Podcast
Questions and Answers
Which of the following best delineates the distinction between Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) according to diagnostic criteria?
Which of the following best delineates the distinction between Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) according to diagnostic criteria?
- The primary differentiating factor lies in the duration of symptoms, with ASD lasting no more than one month, while PTSD persists beyond one month. (correct)
- ASD involves a restricted range of affect, whereas PTSD is characterized by persistent negative emotional states.
- The intensity of the traumatic event is the key determinant; ASD follows less severe traumas compared to PTSD.
- ASD is primarily diagnosed based on the presence of dissociative symptoms, whereas PTSD is defined by intrusive re-experiencing of the traumatic event.
A combat veteran experiencing persistent nightmares, flashbacks, and hyperarousal following deployment would meet the criteria for PTSD if these symptoms:
A combat veteran experiencing persistent nightmares, flashbacks, and hyperarousal following deployment would meet the criteria for PTSD if these symptoms:
- have been present for at least two weeks and are directly linked to a specific traumatic event during combat.
- interfere with his ability to maintain stable interpersonal relationships, regardless of duration.
- are temporarily alleviated by substance use or other maladaptive coping mechanisms.
- have been present for more than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (correct)
What primary nursing intervention should be implemented when a client exhibiting symptoms of PTSD begins to display signs of a flashback?
What primary nursing intervention should be implemented when a client exhibiting symptoms of PTSD begins to display signs of a flashback?
- Administer a prescribed benzodiazepine to immediately reduce anxiety and promote relaxation.
- Stay with the patient, offer reassurance of safety and employ grounding techniques to orient the client to the present. (correct)
- Immediately restrain the client to prevent potential harm to self or others during the dissociative episode.
- Encourage the client to recount the details of the traumatic event in a safe and controlled environment.
Which statement accurately differentiates between Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in early childhood?
Which statement accurately differentiates between Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in early childhood?
Which of the following is the MOST critical diagnostic criterion for dissociative identity disorder (DID)?
Which of the following is the MOST critical diagnostic criterion for dissociative identity disorder (DID)?
A patient undergoing treatment for Dissociative Identity Disorder (DID) begins to express memories of severe childhood abuse that were previously inaccessible. What is the most appropriate therapeutic intervention?
A patient undergoing treatment for Dissociative Identity Disorder (DID) begins to express memories of severe childhood abuse that were previously inaccessible. What is the most appropriate therapeutic intervention?
An individual reports persistent feelings of detachment from their body, as if they are an outside observer of their own life, while maintaining intact reality testing. This presentation is MOST consistent with:
An individual reports persistent feelings of detachment from their body, as if they are an outside observer of their own life, while maintaining intact reality testing. This presentation is MOST consistent with:
Which intervention represents the MOST appropriate initial step in managing a patient experiencing derealization symptoms?
Which intervention represents the MOST appropriate initial step in managing a patient experiencing derealization symptoms?
Which statement is most consistent with the cognitive-behavioral conceptualization of PTSD?
Which statement is most consistent with the cognitive-behavioral conceptualization of PTSD?
A key aspect of Cognitive-Behavioral Therapy (CBT) for PTSD involves challenging maladaptive cognitions related to the trauma, aiming to:
A key aspect of Cognitive-Behavioral Therapy (CBT) for PTSD involves challenging maladaptive cognitions related to the trauma, aiming to:
Which scenario most accurately exemplifies the application of 'exposure therapy' in the treatment of PTSD?
Which scenario most accurately exemplifies the application of 'exposure therapy' in the treatment of PTSD?
During a session, a client with PTSD expresses intense guilt and self-blame regarding actions taken during the traumatic event. Which therapeutic approach would be MOST effective in addressing these cognitions?
During a session, a client with PTSD expresses intense guilt and self-blame regarding actions taken during the traumatic event. Which therapeutic approach would be MOST effective in addressing these cognitions?
A patient with PTSD is prescribed an SSRI. What is the primary rationale for using an SSRI in the treatment of PTSD?
A patient with PTSD is prescribed an SSRI. What is the primary rationale for using an SSRI in the treatment of PTSD?
