Ch 16 Trauma, Stress-related & Dissociative Disorders Flashcards
(22 cards)
Persistent re-experiencing of highly traumatic events that involve actual/threatened death/serious injury to self or others
Intense fear, helplessness or horror, irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, & hypervigilance
PTSD
Trauma & stress-related disorders
Developed after exposure to a highly traumatic events; must have 8 of 14 symptoms
Sense of numbing, derealization, inability to remember one important aspect of the event, intrusive distressing memories of event, recurrent distressing dreams, feeling as the event is recurring, intense prolonged distress, avoidance of thoughts or feelings about the event, sleep disturbances, hypervigilance, irritable/angry/aggressive behavior, exaggerated startled response & agitation or restlessness
Acute Stress Disorder
Trauma & stress-related disorders
Milder, less specific version of ASD & PTSD; however event may not be as severe & nay not be considered traumatic
Hallmarks- cognitive, emotional & behavioral symptoms that negatively impact functioning
Depression, guilt, anxiety, anger, distress, social withdrawal, work/school inhibition
Adjustment Disorders
Trauma & stress-related disorders
Consistent pattern of inhibited, emotionally withdrawn behavior; caused by lack of bonding experiences by 8 mth.
Child rarely directs attachment behaviors toward any adult careigver
Reactive Attachment Disorder (Rare)
Trauma & stress-related disorders
Demonstrate no normal fear of strangers, seen unfazed in response to separation from a primary caregiver
Usually willing to go off w/ people who are unknown to them
Disinhibited social Engagement Disorder (Rare)
Trauma & stress-related disorders
Presence of two or more distinct personality states that recurrently take control of behavior
Usually not aware of alters, perplexed by lost time & unexplained events, each alter has own memories, behavioral patterns & social relationships
DID
Dissociative Disorders
Inability to recall important personal info, autobiographical memory is available but not accessible
(Dissociative Fugue)
Sudden, unexpected travel away from the customary locale & inability to recall one’s identity & info about some or all of the past
Fugue state- tend to lead rather simple lives
Dissociative Amnesia
(specify dissociative fugue)
(Dissociative Disorders)
Depersonalization the focus is on oneself; feelings of being an observer of one’s own body or mental process
Derealization the focus on the outside work; recurring feelings that one’s surrounding are unreal or distant
May feel mechanical, dreamy, or detached from the body
Depersonalization
Derealization D.
(Dissociative Disorders)
developing brain that can increase vulnerability to adverse life experiences
neuroplasticity
positive adaptation, or the ability to maintain or regain mental health despite adversity
resilience
ensures survival of species
attachment
term that means a balance between sympathetic & parasympathetic arousal
window of tolerance
Establish trust & safety
Use developmentally appropriate language to explore feelings
Teach relaxation techniques before trauma exploration
Help ID & cope with feelings w/ art & play
Involve parents or caretakers if appropriate (1:1)
Educate about grief process & response to trauma
Assist parents in resolving their own emotional distress
Coordinate with social workers PRN
Interventions for a child with PTSD
Hx- time of onset, frequency, course, severity, level of distress & degree of functional impairment
Assess- suicidal or violent ideation, family & social support, insomnia, social withdrawal, functional impairment, current life stressors, meds, past medical & psychiatric hx
Assessment for PTSD
Reassurance that reactions to trauma are common
Reactions do not indicate personal failure or weakness
Inform many ways that trauma can present- interpersonal problems with family/friends, occupational problems, &/or substance abuse/alcohol
Facilitate recognition of problems
Instructions in relaxation techniques
Avoidance of caffeine & alcohol
Education for PTSD
Trauma-focused psychotherapy Cognitive restructuring EMRD Brief psychodynamic psychotherapy Imagery Relaxation techniques Hypnosis Group Therapy
Advance Practice Interventions for PTSD
Establish therapeutic relationships Help problem solve Connect to support groups Educate about ASD Coordination of care with others Ensuring & maintaining safety Monitoring response &/or adherence to treatment critical incident stress debriefing (CISD)
Nursing Interventions for acute stress disorder (ASD)
CBT Specialized protocols for EMDR EMDR Protocol for Recent Critical Incidents Recent Event Protocol Recent Traumatic Episode Protocol
Advance Practice for acute stress disorder (ASD)
Physical exam
Electroencephalography
Imaging studies
Specific questions to ID dissociative symptoms
lapses in memory person may not be aware of
Identity, memory, consciousness, life events, mood, suicide risk, & impact of disorder
Pt ability to ID themselves
Changes in voice, behavior & dress may signal an alter & also referral to self as “we”
Memory
1. remember recent & past events
2. memory clear & complete or partial & fuzzy
3. aware of gaps in memory
4. do memories place them with family, in school or work
5. ever lose time or have blackouts
6. find themselves in places with no idea how they got there
Hx
1. wearing clothes you didn’t buy
2. stranger greet & talk to you like old friends
3. ability to engage in tasks changes
4. differing sets of memories from childhood
Assessments for Dissociative Disorders
Provide undemanding, simple routine
Ensure pt. safety by providing safe, protected environment & frequent observation
Confirm identity of pt. & orientation to time & place
Encourage pt. to do things for self & make decisions about routine tasks
Monitor patient for signs of drug dependence
Teach patients and family about medications
Assist w/ major decision making until memory returns
Support pt. during exploration of feelings surrounding the stressful events
Do not flood pt. with data regarding past events
Allow pt. to progress at own pace as memory is recovered
Provide support through empathetic listening during disclosure of painful experiences
Teach pt. grounding techniques suck as taking a shower, deep breathing, touching fabric on chair, exercising or stomping feet
Accept pt. expression of negative feelings
Teach stress-reduction methods
If pt. does not remember significant other, work with involved parties to reestablish relationships
Nursing Interventions for Dissociative Disorders
CBT Psychodynamic psychotherapy Exposure therapy Modified EMDR Hypnotherapy Neuro-feedback Ego state therapy Somatic therapies
Advanced Practices for Dissociative Disorders
disturbances in perception, sensations, autonomic regulation & movement are common
Dance Movement Therapists
Somatic Therapy
