Trauma Related Disorders, Crisis, and Disasters

Trauma-Related Disorders, Crisis, and Disasters


Types of Trauma

  1. Acute Trauma “single and short”

  • A single traumatic event that is limited in time such as a car accident or natural disaster

  1. Chronic Trauma “multiple”

  • Exposure to multiple and/or persistent traumatic events such as abuse, social emotinal neglect, isolation, poverty or hunger

  1. Complex Trauma “identity crisis”

  • Exposure to chronic trauma that also distorts the individuals fundamental sense of self such as persistent social inequity, racism, discrimination due to sexual orientation or gender identity.

  1. System Induced Trauma 

  • Trauma that is experienced during movement through organizational systems such as foster care or juvenile detention

  1. Vicarious Trauma “secondary trauma”

  • Indirect trauma that results from engaging with victims of trauma such as healthcare personnel during COVID, hurricane katrina, or first responders after 9/11

  1. Historical Trauma

  • Psychosocial distress resulting from trauma or adversity passed down through generations of groups of people who shared an identity, affiliation, or circumstance


Bowlby’s Attachment Theory

  • Suggest the attachment relationships formed with caregivers such as parents, during infant and early childhood are necessary for survival and brain development

  • Relationships formed in early childhood influence body functions, social emotional learning, emotiona and behavioral self regulation, cognitive function, relationships and coping mechanisms

  • Relationships enable a person to navigate life stressors and build resilience


Stages of Attachment: 

  1. Birth - 3 months “preattachment stage”

  • Infant forms bond with caregiver or objects

  • Hasnt learned the difference between object or person

  1. 6 weeks - 7 months “indiscriminate attachment”

  • Baby socializes

  • Prefer individuals over objects

  • Can distinguish familiar individuals

  • No separations anxiety or concern about strangers

  1. 7 months - 11 months “discrimination attachment”

  • Distinguishes strangers from familiar people

  • Separation anxiety present

  1. 24 months >

  • Forms attachment

  • Multiple attachments

Dopamine and oxytocin are released in the brain during infant bonding which reinforces the brain’s central reward system.


Polyvagal Theory: Nervous System and Trauma

  • Vagus nerve: “information superhighway”- relays sensory/motor information between the brain and the body; 3 dynamic functions

  1. SNS : involved in survival along with the dorsal vagus nerve: when engaged by traumatic experiencing: signal that a survival response is needed

  2. Ventral Vagus Nerve: social cues (environment) and exhibiyd social behaviors relating to social interaction and the need for safety and connection

  3. ANS: fight, faint flight, freeze, or fawn

Trauma and the Autonomic Nervous System

  • Sympathetic “Fight or Flight”: tachycardia, shallow/fast breathing, muscle tension

  • Dorsal Vagus “Faint or Freeze”: shutting down, second line of defense; diaphragmatic breathing or GI issues; occurs when fight or flight is not possible; freezing is needed to preserve life

  • Ventral Vagus “Fawn or Social Engagement”: using social skills to connect to the stressor

Pathophysiology of Trauma: When the Past Becomes the Present



  • Hypothalamic-pituitary axis (HPA): regulates stress

  • Toxic stress: chronic exposure to stress; body learns fear and trauma are normal, results in neurological changes

Toxic Stress: Impact on Brain and Body

  • Prefrontal cortex (goes offline when confronted with toxic stress)

  • Amygdala (survival and fear system takes over to manage threats) -returns the body to a state of equilibrium and perceived safety

  • Hippocampus

When stress is chronic or toxic and the HPA remains in a prolonged state of hyperarounsal, the clients path can lead to significant clinical manifestations such as:

  • Developmental delays

  • Failure to thrive

  • Insomnia

  • Asthma

  • Learning difficulties

  • Behavioral problems

  • Immune system (increased risk for infection or developing autoimmune disease)

  • Early initiation of sexual activity and smoking

  • Frequent headaches

  • Engaging in risky behaviors

  • Obesity

  • Suicide attempts 

  • Unintented pregancies

And in adults:

  • Diabetes, substance abuse, depression, COPD, depression, fetal death, financial stress, lower quality of life, ischemic heart disease, liver disease, increased risk of infection or developing autoimmune disease, multiple sexual partners, poor work performance, risk of intimate partner violence, risk of sexual violence, STDs, smoking, and suicide attempts


Fear Learning

  • Fear Conditioning: describes neural circuitry that creates a biological memory of a traumatic event, this increases fear arousal and the stress response thus increase the risk for health-threatnening behaviors.