A patient with severe PTSD exhibits a blunted affect, emotional numbing, and anhedonia. Which medication is MOST likely to be prescribed?
A patient with severe PTSD exhibits a blunted affect, emotional numbing, and anhedonia. Which medication is MOST likely to be prescribed?
In the context of trauma-informed care, 'establishing safety' involves which key components?
In the context of trauma-informed care, 'establishing safety' involves which key components?
What is the primary goal of trauma-informed care?
What is the primary goal of trauma-informed care?
Which family dynamic would be MOST indicative of potential attachment disorders in a child?
Which family dynamic would be MOST indicative of potential attachment disorders in a child?
A child diagnosed with Reactive Attachment Disorder consistently avoids seeking comfort from caregivers when distressed. How would this manifest?
A child diagnosed with Reactive Attachment Disorder consistently avoids seeking comfort from caregivers when distressed. How would this manifest?
Which therapeutic intervention is considered MOST appropriate for addressing attachment disorders in young children?
Which therapeutic intervention is considered MOST appropriate for addressing attachment disorders in young children?
An adolescent diagnosed with an adjustment disorder after experiencing a romantic breakup. The MOST appropriate therapeutic intervention?
An adolescent diagnosed with an adjustment disorder after experiencing a romantic breakup. The MOST appropriate therapeutic intervention?
A client diagnosed with an adjustment disorder reports feeling overwhelmed, experiencing insomnia, and having difficulty. Which intervention would be MOST appropriate?
A client diagnosed with an adjustment disorder reports feeling overwhelmed, experiencing insomnia, and having difficulty. Which intervention would be MOST appropriate?
During an assessment, a client reports experiencing significant memory gaps concerning specific time periods and events. However, does not report moving to a new geographic location. This is suggestive of:
During an assessment, a client reports experiencing significant memory gaps concerning specific time periods and events. However, does not report moving to a new geographic location. This is suggestive of:
What statement is most accurate in characterizing dissociative fugue?
What statement is most accurate in characterizing dissociative fugue?
During a clinical interview, a client reports experiencing periods where they feel detached from their body and as if they are observing themselves from outside. Which question would elicit the MOST relevant information?
During a clinical interview, a client reports experiencing periods where they feel detached from their body and as if they are observing themselves from outside. Which question would elicit the MOST relevant information?
A client undergoing treatment for dissociative amnesia suddenly regains a flood of traumatic memories. What is the MOST appropriate initial nursing intervention?
A client undergoing treatment for dissociative amnesia suddenly regains a flood of traumatic memories. What is the MOST appropriate initial nursing intervention?
During a clinical interview, a client diagnosed with Dissociative Identity Disorder is asked to describe their symptoms. Which indicates the client is in an 'alter' state?
During a clinical interview, a client diagnosed with Dissociative Identity Disorder is asked to describe their symptoms. Which indicates the client is in an 'alter' state?
A client with Dissociative Identity Disorder (DID) expresses confusion. Which nursing intervention would be MOST appropriate?
A client with Dissociative Identity Disorder (DID) expresses confusion. Which nursing intervention would be MOST appropriate?
A patient with PTSD is having a flashback. Which intervention is MOST appropriate?
A patient with PTSD is having a flashback. Which intervention is MOST appropriate?
Which is LEAST likely to be a nursing diagnosis for PTSD?
Which is LEAST likely to be a nursing diagnosis for PTSD?
How does 'dissociation' protect a person during a traumatic experience?
How does 'dissociation' protect a person during a traumatic experience?
Which of the following scenarios best describes 'derealization'?
Which of the following scenarios best describes 'derealization'?
What is the primary difference between PTSD and Adjustment Disorder?
What is the primary difference between PTSD and Adjustment Disorder?
A child who willingly goes off with strangers, has no fear of strangers, and appears eager to attach to anyone might be classified as having:
A child who willingly goes off with strangers, has no fear of strangers, and appears eager to attach to anyone might be classified as having:
A combat veteran with PTSD often becomes irritable and lashes out when talking about military combat. Which of the following would be the MOST effective therapeutic approach to manage this behavior?
A combat veteran with PTSD often becomes irritable and lashes out when talking about military combat. Which of the following would be the MOST effective therapeutic approach to manage this behavior?
