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Nurse 1456 Part 2 > Trauma, Stressor, And Dissociative > Flashcards

Trauma, Stressor, And Dissociative Flashcards

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1
Q

Trauma is…

A

How you respond to the incident

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2
Q

Trauma impacts the CNS and imbalances the….

Adaptations occur in (Sympathetic or Parasympathetic) system?

A

HPA

Hypothalamus, Anterior Pituitary, Adrenal Axis

Both systems

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3
Q

Describe how PTSD may affect a preschooler

A

Reduction in play- play that includes reenactment of traumatic events

Negative emotions

Blaming themselves

Detachment

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4
Q

Attachment Disorders happen when there is a grossly inadequate nurturing environment deficits with primary care giver by ….

A

8 months

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5
Q

Children with Reactive attachment disorder …..

A

Consistent pattern of emotional withdrawal. Rarely seeks comfort from adult caregivers

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6
Q

What is disinhibited social engagement disorder….

A

When a child gets neglected, severely and will go with strangers

Isn’t afraid of strangers

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7
Q

Trauma-Related Disorders

Comorbidities

A

Phobias
Somatic
Impulse control
Identity

Learning/attention
Sleep
Depression/ Suicide
Dissociation
Substance abuse

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8
Q

Polyvagal theory is a model that explains ….

A

how the autonomic nervous system (ANS) regulates our emotions, social connections, and fear responses.

ANS is influenced by the central nervous system, and that different physiological states support different behaviors

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9
Q

Dissociation happens from…

A

Following traumatic event

Parasympathetic response triggers hypo-aroused state with dysregulation of the Hypothalamus Pituitary Adrenal axis. Resulting in dissociation

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10
Q

Is dissociation ever normal

A

Yes, exp. When driving and space out.

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11
Q

Episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating _____

A

Cortisol

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12
Q

Severe neglect cause

Decreased serotonin

Increased CRF

Decreased Oxytocin

Describe what each do…

A

Decreased serotonin:

Irritatability / reduced emotional control

Increased CRF

Decreased Deep Sleep, Depression, Anxiety

Decreased Oxytocin

Attachment problems

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13
Q

Type of abuse that is most damaging

A

Emotional?

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14
Q

Damage to the HPA Axis will cause toxic effects of….

A

Cortisol

Impaired emotional regulation & problems with memory

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15
Q

3 brains

1st brainstem
2nd Midbrain and limbic area
3rd Cortical brain

Describe

A

1st brainstem: Survival, Sensory motor input

2nd Midbrain and limbic area: Attachment & emotional development

3rd Cortical brain: Thinking, learning, language, inhibition

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16
Q

Clinical outcomes for severe early abuse

A

Chronic depression
Borderline PD
Attachment problems
Substance abuse
PTSD

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17
Q

To what degree of certainty is a nurse a mandatory reporter

A

Suspected

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18
Q

TEN-4-FACESp

Braising clinical decision rule for children <4

What does it stand for….

A

TEN: Torso, Ears, Neck

FACES:
Frenulum (Cord-like structure that attaches 2 body parts)
Angle of jaw
Cheeks
Eyelids
Subconjunctivae

4 months or younger - bruising anywhere

Patterned bruising: Slap, Grab, Electric cord

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19
Q

Example of grounding tech that can help manage intrusive thoughts when reminded of our traumatic experiences

A

5,4,3,2,1

5 things you can see
4 things, touch
3 things, hear
2 things, smell
1 thing, taste

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20
Q

Trauma intervention for PTSD child.

Priority intervention

A

Establish trust and safety in therapeutic relationship.

Teach relaxation tech before trauma exploration.

Use art & play therapy

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21
Q

Would you invite an abuseive father to have 1:1 play time with his child as part of therapy

A

No

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22
Q

Eye movement desensitization and reprocessing (EMDR) is….

A

Psychotherapy technique

help people heal from trauma and other distressing experiences.

It involves moving the eyes in a specific pattern while processing memories

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23
Q

Immediately after highly traumatic event.