  1. Prevents individuals from distinguishing between their memories and what they are currently experiencing

  2. Can results in hyperarousal manifestations: elevated BP, restlessness, agitation, worry, or aggression

  • Fear Extinction: gradual reduction in autonomic response (BP and HR)

  1. Occurs when neural circuitry acts as a braking system: helps restore the body to equilibrium and sense of safety

  2. Amygdala: communicates with hippocampus about impulses created from toxic stress ad traumatic events

  3. Hippocampus : “vault” stores the memory of the stressor for retrieval when expose to similar stimuli that may trigger the client to re live the traumatic event or stressor: known as memory consolidation 

  4. The past becomes the present


Genetic Implications: Across the Lifespan and in Future Generations


  • When stress responses activates the brain, the individual can develop stress resilience: the ability to adapt, cope, and recover from stressors AFTER they occur,  or stress senstization : overwhelms an individual and predisposes an individual to a mental illness

  • Not all stressors or traumatic experiences will lead to a trauma related disorder

  • Epigenetics: genetic alterations that determine whether a gene will be activated or deactivated

  1. Influences how DNA is translated and expressed across the lifespan and to future generations

  2. Can impact how nerve cells and organ tissues develop when expose to environmental stressors such as abuse and neglect

  3. Historical trauma: colonization, slavery, genocide, coerced assimilation, extreme poverty, mass casualty event (shootings, pandemics, natural disaster)

  4. Inheritable (predisposing) risk factor: disease or disorder that can be inherited from a parent

Trauma Related Disorders in Children and Adults


PACEs: Protective and Compensatory Experiences in Children

  • Experiences that reduce an individuals likelihood of developing mental and physical health issues later in life

  • Include 10 PACEs: parent/ caregiver unconditional love, spending time with a best friend, volunteering or helping others, being active in a social group, having a mentor outside of the family, living in a clean and safe home with enough food, having opportunities to learn, having a hobby, being active or playing sports, having routine and fair rules at home


Adjustment disorder: occurs within 3 months of a stressor and lasts up to 6 months following resolution of trauma “short term diagnosis”; if manifestations continue, reevaluation is done


Reactive attachment disorder (RAD): diagnosed when there is a disturbance in attachment such as removing a child from the caregiving adult or insufficient care due to abuse or neglect


Acute stress disorder (ASD): occurs after an acute or traumatic experience; clinical manifestations last three days to one month after the event, if they continue a diagnosis of PTSD is considered


Post traumatic stress disorder (PTSD):  exposure to traumatic events can be severe and long lasting


Disinhibited social engagement disorder (DSED): reflects a pattern of behaviors in which a child is overly familiar with a relative stranger; diagnosed only in children nine months and older


Crisis and Disaster

  • Common events that affect individuals and communities (eg. pandemics, shootings, wars, terrorism, hurricanes, wildifres

  • Nurses play a key role in saving lives, reducing injury and supporting recovery

Mass Casualty Incidents: large number of people injured or killed at once, creates public health emergencies, nurses work with interdisciplinary teams, over 2.6 billion people affected globally in the last decade


Disaster Management Cycle

  1. Prevention: stop disasters or reduce risk (eg. safety laws, education)

  2. Preparedness : planning and training before disaster (eg. drills, emergency plans)

  3. Response : immediate actions during disaster (eg. rescue, triage, provide care)

  4. Recovery : help people return to normal (eg. mental health, long-term healing)

Nursing Role in Disasters

All Phases

  • Therapeutic communication

  • Emotional support

  • Ensure safety (physical and psychological)