What is the hallmark of dissociative amnesia?
What is the hallmark of dissociative amnesia?
In a patient with Dissociative Identity Disorder, what is the role of the 'host' personality?
In a patient with Dissociative Identity Disorder, what is the role of the 'host' personality?
People experiencing Depersonalization/Derealization Disorder do NOT experience:
People experiencing Depersonalization/Derealization Disorder do NOT experience:
Which of the following is NOT a recommended treatment for someone with trauma?
Which of the following is NOT a recommended treatment for someone with trauma?
Flashcards
Trauma Definition
Trauma Definition
Stressors well beyond daily stress, extraordinary in intensity.
PTSD Definition
PTSD Definition
Persistent re-experiencing of a highly traumatic event.
PTSD Event Pose
PTSD Event Pose
Actual/threatened death, serious injury, or repeated exposure to aversive details.
PTSD-Inducing Events
PTSD-Inducing Events
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Flashback of Trauma
Flashback of Trauma
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Avoidance (PTSD)
Avoidance (PTSD)
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Acute Stress Disorder (ASD)
Acute Stress Disorder (ASD)
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PTSD Timeframe
PTSD Timeframe
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Adjustment Disorder
Adjustment Disorder
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Attachment Disorders
Attachment Disorders
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Reactive Attachment Disorder
Reactive Attachment Disorder
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Disinhibited Social Engagement Disorder
Disinhibited Social Engagement Disorder
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Dissociative Disorders
Dissociative Disorders
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Dissociation Definition
Dissociation Definition
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Dissociative Amnesia
Dissociative Amnesia
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Dissociative Fugue
Dissociative Fugue
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Dissociative Identity Disorder
Dissociative Identity Disorder
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Alternate Personalities Characteristics
Alternate Personalities Characteristics
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Depersonalization
Depersonalization
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Derealization
Derealization
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Study Notes
Trauma and Stressors
- Trauma involves stressors beyond normal daily life and are extraordinary in intensity.
- Individual traumas/stressors include abuse and illness.
- Few people experience stressors like car crashes.
- Group traumas/stressors include natural disasters and wars.
Posttraumatic Stress Disorder (PTSD)
- Persistent re-experiencing of a highly traumatic event characterizes PTSD.
- The event involves actual or threatened death or serious injury.
- Repeated exposure to aversive details of traumatic events can cause of PTSD, example first responders
- Responses of intense fear, helplessness, or horror are felt in PTSD.
PTSD-Inducing Events
- Military combat, prisoner-of-war experiences, or being taken hostage are examples of PTSD-inducing events.
- Crime-related events: bombing, assault, mugging, or rape.
- Natural disasters: floods, tornadoes, and earthquakes, can induce PTSD.
- Human disasters: automobile, airline, and train accidents.
Symptoms Subcategories of PTSD
- Flashbacks of trauma include dreams that are intrusive
Symptoms of PTSD
- Avoidance involves talking about the event.
- Avoidance includes activities, people, and places that arouse memories of trauma.
- Negative cognition/thoughts can be a PTSD symptom.
- Hyperarousal and hypervigilance
Incidence of PTSD
- Men are more likely to have experienced physical assaults, accidents, disasters, combat, and witnessing injury or death.
- Women commonly experience child sexual abuse or sexual assault
- Not everyone who experiences trauma will develop PTSD.
PTSD and ASD
- PTSD and Acute Stress Disorder (ASD) share similar symptoms but differ in duration.
- ASD symptoms are experienced for 1 month or less.
- PTSD symptoms are experienced for more than 1 month, up to years.
Case Study: Home Health Visit (Boston Marathon Bombing)
- A 19-year-old runner was injured by shrapnel in the 2013 Boston Marathon bombing.
- Parents expressed concerns about the son's insomnia and frequent nightmares related to the bombing.
- The survivor experiences heart palpitations, dizziness, sweating, and shortness of breath venturing outside.
- He is hesitant to leave the house or engage in any activities, and calls his parents to return when they leave.
Nursing Diagnoses of PTSD
- Common nursing diagnoses for PTSD include anxiety (moderate, severe, panic).
