(Exam 4) Trauma & Stressor-Related Disorders

resilience

positive adaptation; the ability to maintain or regain mental health despite adversity

normal stress response

hyperarousal in the sympathetic system is balanced by the parasympathetic system

trauma stress response

parasympathetic response triggers a hypo-aroused state; with dysregulation --> can lead to dissociation

dissociation

disconnection of thoughts, emotions, sensations, and behaviors connected with a memory

- severe dissociation occurs for those who have suffered significant trauma

what are our three trauma and stressor-related disorders

- posttraumatic stress disorder (PTSD)

- acute stress disorder

- adjustment disorder

what is PTSD

exposure to trauma causes intense fear, helplessness, detachment, and other symptoms

- CHRONIC; sx last longer than 1 month

what is acute stress disorder

exposure to trauma causes symptoms like PTSD

- SHORT-TERM; sx are time-limited, lasting less than 1 month

- if sx last longer than 1 month --> PTSD

what is adjustment disorder?

maladaptive reaction to stressor

- response occurs within 3 months after onset of the stressor, persists for no longer than 6 months

what is PTSD characterized as

persistent re-experiencing of a highly traumatic event

- sx can begin a month after exposure; delay of months to years is not uncommon

- not everyone who experiences trauma will develop PTSD

what are the S/S of PTSD

- re-experiencing trauma: intrusive recollections, flashbacks

- avoidance of stimuli associated with trauma, accompanied by feelings of detachment

- sx of increased arousal: irritability, hypervigilance, exaggerated startle response, difficulty sleeping

- Alterations in mood: depression, lack of interest in previously pleasurable activities

what is acute stress disorder characterized as

unpleasant and dysfunctional reaction after exposure to a traumatic event

- short-term!

what are the S/S of acute stress disorder

same as those with PTSD

- re-experiencing trauma: intrusive recollections, flashbacks

- avoidance of stimuli associated with trauma, accompanied by feelings of detachment

- sx of increased arousal: irritability, hypervigilance, exaggerated startle response, difficulty sleeping

- Alterations in mood: depression, lack of interest in previously pleasurable activities

what is the nurse's role with acute stress disorder

- establishing a therapeutic relationship

- helping a person to problem solve

- ensuring safety

- monitoring response to treatment

what is adjustment disorder characterized as

- precipitated by a stressful event

- event may not be considered traumatic (retirement, chronic illness, break up)

- can be dx immediately or within 3 months

what is the S/S of adjustment disorder

- guilt

- depression

- anxiety

- anger

- social withdrawal

- impaired function

- academic decline (mostly related to children)

what is the standard intervention for adjustment disorder

psychotherapy!

- reality orientation

- crisis intervention

- family or group therapy

what is the nursing process for trauma & stressor-related disorders

- comprehensive trauma assessment

- reducing arousal and regulating emotion (like deep breathing, imagery, mindfulness exercises)

- teaching topics: coping strategies, self-care, recognition of sx

what are some nursing dx of trauma & stressor-related disorder

- post trauma response

- impaired coping

- insomnia

- social isolation

what are some ways to evaluate the effectiveness of tx in trauma & stress disorders

- client can manage anxiety (using relaxation techniques)

- client experiences enhanced self-esteem

- client exhibits ability to cope as demonstrated by a decrease in sx

what is trauma-informed care

philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care

- not re-traumatizing another individual

what are the practices of trauma-informed care

- safety for everyone

- trustworthiness & transparency

- peer support

- collaboration & mutuality

- empowerment, voice & choice

- cultural, historical & gender issues

what are the pharmacotherapy for trauma & stressor disorders

- antidepressants = first line treatment

SSRIs: Paroxetine (Paxil) & Sertraline (Zoloft) = FDA approved

what are the psychological therapies

- trauma-focused psychotherapy

- EMDR therapy

- group/family therapy

what is EMDR therapy

helps someone process and integrate traumatic memories

- people encouraged to think about the traumatic event while focusing on other bilateral stimulation (eye movements, audio tones, or tapping)

- leads to less dissociation when recalling a traumatic event

PTSD in children and adolescents

External factors can support or put stress on children

- children brought up in a chaotic, non-nuturing environment can suffer neurological consequences that are long-lasting and difficult to remediate

- ACE can lead to lifelong consequences for psychological and physical health

- children are resillient = strong early interventions can lead to child to thrive later

what does posttraumatic stress disorder in children/adolescents look like

comprehensive trauma assessment

- nightmares, intrusive thoughts, flashbacks, memory problems, self-injurious behaviors, somatic sx