Early Phases (Prevention and Response)

  • Safety

  • Physical needs

  • Crisis management

Recovery Phase

  • Mental health assessment

  • Monitoring trauma effects

  • Supporting coping


Crisis: a stressful life event that feels overwhelming and requires immediate intervention

  • Can happen with or without a disaster and makes people feel vulnerable, out of control, and uncertain (eg. death/loss. Abuse, lack of support, and trauma)

  • Anxiety, anger/aggression, agitation, depression, euphoria

 Mental Health Emergency: risk of harm to self or others → immediate action is needed

  • Interventions: help the client return to equilibrium (assess {is there a mental health emergency?} Yes→ emergency intervention and stabilize then crisis intervention, No→ crisis intervention only

Increase risk of crisis:

  • Previous trauma

  • Poverty/homelessness

  • Lack of support systems

Stages of Crisis

  • Stress builds over time

  • Coping fails → crisis occurs

  • After intervention → stress decreases

 Crisis is a continuum, not sudden.

Disasters

1. Human-caused (terrorism, mass shootings, industrial accidents)

2. Natural (earthquakes, hurricanes, wildfires, floods)

Effects of Disasters

  • Emotional:

    • Grief

    • Bereavement

    • Trauma

  • Social:

    • Loss of roles

    • Displacement

  • Economic:

    • Job loss

    • Food insecurity

Nursing Priorities in Disaster

  • During disaster

    • Triage

    • Save lives

    • Address physical + mental needs

  • After disaster

    • Monitor mental health

    • Support recovery

    • Connect to resource

Trauma Related Disorders


  • Prevalence: the portion of the population that has specific characteristics of a disease or disorder

  • PTSD: most common (6.8% of population): women are twice as likely as men to develop PTSD→ intimate partner violence and sexual assault: women who have experienced 4 or more ACEs and have a Hx of interpersonal violence are at an increased risk for PTSD

  • African Americans, Hispanic Americans, and Indigenous People are more affect


Adjustment Disorders: High Risk Populations

  • Increase prevalence rates among recently unemployed or loss of a loved one


Etiology and Risk Factors

  • Childhood maltreatment: abuse, neglect, or exploitation of individuals under the age of 18

  • Interpersonal violence: violence acts commited against children or adults (physical, sexual, emotional abuse or coercion): occurs in intimate relationships where trust is compromised

Sexual abuse occurs every 68 seconds in the United States.


Factors Resulting in Increased Riks of Experiencing Violence or Abuse

  • Having a disability, living in institutional care and deprived of liberty, living in extreme poverty, unaccompanied or separated from family (migrants, refugees, asylum seekers), facing discrimination for sex or gender identity, marginalized social and ethnic groups, living with other social and economic disadvantages, being a women or child


Adverse Childhood Experiences

  • Genetic vulnerability: genetic predisposition to develop disease when interacting with environmental factors

  • 3 categories: abuse, neglect, and household function

  • Linked to STDs, mental illness, premature death

  • Increased risk of economic vulnerability in the future due to affecting academic success


Cultural Considerations and Vulnerable Populations


  • Historical trauma: “ soul wounds” on the collective psych (conscience): describes the part of the unconscious memory that is common to humankind, t contains inherited ideas or other cultural phenomena and is considered an accumulation of primities human ideas and images

  • Suggests wounds become a part of survivors trauma and will follow future generations


Bias is the tendency of an individual to make broad decisions or stereotypes about other individuals or groups based on thoughts, feelings, or perceptions rather than evidence, harming their ability to make equitable decisions.



Clinical Presentation of Trauma Related Disorders


Shared Diagnostic Criteria for Acute Stress Disorder and Post-traumatic Stress Disorder

  • Exposure to a traumatic event (firsthand, witnessing, learning of a close friend/family trauma, or repeated exposure)

  • Intrusion manifestations ( trauma keeps coming back even if the person doesn’t want it) eg. flashbacks, nightmares, emotional distress..

