Trauma & Stressor Disorders (329 E3) Flashcards
acute stress disorder: clinical picture
Diagnosed 3 days to one month following the traumatic event, if 1+ mo then dx is changed to PTSD
The person continually re-experiences the event, avoids situations that remind him/her of the event and has increased anxiety and excitation that negatively affects lifestyle
patients must have been exposed directly or indirectly to a traumatic event, and≥9 of the following symptoms from any of the 5 categories: Intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms and, arousal symptoms
these sx must cause significant distress or impair social functioning and they should not be attributable to the physiologic effects of a substance or other medical disorder
ASD: intrusion symptoms
Recurrent, involuntary, and intrusive distressing memories of the event
Recurrent distressing dreams of the event
Dissociative reactions (e.g., flashbacks in which patients feel as if the traumatic event is recurring)
Intense psychological or physiologic distress when reminded of the event (e.g., by entering a similar location, by sounds similar to those heard during the event)
ASD: avoidance symptoms
Efforts to avoid distressing memories, thoughts, or feelings associated with the event
Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) associated with the event
ASD: arousal symptoms
-Sleep disturbance
-Irritability or angry outbursts
-Hypervigilance
-Difficulty concentrating
-Exaggerated startle response
ASD: dissociative symptoms
An altered sense of reality (e.g., feeling in a daze, time slowing, altered perceptions)
Inability to remember an important part of the traumatic event
ASD: negative mood
Persistent inability to experience positive emotions (e.g., happiness, satisfaction, loving feelings)
ASD application of the nursing process
Assessment: Data collection through patient history, interviewing, observing, and interaction.
Priority Problems: Examples-Anxiety and impaired coping
Outcomes: Examples-Reduced response to trauma; decreased anxiety and improved adaptation
Implementation-Interventions: Examples-Establishing trust and safety, use of art and play therapy in children, health teaching and health promotion (strategies to improve coping including relaxation techniques, to enhance self-care, and facilitate recognition of symptoms) and community supports.
Evaluation: Examples-The child’s safety has been maintained; anxiety has been reduced, and stress is handled adaptively, and emotions and behavior are appropriate for the situation
what are main concerns with ASD
safety and anxiety reduction
ASD treatments
-CBT (trauma focused)
-EMDR
what are the 4 components of trauma focused CBT therapy
1) learning how your body responds to trauma & stress
2) symptom management skills
3) helping the patient to identify and reframe problematic thinking patterns
4) exposure therapy
PTSD clinical picture
Persistent re-experiencing of a highly traumatic event.
Responses of intense fear, helplessness, or horror are felt.
Diagnosis for PTSD requires specific types of trauma exposure:
-Directly experiencing a traumatic event
-Witnessing, in person, a traumatic event that happened to someone else
-Learning about a traumatic event happening to a close friend or family member(cases of death must be violent or unexpected)
Does not include exposure to electronic media like television, movies or photographs
Can begin a month after exposure, but a symptom delay of months or years is not uncommon
4 core symptom groups in PTSD
Re-experiencing Symptoms
Avoidance Symptoms
Arousal & Reactivity Symptoms
Cognitive & Mood Symptoms
PSTD: Re-experiencing Symptoms
through recurrent intrusive recollections of the event or dreams about the event
the flashbacks are dissociative experiences during which the event is relived
vivid sensory input
PSTD: avoidance symptoms
where the individual avoids stimuli associated with the traumatic event and this causes the individual to maybe avoid talking about the event, avoiding activities/people/places that arouse memories of the trauma
associated with feelings of detachment, emptiness and numbing
PSTD: arousal & reactivity sx
irritability, difficulty sleeping, difficulty concentrating, hyper vigilance and exaggerated startle response
PSTD: cognitive & mood symptoms
alterations in mood -> chronic depression, negativity, a lack of interest in previously pleasurable activities
people w/ PTSD have
difficulty w/ interpersonal, social and occupational relationships & trust is an common issue
to meet criteria for PTSD
Have symptoms for longer than 1 month.
The symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work.
The symptoms also must be unrelated to medication, substance use, or other illness.
PTSD: risk factors
Being exposed to previous traumatic experiences, particularly during childhood
Getting hurt or seeing people hurt or killed
Feeling horror, helplessness, or extreme fear
Having little or no social support after the event
Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
Having a personal or family history of mental illness or substance use
according the national institutes of mental health
Not everyone who lives through a dangerous event develops PTSD—many factors play a part.