Symptoms last 3 days

Diagnosis within 1 month

After 1 month: Resolution or PTSD

DIAGNOSIS IS POSTTRAUMA SYNDROME

Name the disorder

A

Acute stress disorder

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24
Q

Acute Stress Disorder

Immediately after highly traumatic event.

Symptoms last 3 days

Diagnosis within 1 month

After 1 month: Resolution or PTSD

DIAGNOSIS IS POSTTRAUMA SYNDROME:

Name effective treatments

A

CBT & EMDR Eye movement desensitization and reprocessing

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25
Q

Acute stress disorder

Must display ____ symptoms out of 14 during or after traumatic event

  1. Sense of numbing
  2. Derealization
  3. Inability to remember 1 important aspect
  4. Intrusive memories
  5. Nightmares
  6. Feels the event is recurring
  7. Intense Prolonged reactivity
  8. Avoidance of thoughts or feelings about the event
  9. Sleep Disturbances
  10. Hypervigilamce
  11. Irritable
  12. Angry
  13. Exaggerated startle response
A

8 out of 14

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26
Q

This disorder

Is precipitated by a stressful event Not as severe or considered a Traumatic event.

Debilitating cognitive, emotional, and behavioral symptoms that impact normal functioning

Treatment….

A

Adjustment disorder

Treatment: SSRI

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27
Q

Average age of onset for PTSD

A

23

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28
Q

Women or men more likey for PTSD

A

Women 2x more likely

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29
Q

PTSD

Short-term dissociation may be adaptive

True or false

A

True

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30
Q

NSESS vs CAPS 5

A

NSESS is a quick self-assessment tool, while CAPS-5 is a more thorough clinician-administered interview for diagnosing PTSD.

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31
Q

Psychopharmacology for PTSD

A

SSRI / SNRI

Clonidine (Catapress) / Prazosin (Minipress) - centrally acting Alpha agonist. Used for hyperarousal & intrusive symptoms

Propranolol (Inderal) betablocker

Prazosin- decreases nightmares

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32
Q

Prazosin

A

decreases nightmares

PTSD

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33
Q

Joseph P. Dryer project is…

A

Peer to peer veterans help

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34
Q

Characterized by disruptions or alterations in consciousness, memory, identity, or perception.

Response to trauma or stress, serving as a coping mechanism to detach from painful experiences.

A

Dissociative disorders

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35
Q

Dissociative Disorders (3)

A

Depersonalization/ derealization disorder

Dissociative amnesia

Dissociative identity disorder

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36
Q

Depersonalization disorder

Dissociative amnesia

Dissociative fugue / identity disorder

Describe

A

Depersonalization disorder: disconnected from mind or body

Dissociative amnesia: Ability to integrate memories is Impaired

Dissociative fugue / identity disorder:
Unable to maintain identity

37
Q

Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.

5 types

Localized:
Selective:
Generalized:
Continuous:
Systematized:

A

Localized: Can’t remember event that took place during specific period of time (after trauma)

Selective: Only recall some part of the event

Generalized: Prolonged memory loss - Lifetime

Continuous: Forgets all events from a given time forward to the present

Systematized: Limited to specific type of information

38
Q

Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.

5 types

Localized:
Selective:
Generalized:
Continuous:
Systematized:

A

Localized: Can’t remember event that took place during specific period of time (after trauma)

Selective: Only recall some part of the event

Generalized: Prolonged memory loss - Lifetime

Continuous: Forgets all events from a given time forward to the present

Systematized: Limited to specific type of information

39
Q

Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.

5 types

Localized:
Selective:
Generalized:
Continuous:
Systematized:

A

Localized: Can’t remember event that took place during specific period of time (after trauma)

Selective: Only recall some part of the event

Generalized: Prolonged memory loss - Lifetime

Continuous: Forgets all events from a given time forward to the present

Systematized: Limited to specific type of information

40
Q

Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.

5 types

Localized:
Selective:
Generalized:
Continuous:
Systematized:

A

Localized: Can’t remember event that took place during specific period of time (after trauma)

Selective: Only recall some part of the event

Generalized: Prolonged memory loss - Lifetime

Continuous: Forgets all events from a given time forward to the present

Systematized: Limited to specific type of information

41
Q

Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.