  • Negative alterations in cognition and mood

  • Dissociative manifestations (mentally checkin out)

  • Avoidance manifestations (social withdrawal)

  • Arousal manifestations

  • Clinical significant distress negativley impacts personal function


Key feature that distinguishes acute stress disorder (ASD) [ 3 days to one month past the traumatic experience] and post-traumatic stress disorder (PTSD) [longer than one month and are experienced indefinitely] is the timeline


Post-tramatic Stress Disorder in Children and Adolescents


Reactive attachment disorder (RAD)

  • Early diagnosis (before age 5: early childhood or infancy after 9 months of age

  • Absence of adequate cargiveing during child hood

  • Child becomes withdrawn from adults or other caregivers due to unmet needs

  • Can be caused by lack of touch or attention from caregivers

  • Child unable to relate to others

  • No attachment figure for comfort or social interaction

Disinhibited social engagement disorder (DSED)

  • Diagnosed during childhood after 9 months of age

  • Absence of caregiving during childhood

  • Displays overly familiar behaviores toward strangers without regard to social boundaries

  • Unable to relate to others

Post-traumatic stress disorder (PTSD)

  • Manifestions >1 month (distress and impair ability to function in socal and occupational roles)

  • Connected to anxiety response

Acute stress disorder (ASD)

  • Manifestions consistent with PTSD

  • Last 3 days to one month AFTER traumatic experience

  • Anxiety response

Adjustment disorder (AD)

  • Emotional + behaviroal reaction to a specific stressor

  • Within 3 months of the stressor

  • Resolsve within 6 months after the stressor ends

  • Symptoms are not severe enough to mee criteria for other disorders and are not just worsening of an existing mental illness

Stressor→reaction within 3 months→ gone by 6 months→not another disorder


DSM 5 TR Criteria for PTSD: Individuals Older Than 6 Years

A. Stressor (1 required)

Exposure to serious trauma:

  • Direct

  • Witnessed

  • Learned (close person)

  • Indirect (job-related)

B. Intrusion (≥1)

Reliving the trauma

  • Memories

  • Nightmares

  • Flashbacks

  • Emotional/physical distress with triggers

C. Avoidance (≥1)

Avoid reminders

  • Thoughts/feelings

  • People/places

D. Negative Mood/Cognition (≥2)

Changes in thinking/feeling

  • Memory gaps

  • Negative beliefs (“world is unsafe”)

  • Blame (self/others)

  • Isolation

  • Loss of interest

  • Can’t feel positive emotions

E. Arousal/Reactivity (≥2)

Hyper-alert state

  • Irritability/aggression

  • Risky behavior

  • Hypervigilance

  • Startle response

  • Poor concentration

  • Sleep problems

F. Duration

  • > 1 month

G. Functional Impact

  • Causes distress or impaired functioning

H. Not due to something else

  • Not meds, substances, or illness

Specifiers

  • Dissociative: depersonalization or derealization

  • Delayed: full symptoms appear ≥6 months later

👶 PTSD in Children ≤6 — Key Points

A. Trauma Exposure (≥1)

  • Directly experienced

  • Witnessed (NOT media)

  • Learned it happened to caregiver

B. Intrusion (≥1)

👉 Reliving (often through play)

  • Traumatic play

  • Nightmares

  • Flashbacks

  • Emotional distress with reminders

  • Physical reactions (↑ HR, sweating)

C. Avoidance OR Negative Mood (≥1)

👉 Kids combine these into ONE category

  • Avoid people/places/reminders

  • Fear, shame, sadness

  • Loss of interest

  • Social withdrawal

  • Less positive emotions

D. Arousal (≥1)

👉 Think “irritable + on edge”

  • Temper tantrums / anger

  • Hypervigilance

  • Startle response

  • Poor concentration

  • Sleep problems

⏱ Other Requirements

  • > 1 month

  • Causes distress or problems (school/relationships)

  • Not due to substances/illness

🔥 BIG EXAM DIFFERENCE (Kids vs Adults)

  • Kids:

    • Play = trauma expression

    • Fewer symptoms required

    • Avoidance + mood COMBINED

  • Adults:

    • More separate categories

    • More symptoms required

🧠 General Trauma Manifestations (All Ages)

1. Intrusion

  • Memories, nightmares, flashbacks

2. Avoidance

  • Avoid thoughts, people, places

3. Negative Mood

  • Guilt, shame, isolation

  • Can’t feel happy

4. Arousal

  • Hypervigilance

  • Irritability

  • Sleep issues

  • Risky behavior

⚠ Dissociative Symptoms

  • Depersonalization: “I’m not real”

  • Derealization: “World isn’t real”

🔑 Easy Memory Trick

👉 Kids = “PLAY + TANTRUM + WITHDRAW”

  • Play → intrusion

  • Tantrums → arousal

  • Withdraw → avoidance/mood

🧠 Adjustment Disorder (AD) — Key Points

  • What it is: Emotional/behavioral response to a specific stressor

  • Examples of stressors: Job loss, death, life changes

⏱ Timing

  • Starts: Immediately → within 3 months

  • Ends: Within 6 months

⚠ Key Features

  • Distress is out of proportion to the stressor

  • Causes impaired daily functioning

  • High risk for suicide (VERY testable)

❌ NOT:

  • Normal grief

  • Another mental disorder

👶 PTSD in Children — Unique Features

1. Time Skew

  • Child remembers trauma out of order

2. Omen Formation

  • Child thinks:
         👉 “I should’ve seen it coming”
         👉 “I can prevent it next time”

3. Post-Traumatic Play

  • Repetitive acting out the trauma through play

🧵 Resilience vs Trauma (THREADS vs FRAYED)

✅ THREADS = Healthy/Resilient Child

  • Thinking (brain development)

  • Hope

  • Regulation (self-control)

  • Efficacy (can handle situations)

  • Attachment (healthy relationships)

  • Development (skills)

  • Support (safe environment)

⚠ FRAYED = Trauma Effects

  • Fits, frets, fear

  • Regulation problems

  • Attachment issues

  • Yelling/yawning (stress behaviors)

  • Educational delays

  • Defeat & dissociation

🔥 Quick Memory

👉 Adjustment Disorder = “3–6 rule”

  • ≤ 3 months onset

  • ≤ 6 months duration

👉 Kids PTSD = “Play + Blame + Confused Timeline”

🧠 NURSING ROLE IN TRAUMA CARE (CORE FOUNDATION)

  • Goal is NOT to fix trauma

  • Goal = understand impact + support healing

  • Nurse provides:

    • Therapeutic presence

    • Collaboration with client/family

    • Trauma-informed care (TIC)

🚨 PRIORITY INTERVENTION

👉 Create a SAFE environment (psychological + physical)

  • Promotes:

    • Safety

    • Belonging

    • Stability

  • Helps return client to homeostasis

⚠ TRAUMA EFFECTS ON CLIENT

  • Poor self-regulation

  • Maladaptive coping

  • Trigger responses:

    • Startle to noise

    • Fear in crowds

    • Aggression when overwhelmed

👉 Nurse must recognize manifestations to guide care

🛑 AVOID RETRAUMATIZATION

Always ask:

  • Am I promoting Safety?

  • Am I showing Respect?

  • Am I building Trust?

👉 Words + tone + body language matter

🧠 TRAUMA-INFORMED CARE (TIC)

Key principles:

  • Be aware, sensitive, responsive

  • Focus on client-centered care

  • Ask:
         👉 “What happened to you?” (NOT “What’s wrong with you?”)

