trauma, stressor-related and dissociative disorders Flashcards
posttraumatic stress disorder (PTSD) in preschool children s/s
- detaching from others
- blame themself for event
- not playing as much
- repetive play
- withdrawn
- sad/negative feelings/emotions
reactive attachment disorder
consistent pattern of withdrawn behavior
- lacking good attachement
- lack of bonding before 8 months
- easier to treat
disinhibited social engagement disorder
- extremely friendly/happy
- not afraid of strangers
interventions for trauma- related disorders in children
- forceful hold
- more interaction with caregiver
developmental assessment
see if there is a delay
- nightmares, hallucinating, self injury, flashbacks
- interview the child, screening, observe wile they play, interactions with others
nursing diagnosis for kids
risk for impaired attachment
- caregiver form bond
- consistency
risk for impaired development
- special ed classes
stage 1 interventions
Stage 1: Provide safety and stabilization
- environment they feel safe in, educating them
stage 2 interventions
Stage 2: Reduce arousal and regulate emotion through symptom reduction
- emotion and memory, comfortable with others, not avoiding situation
stage 3 interventions
Catch up on developmental and social skills; develop a value system
- help with social engagement
- problem solving skills
- effective coping skills
- health social supports
interventions for children with ptsd
- Establish trust and safety
- Use developmentally appropriate language
- Teach relaxation techniques
- Use art and play to promote expression of feelings
- Involve caretakers in 1:1s, unless they are the cause of trauma
- Educate child and caretakers about grief process
- Assist caretakers in resolving personal distress
- Coordinate with social work for protections
interventions therapies and meds
- CBT: cognitive behavioral therpay- reframing negative thoughts
- EMDR
- SSRI: first-line, improving social and school function, decrease level of avoidance; no numbing feelings
post traumatic stress disorder adults
- Re-experiencing of the trauma: fearful, anxious, shame, guilt, nightmares, explosive
- Avoidance of stimuli associated with trauma
- Persistent symptoms of increased arousal
- Alterations in mood
+ want them in presence
+ identify what real vs not
post-traumatic stress disorder diagnosis
Post trauma syndrome
- symptoms over a month impaired function, anxiety
Complicated grieving
- morning the situation
post-traumatic stress disorder outcome identification
Manage anxiety.
Increase self-esteem.
Improve ability to cope.
ptsd implementation
meds
- The same 3-stage model used for children
- Psychoeducation
- Psychopharmacology
+ persosin (key med): sleep disturbance
+ propanol: helps with anxiety - checking vitals
acute stress disorder
- Immediately after a highly traumatic event
- Symptoms persist for 3 days
- Diagnosis made within month
- symptoms the same
After 1 month
- Resolution or
- Becomes PTSD
ASD diagnosis s/s
Alterations in concentration Anger Dissociative amnesia Headache Irritability Nightmares Victimization
asd implementation
- Establish therapeutic relationship
- Assist to problem solve
- Connect person to supports
Collaborate for coordination of care - Ensure and maintain safety
- Refer to a licensed mental health provider
- Monitor response and/or adherence to treatment
- Advanced practice: cognitive-behavioral therapy (CBT)
adjustment disorder
- Precipitated by stressful event (not traumatic)
- Debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning
- Responses to stressful event may include combinations of depression, anxiety, and conduct disturbances
- struggle adls, bills, cognitive issues (memory)
dissociative disorders
- Occur after significant adverse experiences/traumas
- Individuals respond to stress with severe interruption of consciousness
- Unconscious defense mechanism
- Protects individual against overwhelming anxiety through emotional separation
dissociative disorder types
Depersonalization/derealization disorder
Dissociative amnesia
Dissociative identity disorder
depersonalization
- cut off from self
- robot
- not intube
- outside observer
- out of body experience
derealization
- cut off from world
- in dream
- objects feel bigger/smaller
- sounds overwhelming
Dissociative Amnesia
- Inability to recall important personal information (driving home and zoning out)
- Often of traumatic or stressful nature
Dissociative fugue
- Subtype characterized by sudden, unexpected travel and inability to recall one’s identity
Dissociative Identity Disorder
- Presence of two or more distinct personality states
- protect from traumatic event
- moral compas irratic
Each alternate personality (alter) has own pattern of
- Perceiving
- Relating to and
- Thinking about the self and environment
Dissociative Disorders Assessment
- History: how long, short or long term memory, injuries (concussion, seizure)
- Moods
- Impact on patient and family
- Suicide risk
- Self-assessment
Dissociative DisordersImplementation
Interventions
- Psychoeducation
- Pharmacological interventions: meds to treat others disorders no specific meds
