Included In This Lesson
Study Tools
Outline
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.
- Assess anxiety level
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.
A Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.
References
Transcript
Let’s take a look at the care plan for post-traumatic stress disorder, also known as PTSD. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of PTSD, also subjective and objective data and nursing interventions and rationales included in the care plan.
PTSD is a condition that develops when a person has been exposed to a serious situation, like a natural disaster, a serious accident, or life-threatening event. This condition, depending on the severity, can cause debilitating symptoms that can negatively affect relationships, communication, and even daily activities. PTSD affects all ages from children to senior adults with symptoms flaring up without any known trigger at all. Aside from emotional difficulty, these patients may experience physical manifestations, such as chronic pain, headaches, and even can lead to drinking and drug addictions as well as physical abuse.
Diagnostic criteria includes exposure to death, threatened death, serious injury, or actual or threatening sexual violence. Exposure can be direct exposure meaning personally witnessed, It can mean repeated exposure, or it can mean indirect exposure, like what we would see with first responders, child victim advocates, or even law enforcement. Intrusion or persistently re-experienced stressors in at least one of the following ways, including recurrent memories, traumatic nightmares, flashbacks, prolonged distress, following traumatic reminders also included in diagnosing PTSD.
Additional criteria includes negative alterations in mood and cognitions that began or got worse after the initial event, which includes two of the following:Inability to recall key facts or features of the event, persistent or negative beliefs, persistent distorted blame, persistent negative emotions, significant lack of interest, feeling of alienation, or inability to experience positive emotions. Also, alterations and reactivity since the traumatic event, which includes two of the following aggressive self-destructive behavior: hyper-vigilance, exaggerated startle response, difficulty concentrating, or issues with sleep. The duration of symptoms must be greater than one month. There must be functional impairment from symptoms, with symptoms, not being related to medication, mental illness or substance abuse. So, the desired outcome for a patient with PTSD will be to identify triggers, learn and utilize positive coping strategies, as well as demonstrate control of emotions and relaxation techniques, and the patient will absolutely be free from injury.
Let’s take a look at some of the subjective and objective data that your patient with PTSD may present with. Now remember subjective data are going to be things that are based on your patient’s opinions or feelings. A patient with PTSD may express irritability or being easily agitated, difficulty sleeping, or nightmares, mood swings, outbursts of anger, difficulty communicating with others, impaired relationships and loss of memory.
Objective or measurable data may include alcohol or drug abuse since the event, suicidal or homicidal ideation, self-mutilation or self destructive behavior.
Let’s take a look at the nursing interventions, which are super important to a care plan for a patient with PTSD. Assess vital signs and perform a nursing assessment, determine your patient’s baseline for vitals and assess for any underlying or accompanying medical condition. It is crucial to determine the safety of the patient as well as others, by assessing for suicidal and homicidal ideations. Assess the anxiety level in the patient to determine the severity of the condition and the course of treatment or therapy. Establish trust with the patient, meaning listen to what they have to say and behave in a calm manner. When a patient has a high level of anxiety, establishing trust can help them to calm down. PTSD patients often have difficulty communicating due to racing thoughts or inability to concentrate. Avoid rushing them and allow them more time to answer or respond to promote security and instill a sense of value. Allow the patient the freedom to acknowledge their feelings and release any repressed emotions that may be exacerbating with distress. A safe environment should be free from actual or perceived judgment and physical or perceived danger.
Encourage them to verbally identify current ineffective coping techniques, which helps the patient to understand their current behaviors that may be preventing effective healing or treatment. Also, encourage the patient to write about the traumatic event, which helps you as the provider to better understand the nature of the client’s condition and anticipate triggers that may cause symptoms. It also allows the patient and the provider to review the evolution of the emotions toward the event. Encourage the patient to keep a journal of stressors and emotional reactions to those stressors. Journaling can help the patient to identify triggers that prompted anxiety or symptoms and evaluate the outcomes of those reactions. Help the patient to learn, to manage the anxiety that can accompany flashbacks or environmental stressors or triggers like visualization and relaxation techniques, deep breathing, and imagery.
Medications like SSRI, selective, serotonin re-uptake inhibitors and SNRI, serotonin norepinephrine reuptake inhibitors are antidepressants that have proven to be effective for chronic management of symptoms. Patients with PTSD are often fearful, so providing a calm environment can help lessen or relieve anxiety and promote a feeling of safety. Support groups and other community resources like service animals can provide support that the patient needs to function in their daily lives. Facilitate this through community resources, using a case manager or a social worker.
Okay, guys, here is a look at the completed care plan for PTSD. We love you guys. Now go out and be your best self today and as always, happy nursing!
Miriam Wahrman, MSN/Ed, RNC-MNN 
Nichole Weaver, MSN/Ed, RN, CCRN 