- Further Nursing diagnoses include impaired coping
- Social isolation and insomnia are nursing diagnoses for PTSD
- Sleep deprivation and hopelessness are also diagnoses
- Chronic low self-esteem and self-care deficit
PTSD Treatment Options and Nursing Interventions
- Counseling and therapy (individual or group) can provide support.
- Medication as another options includes Antidepressants for symptoms of depression or anxiety
- Benzodiazepines for insomnia
- Exposure therapy + Relaxation techniques is very useful.
- Establish a trusting relationship and provide safety.
Nursing Interventions
- Assign same staff member; safe and predictable environment.
- During a flashback the nurse should stay with the patient and reassure safety
- Ask permission for touch and use grounding techniques when appropriate.
- Relaxation exercises can reduce stress and encourage discussion at at own pace.
- Discuss coping strategies that were useful in stressful situations in the past.
Related Disorders: Adjustment Disorder
- Adjustment disorder can occur when a person struggles to cope with a significant life change.
- Examples like divorce, breakup, job loss, academic stress, or retirement.
- Psychotherapy: Verbalization of emotions related to stressors
- Antidepressants can help with depressive symptoms
- Benzodiazepines can help reduce anxiety
Related Disorders: Attachment Disorders
- Attachment Disorders are psychiatric conditions in children with an inability to form emotional attachments.
- These disorders are caused by an inadequate nurturing environment during child's early years (under 8 months).
- Reactive attachment disorder: emotionally withdrawn, rarely seeks comfort to caregivers
- Disinhibited social engagement disorder: children with no normal fear of strangers
Risk Factors and treatment of Attachment Disorders
- Risk factors include foster homes and impaired parenting (psychiatric problem, criminal behavior, substance abuse).
- Another risk factor includes prolonged separation from parents or caregivers
- In addition, a significant risk factor includes Frequently changing caregivers
- Family therapy – goal is to strengthen relationship between caregiver and child.
- Without treatment, it can lead to life-long consequences such as lack of trust and insecurity.
Related Disorders: Dissociative Disorders
- Dissociative disorders occur after traumas or adverse events with dissociation as the predominant response.
- Dissociation is a defense mechanism that protects against overwhelming anxiety through emotional separation.
- Childhood physical, sexual, or emotional abuse and other traumatic life events are risk factors.
- Dissociation allows them to fragment the good from the bad.
- Dissociation interferes with relationships and ability to function and cope.
Dissociative Amnesia
- Main type of dissociative disorder: inability to recall important personal information, often of a traumatic nature.
- Amnesia may be localized or selective with the Risk factor: adverse child experience
- No specific treatment, but Benzodiazepines for anxiety can help
Dissociative Fugue
- A subtype of dissociative amnesia.
- Client suddenly moves to a new geographic location with no memory of past events and often an assumption of a new identity.
Dissociative Identity Disorder
- Formerly multiple personality disorder.
- 2 or more distinct states that take recurrent control.
- One state – function on daily basis and blocks access of traumatic memories
- 2nd personality - fixated on traumatic experience
- Alternate personalities has different ways of thinking, memories, and behavior.
- Risk factor: severe sexual, physical or psychological trauma in children
Characteristics of Alternating Personalities
- Individuals may behave like a different sex or religion
- Dominant hand and voice can be different
- Intelligence can vary from personality to personality
- Switching can last minutes to months
Depersonalization/Derealization disorder
- Depersonalization is defined as feeling of watching own body or mental process
- Patient feels detached from actions, self, feelings, thoughts, body or sensation
- Derealization is defined as feelings where other people and objects are unreal
- The patient would feel detached from world around, dreamlike, artificial, or foggy
- Walking aimlessly is a sign of derealization
Dissociative Disorder Treatment Options
- Individual and group therapy can provide support and coping strategies.
- Cognitive-behavioral therapy can help individuals reframe negative thought patterns.
- Medications (for anxiety or depression or both) can help with managing symptoms.
- Provide simple, undemanding routine in a safe environment and with frequent observation.
- Confirm identity of patient providing orientation and grounding techniques while reducing stressors.
- Allowing them to progress at own pace is very important.
- Work to reestablish relationships if the patient does not remember significant others.
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