Some of these factors are present before the trauma; others become important during and after a traumatic event
most common co morbidies w/ PTSD
MDD
anxiety disorders
sleep disorders
dissociative disorders
substance use disorders
PTSD in preschool children
may manifest as a reduction in play—play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion
PTSD in children
may blame themselves for the traumatic event
PTSD in Children & Adolescents: Clinical Picture
-Reliving the event over and over in thought or in play
-Nightmares and sleep problems
-Becoming very upset when something causes memories of the event
-Lack of positive emotions
-Hypervigilance or constantly looking for possible threats, being easily startled
-Acting helpless, hopeless or withdrawn
-Denying that the event happened or feeling numb
-Irritability, aggressive or self-destructive behaviors
-Problems concentrating
-Feelings of detachment or estrangement from others including avoiding places or people associated with the event
-Diminished interest or participation in significant activities.
-Somatic symptoms such as headaches, stomachaches, or pain; memory problems, etc.
PTSD treatments
primary tx is trauma-focused psychotherapy
Exposure (PE)
Cognitive Processing Therapy (CPT)
Eye Movement Desensitization and Reprocessing (EMDR)
Often combined with anxiety management/stress reduction that focuses on the alleviation of symptoms.
medications for PTSD
SSRIs: sertraline, paroxetine, fluoxetine (off label)
SNRI: venlafaxine (off label)
MAIO: phenelzine
PTSD: Treatments for Children & Adolescents
Cognitive Behavioral Therapy
Play Therapy
EMDR
currently there are no FDA approved medications for children but SSRI’s may improve social & school functioning
Eye Movement Desensitization & Reprocessing Therapy
Recommended as a first-line treatment for traumatized children
helps people process traumatic memories -> individuals are encouraged to think about the traumatic event while also focusing on other stimulation, such as eye movements, audio tones, or tapping
retrains pts to associate the traumatic event w/ positive coping
EMDR may work through neurological and physiological changes that help to process and integrate traumatic memories
PTSD: Application of the Nursing Process
Assessment: Data collection through patient history, interviewing, screening, testing, observing, and interaction.
Priority Problems: Examples-Anxiety, impaired coping, social isolation and hopelessness.
Outcomes: Examples-Improved response to trauma; ability to manage anxiety
Implementation-Interventions: Examples-Establishing trust and safety, use of art and play therapy in children, health teaching and health promotion (strategies to improve coping including relaxation techniques, to enhance self-care, and facilitate recognition of symptoms) and community supports
Evaluation: Examples-The child’s safety has been maintained; anxiety has been reduced, and stress is handled adaptively, and emotions and behavior are appropriate for the situation
Trauma-Informed Care
A trauma-informed approach to care acknowledges, that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — to provide effective health care services with a healing orientation
is a treatment framework that involves recognizing and responding to the effects of all types of trauma, recognizing the signs and symptoms of trauma, and actively avoiding re-traumatization
PTSD:
Use of trauma-informed care conceptual model
Provider recognition of patients who may have PTSD
Collaboration
Individualizing care
Inpatient Issues That May Affect PTSD:
Sleep hygiene
Pain
Anxiety and anger
Depersonalization/Derealization Disorder: Clinical Picture
Results in persistent or recurrent episodes of depersonalization, derealization, or both.
Episodes of depersonalization-derealization disorder may last hours, days, weeks or months.
Impacts on relationships, work and daily activities
Depersonalization
An extremely uncomfortable feeling of being an observer of one’s own body or mental processes
- Feelings of unreality, detachment, or unfamiliarity with parts of self or the whole self are features of this disorder
- A patient may feel detached from their entire self, aspects of herself/himself, including feelings, thoughts, body parts, or sensations.
Derealization
The focus is on the outside world. It is the recurring feeling that one’s surroundings are unreal or distant
- The person may feel like they are walking around in a fog, bubble, or dream. It may feel like there is an invisible veil between them and the rest of the world
- Visual distortions are manifested in blurriness, changes in the visual field (widened or narrowed) and altered size of objects
- Auditory distortions include the muting or heightening of sound
co morbidities of Depersonalization/Derealization Disorder
Occurs with major depressive disorder, anxiety disorders, and personality disorders—avoidant, borderline, and obsessive-compulsive
risk factors for developing Depersonalization/Derealization Disorder
Certain personality traits
Serious trauma in children or adult such as experiencing or witnessing a traumatic event such as violence or abuse.
Severe stress
Depression and anxiety
Substance misuse
Depersonalization/Derealization Disorder treatment
often short-lived and go away on their own without treatment
some treatment modalities have been used with success, including self-hypnosis, CBT and repetitive transcranial magnetic stimulation (rTMS), no meds are proven effective
therapies are used to help the person figure out why this is occurring and learn techniques to help take their minds off the sx
