Pathophysiology
Post-traumatic Stress Disorder (PTSD) is a condition that develops when a person has been exposed to a serious situation such as a natural disaster, serious accident, death of a loved one or life-threatening event. This condition causes debilitating symptoms that, depending on the severity, can negatively affect relationships, communication and daily activities. PTSD affects all ages from childhood to senior adult and symptoms may flare up without any known trigger. Aside from emotional difficulty, clients may experience physical manifestations such as chronic pain and headaches and can lead to drinking and drug addictions as well as physical abuse.
Etiology
Diagnostic Criteria:
- Exposure to death, threatened death, serious injury or actual or threatening sexual violence. Direct exposure (personally witnessed), repeated exposure, or indirect exposure (i.e. first responders, child victim advocates, law enforcement, etc.)
- Intrusion or persistently re-experienced stressors in at least one of the following ways: recurrent memories, traumatic nightmares, flashbacks, prolonged distress following traumatic reminders, significant physical symptoms after exposure to stressors
- Avoidance of distressing trauma-related stressors after the event in at least one way
- Negative alterations in mood and cognitions that began or got worse after the initial event. Must include 2 of the following: Inability to recall key features of the event, persistent or negative beliefs, persistent distorted blame, persistent negative emotions, significant lack of interest, feeling of alienation, inability to experience positive emotions
- Alterations in reactivity since the traumatic event. Must include 2 of the following: aggressiveness, self-destructive behavior, hypervigilance, exaggerated startle response, difficulty concentrating, sleep problems
- Duration of symptoms must be greater than one month
- Functional impairment from symptoms
- Attribution – not related to medication, substance use or other medical illness
Desired Outcome
Client will be able to identify triggers. Client will learn and utilize positive coping strategies. Client will demonstrate control of emotions and relaxation techniques. Client will be free from injury.
Post-Traumatic Stress Disorder (PTSD) Nursing Care Plan
Subjective Data:
- Irritability, easily agitated
- Difficulty sleeping, nightmares
- Lack of interest or pleasure in activities
- Feeling emotionally numb
- Easily startled or frightened
- Mood swings, outbursts of anger
- Difficulty communicating with others
- Impaired relationships
- Loss of memory
Objective Data:
- Alcohol or drug use since event
- Suicidal or homicidal ideations
- Self-mutilation or self-destructive behavior
Nursing Interventions and Rationales
- Assess vitals and perform nursing assessment
Determine baseline for vitals and assess for underlying or accompanying medical conditions
- Assess client for suicidal or homicidal ideations
To ensure safety of the client and others.
Determine severity of condition and course of treatment or therapy
- Establish trust with the client
- Listen to what the client is saying
- Behave in a calm manner
Especially when a client has a high level of anxiety, establishing trust can help the client calm down and make treatment more effective
- Provide extra time for care and allow client extra time to respond to questions
Clients often have difficulty communicating due to racing thoughts or inability to concentrate. Avoid rushing the client and allow them more time to answer or respond to promote security and instill a sense of value.
- Encourage client to express emotions in a safe environment
Allows the client the freedom to acknowledge their feelings and release any repressed emotions that may be exacerbating their distress. A safe environment should be free from actual or perceived judgement and physical or perceived danger.
- Encourage client to verbally identify current ineffective coping techniques
Helps the client understand their current behaviors that may be preventing effective healing or treatment.
- Encourage client to write about the traumatic event
Allows provider to better understand the nature of the client’s condition and anticipate triggers that may cause symptoms. Also allows client and provider to periodically review evolution of emotions toward the traumatic event
- Encourage client to keep a journal of stressors and emotional reactions to those stressors
Helps client identify triggers that prompt anxiety or symptoms and evaluate the outcomes of those reactions.
- Teach visualization and relaxation techniques such as deep breathing and imagery
Helps client learn to manage anxiety that accompanies flashbacks or environmental stressors and triggers
- Administer medications appropriately and monitor for side effects or dependance
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that have proven to be effective for chronic management of symptoms.
- Provide calming and reassuring environment
Clients with PTSD are often fearful. Providing a calm, relaxing environment can help lessen or relieve anxiety and promote a feeling of safety.
- Facilitate access to community resources using Case Manager or Social Worker
Support groups and other community resources such as service animals, etc., can provide support that the client needs to function in their daily lives.
References
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