5 types

Localized:
Selective:
Generalized:
Continuous:
Systematized:

A

Localized: Can’t remember event that took place during specific period of time (after trauma)

Selective: Only recall some part of the event

Generalized: Prolonged memory loss - Lifetime

Continuous: Forgets all events from a given time forward to the present

Systematized: Limited to specific type of information

42
Q

Dissociative fugue….

A

Inability to recall identity & information from the past and accompanied by travel away from customary locale

43
Q

Dissociative Identity Disorder….

A

Personality is split into “parts” with distinct memory and behavior.

One part maybe the child, protector, day-to-day Personality.

It’s not Multiple Personality Disorders, All same Personality just different aspects of it

44
Q

Mental comorbidities with Dissociative Disorders

A

Depression
Panic attacks
Eating disorders
PTSD,OCD,ADD, SUD

45
Q

What is Conversion disorder….

A

Physical symptoms from stress or trauma

46
Q

_____ maybe present with conversion disorder or personality disorder

A

Dissociative amnesia

47
Q

Dissociative fugue may cooccur with…

A

PTSD

48
Q

Dissociative identity disorder

May also have;

PTSD
BPD
Sexual/ Eating disorders

And….

A

Sleep disorder

49
Q

Depersonalization disorder may cooccur with

Hypochondriasis
Mood anxiety disorder
OCD

And…

A

Schizophrenia

50
Q

Depersonalization disorder believed to be related to childhood trauma has these biological factors… (3)

A

Epilepsy, brain Tumors, & schizophrenia

51
Q

Dissociative Disorders Etiology:

Primitive ego defense mechanism.

Different parts of their personality not fully integrated with eachother

T or F

A

T

52
Q

Some culture bound Disorders look like dissociative disorders

T or F

A

T

53
Q

Which dissociative disorders may function well in an undemanding job / social situation

A

Fugue

54
Q

Treatment goal for Dissociative disorders

A

Integration of parts into single personality

55
Q

Grounding tech for Dissociative Disorders.

Patient can learn triggers to dissociation and interrupt by….

A

Singing
Playing an instrument
Talking to someone
Ice on hands

56
Q

Dramatic memory retrieval can be accomplished through….

A

IV Benzodiazepine/ Barbiturates

57
Q

Advanced Practice Nurse Interventions:

CBT,Psychotherapy, exposure therapy, EMDR,hypnotherapy, neurofeedback.

Sensorimotor therapy combines talk therapy with body centered Interventions: Dance, body awareness, mindfulness

Goal……

A

Reduce symptoms, integrate traumatic memory, restore ability to Stay in the Moment

58
Q

Feeling of a dreamlike state or of being detached observer typically can occur in a patient experiencing which of the following.

Dissociative fugue
Dissociative amnesia
Depersonalization disorder
DID

A

Depersonalization disorder

59
Q

Dissociative Disorders are a spectrum of severity.

Name least to most severe

A

Depersonalization/ derealization disorder

Dissociative amnesia

Dissociative Identity Disorders

60
Q

Most common type of Dissociative amnesia

A

Localized: Trouble recalling traumatic event or months / years surrounding event

61
Q

Dissociative amnesia

Generalized

Describe absence of memory time frame….

Onset…..

Wandering/ Travel may happen called….

A

Can’t remember any of their past

Onset Sudden, Stress-Induced

Dissociative fugue

62
Q

Dissociative amnesia

Systematized

Describe….

A

Forgets a Category of information associated with the trauma

Eg person, location

63
Q

Dissociative amnesia

Continous

Describe

A

Forgets each new event after it happens

Retains nothing but Present Moment

Dory from Finding Nemo

64
Q

DID

Sudden & dramatic shifts in way they:
Perceive
Think
Feel

Usually Aware that it is unusual

May hear other personality speaking to them

Disoriented, Powerless to understand their moods & behavior

A

Covert

65
Q

DID

Outright Assume 2 or more personalities / alters (alter ego)

Not always aware it is happening

Forgets portions of their day

FUGUE

MORE DANGEROUS OF THE 2 TYPES

A

Overt

66
Q

Anxiety Disorders can impair sense of: Identity, Time, Sensation

What is the difference between this and DID

A

The time length

Anxiety = minutes/ hours

DID = Years

67
Q

What did Harlows monkey experiment demonstrate.

