing
39
what is EMDR?
psychotherapy for PTSD/ASD eye movement cause a decrease in imagery vividness and distress and increase memory access concentrate on emotion or sensation surrounding traumatic event- client focus eye movement on therapist's fingers- moving from left ot right
40
how many EMDR sessions would someone with PTSD need?
5-12 sessions
41
what is video game therapy?
"serious games"- phrase referring to any game whose main purpose is other than entertainment educate user or help solve a problem virtual reality exposure therapy
42
what is pet therapy?
animals can directly influence a person's mental and physical well-being
43
what have pets been known to do?
reduce death rate from recurrence of heart attack lower blood pressure, which can occur as a result of simply petting a dog or cat enhance mood and improve social interaction among nursing home clients diminish depression emotional support animals
44
what is trauma-informed care?
we should explain why we're asking sensitive questions we should explain why we need to perform a physical exam, especially if involves breast/genitals
45
what are the four components of trauma-informed care?
realize recognize respond resist
46
what is dissociative disorders?
after trauma interruption of consciousness unconscious defense mechanism- protective
47
what can dissociate disorders lead to?
can lead to disturbances in memory, consciousness, self-identity, perception intact reality testing- not delusion/hallucinations
48
what is depersonalization?
characterized by persistent feelings of unreality, detachment from oneself or one's body, thought, feelings, sensations, and actions observing oneself from outside body
49
what is derealization?
alteration in perception of external environment objects or people in environment may seem altered in shape or size environment automated or mechanical- unreal or distant
50
what is dissociative amnesia?
inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness, substance, or neurological or medical condition
51
what is localized amnesia?
unable to recall incidents associated with traumatic events
52
what is selective amneisa?
can recall only certain incidents associated with event for specific period after event
53
what is generalized amnesia?
amnesia for identity and life history
54
what is dissociative fugue?
a sudden, unexpected travel away from customary place of daily activities or bewildered wandering unable to recall some or all of past assumption of new identity common
55
what is the treatment for depersonalization-deralization disorder?
medications- antidepressants (clomipramine), mood stabilizers, anticonvulsants, and antipsychotics insight psychotherapy CBT
56
what is the treatment for dissociative amnesia ?
supportive psychotherapy sponteanous
57
what is dissociative identity disorder?
two or more distinct personalities only 1 personality evident of a time 1 is dominant- blocks access to trauma
58
what is switching?
transition from one personality to another usually sudden, often dramatic and usually precipitated by stress
59
what are the side effects of switching with DID?
rapid eye blinking changes in voice or facial expression disruption in train of thought
60
what are the psychological risk factors of dissociated disorder?
primitive ego defense mechanism childhood physical, sexual, emotional abuse, traumatic life event
61
what are the biological risk factors for dissociative disorder?
altered communication between brain due to massive release of neurotransmitters during threat-inhibits connection temporal lobe epilepsy
62
what are the assessments for the dissociative disorder?
need to allow the patient to become comfortable with to be able to receive accurate info during the history gathering accurate history: life events history abuse, recent injury, history of temporal lobe epilepsy, and is memory clear or fuzzy must assess for suicide risk/self-harm impact on family always refer to therapist may seek helps for anxiety/depression symptoms
63
what is the goal of the dissociative identity disorder?
optimize function and potential
64
what is the integration vs collaboration treatment?
if integration= become total of all feelings, experiences, memories, skills, talents
65
what is the intensive long-term psychotherapy treatment for DID?
abreaction awareness of other personalities may need periods of hospitalizations usually do not do well in inpatient psych units, so are usually in specialized unit
66
what is abreaction?
remember with feeling/re-experiencing the trauma
67
what are common nursing diagnoses for clients with dissociative disorders include?
disturbed thought processes; impaired memory powerlessness ineffective coping risk for suicide disturbed personal identity disturbed sensory perception
68
what is the goal for dissociative disorder treatment?
restoring normal thought processes- integrate and link neuronal networks that have become disconnected
69
what are the nursing interventions for dissociative disorder?
grounding techniques
70
what are grounding techniques?
increase body awareness and mindfulness- shower, deep breathing, touch fabric on chair, exercise, stomp feet- helps keep person in present
71
what are dissociative disorder treatments?
EMDR CBT exposure therapy hypnotherapy neurofeedback may use antidepressants, antianxiety medications
72

Psychiatric Mental Health Nursing (13 decks)

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