🌍 CULTURAL HUMILITY

  • Client perspective shaped by:

    • Personal experiences

    • Relationships

    • Culture & systems

Nurse must:

  • Respect differences

  • Avoid assumptions

  • Recognize biases

👉 Cultural misunderstanding → misdiagnosis + poor outcomes

⚠ BIAS (VERY TESTED)

Types:

  • Explicit bias → conscious

  • Implicit bias → unconscious

👉 Effects:

  • Communication breakdown

  • Health inequities

  • Retraumatization

🛡 UNIVERSAL TRAUMA PRECAUTIONS

👉 Assume EVERYONE has trauma

  • Be:

    • Nonjudgmental

    • Compassionate

    • Respectful

  • Protect:

    • Culture

    • Identity

    • Dignity

Environment:

  • Low noise

  • Safe space

  • Support choices

🧠 SECONDARY TRAUMATIC STRESS (NURSE)

  • Nurse may reexperience trauma symptoms

  • Leads to:

    • Burnout

    • Emotional exhaustion

👉 Requires:

  • Self-reflection

  • Coping strategies

🧘 4 C’s OF TRAUMA-INFORMED CARE (HIGH-YIELD)

1. Calm

  • Control tone, stay regulated

2. Contain

  • Limit trauma exposure

  • Don’t force discussion

3. Care

  • Self-care + compassion

4. Cope

  • Build coping skills + resilience

🫁 BOX BREATHING (CALMING TECHNIQUE)

  • Inhale 4

  • Hold 4

  • Exhale 4

  • Hold 4

🚨 CRISIS INTERVENTION (NURSING SKILLS)

  • Let client talk

  • Use silence

  • Do NOT argue or contradict

  • Use problem-solving

  • Avoid blame

  • Follow through

⚡ CRISIS STAGES

Stage 1: Normal stress

  • Calm, rational

Stage 2: Anxiety rising

Stage 3: 🔥 LOSS OF CONTROL

  • Pacing

  • Aggression

  • Yelling

Stage 4: Panic

👉 Stage 3 = MOST TESTED

🏥 DISASTER MENTAL HEALTH CARE

Psychological First Aid:

  • Ask:

    • “What do you need?”

  • Assess:

    • Coping ability

  • Identify:

    • Resources

Priorities:

  • Food, shelter, safety

  • Reconnect with support systems

⚠ WHEN TO REFER (VERY IMPORTANT)

  • Suicidal/homicidal thoughts

  • Substance abuse

  • Severe anxiety/depression

  • Disorientation

  • Abuse/violence

  • Persistent dysfunction

👶 AGE-RELATED TRAUMA RESPONSES (FULL DETAIL)

🧸 Ages 1–5 years

Behavioral

  • Regression:

    • Bed-wetting

    • Thumb sucking

    • Clinging to parents

  • Fear of the dark

  • Refuses to sleep alone

  • Increased crying

  • Unrealistic fear of event happening again

Physical

  • Loss of appetite

  • GI problems

  • Sleep disturbances

  • Nightmares

  • Speech difficulties

  • New onset tics

Psychological

  • Anxiety

  • Fear

  • Irritability

  • Angry outbursts

  • Sadness

  • Withdrawal

  • Excessive crying

🧒 Ages 6–10 years

Behavioral

  • Decline in school performance

  • Aggression at home/school

  • Hyperactivity or “silly” behavior (NEW onset)

  • Regression:

    • Whining

    • Clinging

    • Acting younger

  • Competing for parents’ attention

  • Unrealistic fear of recurrence

Physical

  • Appetite changes

  • Headaches

  • GI problems

  • Sleep disturbances

  • Nightmares

Psychological

  • Avoids school

  • Withdraws from friends/activities

  • Angry outbursts

  • Preoccupation with disaster/safety

🧑‍🎓 Ages 12–18 years (ADOLESCENTS)

Behavioral

  • Decline in academic performance

  • Rebellion

  • Loss of responsibility

  • Mood changes

  • Agitation

  • Decreased energy

  • Apathy

  • Reckless behavior (VERY TESTED)

  • Social withdrawal

  • Substance use

Physical

  • Appetite changes

  • Headaches

  • GI problems

  • Skin issues (acne/rash)