A

That need for Maternal care is separate from food and warmth.

How, gave orphan baby monkey 2 fake mommies to chose from .

1 made of wire that produced heat and had milk giving nipples

1 made of cloth and fur. The baby chose the furry one

68
Q

Results from trauma, with symptoms persisting longer than 1 month, including re-experiencing, avoidance, negative thoughts, and hyperarousal.

Occurs shortly after trauma, with similar symptoms to PTSD but lasts between 3 days and 1 month

Triggered by a less severe life stressor (not necessarily trauma), with emotional and behavioral symptoms starting within 3 months and typically resolving within 6 months.

Adjustment Disorder, PTSD, Acute stress

A

PTSD: Results from trauma, with symptoms persisting longer than 1 month, including re-experiencing, avoidance, negative thoughts, and hyperarousal.

ASD: Occurs shortly after trauma, with similar symptoms to PTSD but lasts between 3 days and 1 month.

Adjustment Disorder: Triggered by a less severe life stressor (not necessarily trauma), with emotional and behavioral symptoms starting within 3 months and typically resolving within 6 months.

69
Q

Therapy for PTSD

Meds…

A

Exposure
Group

Meds.
SSRI
Antisocial anxiety (according to video not powerpoint)

Clonidine/ Catapress

Propranolol

Antinightmare med

70
Q

Crisises 3 types

Maturational

Situational

Adventitious

A

Maturational: Life changing event that is a normal part of life. Marriage, Retirement, Kids growing up

Situational: Loss of a job, death of a loved one.

Adventitious: Natural disaster, Terrorist attack, Violent crime

71
Q

2 types of loss

A

Actual loss: Tangible- Loss of a loved one

Perceived loss: Not felt by others - Loss of mental acuity

72
Q

Greif 5 stages

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

DABDA

73
Q

Types of grief

A

Complicated greif / Prolonged: >1yr affects daily functioning

Anticipatory greif: A patient given a terminal diagnosis

Disenfranchised greif: Not publicly announced- A hidden miscarriage

74
Q

Which intervention in the emergency room was shown to reduce the amount of intrusive memories…

A

Video games

Box 296

75
Q

6 F’s reactions

A

Fight, flight, freeze, faun, fine, faint

76
Q

(This part of the brain) sounds the alarm. Too much alarm sounding, and it increases in size leading to heightened stress response

A

Amigdala

77
Q

Rapid phase of brain dev happens during ____ years of life and brain is more vulnerable to adverse effects

A

5

78
Q

Personality Disorders related to severe early abuse of a child

A

Borderline

79
Q

Priority nursing diagnosis in PTSD

Others

A

Post trauma response

Anxiety, Impaired coping, isolation, insomnia, HOPELESSNESS,

80
Q

How long does CPS have to call you back after reporting…

A

30 days

81
Q

Nurses ARE required to report instances of child abuse to CPR

A

Yes

82
Q

Implementation of stages (3)

A
  1. Provide safety
  2. Reduce arousal & regulate emotion through symptom reduction
  3. Catch up on dev & social skills, dev a value system
83
Q

Adjustment Disorder symptoms maybe treated with this medication

A

Antidepressants

84
Q

Seroquel for PTSD in adults. Increases sleep & ____ watch out for metabolic syndrome

A

BDNF

Brain derived Neurotrophic Factor

85
Q

What type of communication will a nurse engage in during times of crisis that they would not normally do

A

Give advise

86
Q

Tertiary care is…

A

Hospital or ER

Primary = Prevention

2nd = minimize symptoms of active anxiety

87
Q

Phase model treatment is most effective. Describe the 3 phases

A

Phase 1.

Safety & Stabilization (emotional too)
Teaching Stabilization tech
Address basic needs: Medical, Housing

Phase 2

Trauma processing

Phase 3

Integration and Reconnection – Helping the individual integrate their experiences, reconnect with a sense of purpose, and focus on future goals and personal growth.

88
Q

Evidence based treatments for Trauma are…

A

CBT & EMDR

Nurse 1456 Part 2 (4 decks)

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