- may re-enact trauma in play!!

what are the treatment modalities for PTSD in children and adolescents

CBT and eye movement desensitization and reprocessing (EMDR)

what are our child-specific disorders

- reactive attachment disorder

- disinhibited social engagement disorder

reactive attachment disorder

pattern of inhibited and emotionally withdrawn behavior

- child rarely seeks comfort or responds to comfort with adult caregivers when distressed

disinhibited social engagement disorder

demonstrate no normal fear of strangers

- unfazed in response to separation from a primary caregiver

what are risk factors for child-specific trauma-related disorders

- shifts in primary caregivers (change in foster homes, extended hospitalization

- impaired parenting due to severe psychiatric problems or substance use disorders (disrupts bonding experience)

what is dissociation

An unconscious defense mechanism that protects against overwhelming anxiety through emotional separation

- often occurring after significant trauma

- results in disturbances in memory, consciousness, self-identity, perception

what are our dissociative disorders

- dissociative amnesia

- depersonalization/derealization disorder

- dissociative idenity disorder

what is dissociative disorder

inability to recall information, often of a traumatic nature, that is too pervasive to be explained by ordinary forgetfulness

what is depersonalization/derealization disorder

temporary change in the quality of self-awareness

what is dissociative identity disorder

presence of two or more distinct personality states that recurrently take control of behavior

localized amnesia

unable to remember all events in a certain period

selective amnesia

able to recall some but not all events in a certain period

generalized amnesia

amnesia for identity and total life history

dissociative fugue

sudden, unexpected travel away from customary location and inability to recall one's identity and information about some or all the past

(think of Walter White)

depersonalization

disturbance in the perception of oneself

derealization

alteration in the perception of the external environment

depersonalization-derealization disorder

characterized by a temporary change in the quality of self-awareness

- feelings of detachment from the environment

- being an observer of one's own body or mental process

dissociative identity disorder (DID)

each alternate personality has its own pattern of perceiving, relating to, and thinking about the self and the environment

- risk factors: physical and sexual abuse

- suicide risk is extremely high

what are the treatment modalities for DID

psychotherapy is the treatment of choice

- medication prescribed only to alleviate sx

what are nurses mandated to report

abuse to children UNDER 18 and adults OVER the age of 65

physical abuse

infliction of physical pain or bodily harm

sexual abuse

any sexual act without consent

emotional abuse

undermining of a person's self-worth; may include criticism, name-calling, intimidating, isolating

neglect

failure to provide for physical, emotional, educational, and medical needs

economic abuse

controlling a person's access to economic resources, making an individual financially dependent

what is the cycle of violence

pattern of behavior that perpetrators of violence may use to control their partners; without intervention cycle will repeat

- tension-building stage (walking on eggshells)

- acute battering stage (abuse happens)

- honeymoon stage (loving)

what is the assessment for trauma interventions

- identify indicators of abuse

- levels of anxiety

- coping mechanisms

- support systems

- suicide and homicide potential

- alcohol and drug misuse

what do we do for those who we are not mandated to report on?

community referral and support

crisis

sudden event or situation that disturbs homeostasis

- coping mechanisms cannot resolve the problem

crisis intervention

directive, time-limited and goal-directed strategy designed to assist individuals who are experiencing a crisis

what are the 3 things that a successful outcome for a crisis depends on

- the realistic perception of the event

- adequate situational supports

- adequate coping mechanisms

what are the types of crisis

- maturational/developmental

- situational

- adventitious

maturational/developmental

occur in response to failed attempts to master developmental tasks associated with life cycle transitions

- marriage, birth of a child, retirement, death of parent, etc

situational

from events that are unusually distressing and often unanticipated

- loss of job, accident, divorce, loss of loved one

adventitious

traumatic and external event that happens unexpectedly

- epidemics, fires, earthquakes, terrorism, wars, shootings, etc

what are the 4 phases of crisis

1. expsure to stressor

2. usual coping mechanisms fail and threat persist; anxiety remains high

3. all possible resources (internal and external) called to resolve the problem

4. if resolution has not occured; anxiety can overwhelm to a breaking point

what is the minimum goal for crisis intervention

resolution of the crisis and restoration to the level of functioning that existed before the crisis period

what is the maximum goal for crisis intervention

achieve functioning above the pre-crisis level