  • Vague body pains

  • Sleep disturbance

Psychological

  • Loss of interest in peers/hobbies

  • Depression/sadness

  • Resistance to authority

  • Feelings of inadequacy & helplessness

🧑 Adults

Behavioral

  • Avoidance of reminders

  • Increased activity OR withdrawal

  • Crying easily

  • Increased conflict/violence

  • Hypervigilance

  • Isolation

  • Substance abuse

Physical

  • Sleep problems

  • Fatigue

  • GI issues

  • Appetite changes

  • Somatic complaints

  • Worsening chronic illness

Psychological

  • Depression

  • Irritability/anger

  • Anxiety/fear

  • Hopelessness/despair

  • Guilt/self-doubt

  • Mood swings

  • Embarrassment about needing help

👵 Older Adults

Behavioral

  • Withdrawal/isolation

  • Refusal to leave home

  • Mobility issues

  • Difficulty adjusting to relocation

  • Medication misuse

Physical

  • Worsening chronic conditions

  • Sleep disturbance

  • Memory problems

  • Sensory decline (vision/hearing)

  • Temperature sensitivity (hypo/hyperthermia)

Psychological

  • Depression

  • Despair

  • Apathy

  • Confusion/disorientation

  • Agitation/anger

  • Anxiety in new environments

  • Embarrassment about needing help

🔥 HIGH-YIELD PATTERNS (EXAM TRICKS)

  • Young kids → REGRESSION + FEAR

  • School-age → SCHOOL ISSUES + AGGRESSION

  • Teens → RISKY BEHAVIOR + SUBSTANCE USE

  • Adults → ANXIETY + SUBSTANCE USE + CONFLICT

  • Older adults → CONFUSION + WITHDRAWAL + PHYSICAL DECLINE

🧠 SUPER SIMPLE MEMORY

👉 “Little = regress, Middle = act out, Teens = risk, Adults = cope poorly, Elderly = decline”

🛡 PREVENTION LEVELS (HIGH-YIELD)

Primordial

  • Prevent risk factors (poverty, inequality)

Primary

  • Prevent trauma (education, resilience)

Secondary

  • Early detection (screening, counseling)

Tertiary

  • Treat disorder (therapy, meds)

🔄 TRAUMA-INFORMED PREVENTION

Primordial:

  • Policies, reduce inequality

Primary:

  • Prevent ACEs

  • Promote parenting + resilience

Secondary:

  • Screen for trauma

  • Provide early support

Tertiary:

  • Crisis care

  • Therapy + medication 

🧠 NURSING PROCESS IN TRAUMA CARE (FULL BREAKDOWN)

🔍 1. RECOGNIZE CUES (ASSESSMENT)

Common trauma presentations

Clients may show:

  • Anxiety

  • Sleep problems

  • Intrusive thoughts

  • Aggression/anger

  • Depression

👉 Trauma can appear with other disorders too (mood, anxiety, personality)

What nurses must assess

  • Mental health history

  • Family history

  • Severity of symptoms

  • Coping styles

  • Social support

  • Medications

  • Risk for violence/self-harm

🔑 FOUR R’s OF TRAUMA CARE (VERY TESTED)

  • Realize → trauma impacts people

  • Recognize → identify signs

  • Respond → use trauma-informed care

  • Resist retraumatization

🧠 4 TRAUMA DOMAINS (CRITICAL)

You MUST assess:

  • Cognitive → thinking, beliefs

  • Behavioral → actions

  • Emotional (affective) → feelings

  • Physiological → body responses

👶 CHILD DIFFERENCES (IMPORTANT)

Children:

  • May NOT verbalize trauma

  • Need:

    • Play

    • Drawing

    • Toys

👉 Trauma can be triggered ANY time during care (school, hospital, etc.)

⚠ CHILD TRAUMA MANIFESTATIONS

  • Regression

  • Trauma play

  • Nightmares

  • Poor school performance

  • Withdrawal

  • Substance use

  • Irritability

  • Mood swings

📋 ASSESSMENT METHODS

  • Medical history

  • Mental health history

  • Physical exam

  • Psychosocial assessment

  • Cultural assessment

  • Mental status exam

🧠 MENTAL STATUS EXAM (WHY IMPORTANT)

Assesses:

  • Thinking

  • Emotions

  • Behavior

Observe:

  • Speech

  • Memory

  • Coordination

  • Affect

👉 Helps guide care planning

🧸 CHILD DATA COLLECTION

  • Use:

    • Drawing

    • Play

  • Goals:

    • Understand child + family needs

    • Develop care plan

📊 SCREENING TOOLS (VERY TESTED)

Examples:

  • PCL-5 (PTSD checklist)

  • ACEs

  • LEC-5

  • C-SSRS (suicide risk)

  • PC-PTSD-5

⚠ SCREENING RULES

  • DO NOT force trauma disclosure

  • Ask general questions first

  • Avoid asking if patient is intoxicated

  • Explain purpose of questions

👉 Client must feel in control

💬 TRAUMA-INFORMED COMMUNICATION DURING SCREENING

  • Warn client:

    • Questions may be uncomfortable

  • Provide support

  • Use active listening

👉 This builds trust + reduces stigma

⏱ TIMING IS CRITICAL

DO NOT ask trauma details if:

  • Client in crisis

  • Client in acute distress

🧠 ANALYZE CUES (PRIORITIZE HYPOTHESES)

Assess risk for:

  • Violence

  • Suicide

  • Self-harm

Key emotional risks:

  • Helplessness

  • Hopelessness

  • Guilt

👉 ↑ risk for suicide

🚨 DIRECT SAFETY ASSESSMENT (ALWAYS ASK)

  • Suicidal thoughts

  • Plan

  • Intent

  • Past attempts

  • Self-harm

  • Substance use

Also assess:

  • Coping skills

  • Past stress responses

  • Hallucinations (especially command hallucinations)

🚨 IF POSITIVE FINDINGS → ACTION

  • Remove harmful objects

  • Notify team immediately

🧠 PLANNING (GENERATE SOLUTIONS)

Key goals:

  • Promote safety

  • Build trust

  • Restore routine

  • Support coping

Important strategies:

  • Assign same staff (consistency)

  • Protect privacy

  • Give clear instructions

  • Set SMART goals

  • Offer choices

⚠ WHY CHOICES MATTER (VERY TESTED)

  • Trauma = loss of control

  • Giving choices → restores control

🚨 TRIGGERS TO AVOID

  • Forcing information

  • Lack of explanation

  • Touching without permission

👉 Can cause fight/flight/freeze/fawn

⚙ IMPLEMENTATION (TAKE ACTION)

  • Introduce self + role

  • Use simple language

  • Use open-ended questions

  • Limit trauma details

  • Validate feelings

  • Encourage coping skills

  • Give choices

  • Ask before touching

  • Use crisis intervention if needed

  • Administer meds

🧠 EVALUATION

Look for:

  • ↓ symptoms

  • ↑ functioning

  • Better coping

Teaching strategies:

  • Small info at a time

  • Use teach-back

  • Allow time to process

🏠 DISCHARGE PLANNING

  • Connect to:

    • Therapy

    • Medications

    • Community resources

  • Address:

    • Housing

    • Finances

    • Access to meds

👉 Prevent gaps in care

💊 TREATMENT OPTIONS

Therapy:

  • CBT

  • Exposure therapy

  • Cognitive processing therapy

  • EMDR

  • PCIT (kids)

Medications:

  • SSRIs: sertraline, fluoxetine, paroxetine

  • SNRI: venlafaxine

  • Benzos: for anxiety

  • Prazosin: nightmares (off-label)

👉 No medication “erases” trauma

💪 RESILIENCE (VERY IMPORTANT CONCEPT)

Builds through:

  • Relationships

  • Routine

  • Coping skills

Positive outcomes:

  • Stronger relationships

  • New purpose

  • Growth after trauma

🌱 PROTECTIVE FACTORS

  • Support systems

  • Positive coping

  • Safe environment

🔥 EXAM CHEAT SHEET (DO NOT MISS)

  • #1 = SAFETY

  • DO NOT force trauma discussion

  • Use 4 R’s

  • Assess suicide risk DIRECTLY

  • Give choices

  • Avoid retraumatization

  • Children = play-based assessment

  • Teach-back = evaluation

  • Consistency = trust

  • Trauma affects ALL domains