Post-Traumatic Stress Disorder (PTSD)
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Outline
Objective:
To understand the etiology, presentation, and nursing implications for a patient with posttraumatic stress disorder.
Etiology:
Posttraumatic Stress Disorder occurs as a result of a traumatic experience and causes the person to relive the trauma and the emotions involved with the trauma frequently and in varied ways.
Nursing Points:
General-
- May relive the trauma, frequently dream about it, or have flashbacks
- Traumatic events can range widely:
- Rape
- Traumatic accidents
- Wartime experiences
- Natural disasters
- Crime
- Many more
- Affects daily functioning
Assessment-
- Sleep issues: insomnia, nightmares
- Other mental health issues: depression, anxiety
- Avoidance of triggers
- For example, if a woman was raped in a bar, she may avoid bars or that particular bar
- Flashbacks
- Hypervigilance
- Guilt related to the event
- If they survived and others did not
- If they would have done something differently
Therapeutic Management-
- Validate feelings
- Promote the coping mechanisms that work for them
- Relaxation techniques
- Encourage outpatient therapy, support groups
- Therapy / service animals
- Help patient to identify their own feelings, response, and the actual precipitating event
Nursing Concepts-
- Safety
- Coping
- Mood Affect
Patient Education-
- Identify and avoid triggers
- Connect with community resources
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Post-Traumatic Stress Disorder (PTSD)
Transcript
Okay, in this lesson we’re going to talk about Post-Traumatic Stress Disorder or PTSD.
PTSD is a mental health disorder that results after someone experiences a trauma. Now, this could be any kind of trauma. It’s commonly associated with war veterans, but it is also seen in victims of rape and abuse, people who’ve been in traumatic accidents, survived natural disasters, been victims of a crime, etc. Many people who lived through Hurricane Katrina or the Tsunami in Asia are now suffering from PTSD. Unfortunately for them, one of the hallmark signs of PTSD is that they relive the traumatic event over and over. They may dream about it or have flashbacks. These issues begin to affect their daily functioning.
Patients may experience issues sleeping. I mean, can you imagine if every time you fall asleep, you dreamt about the worst day of your life? They have nightmares and it causes a lot of anxiety and even depression. All of this begins to compound on each other because they’re too anxious to sleep, even if they do sleep they have nightmares, they’re exhausted, probably irritable, and it can lead into a dark hole of depression. Many patients with PTSD will begin avoiding their triggers. Usually we’d say this is a good thing, but it can actually really limit their lives. Let’s say a person was raped in an alleyway – they may find it difficult to walk down the street because they have to pass alleys. Or maybe there’s a certain type of location they avoid, like a bar. Or maybe anyone with the same hair color as their attacker can trigger a panic attack, so they start to just stay home all the time to avoid experiencing it. I can be very limiting. Patients with PTSD will also be hypervigilant – they’re always looking around, on edge, trying to figure out how they could get out of a situation if they needed to. And they also experience guilt. This could be survivor’s guilt – like why did I survive and someone else didn’t? Or it could be guilt feeling like maybe they could’ve done something differently. But this just feeds back into the anxiety and depression and can really do a number on someone’s coping abilities.
So, what do we want to do for them? Well no matter what the situation, we always want to validate their feelings. Sometimes just having someone say that your feelings are valid and that you’re allowed to feel what you’re feeling is so powerful. We want to promote whatever coping mechanisms work for them. And I’ll add here – healthy coping mechanisms. Maybe exercising or relaxation techniques. Maybe journaling. They need to figure out what works to keep them out of the danger zone and prevent a panic attack. We also highly encourage therapy and support groups – just knowing you’re not alone is powerful enough, but them being able to share what works for them is also very helpful. There are also service dogs specifically trained to identify emotional agitation and anxiety, so we can help connect them with those resources as well. And finally we want to help them identify their feelings, their responses to certain situations and what their triggers are – and sometimes therapy may have to help them identify the traumatic event because they may not know right away.
I know for me, personally, there were a lot of repressed memories (remember that defense mechanism we talked about) and they kept me from really understanding why I was feeling the way I was feeling. So getting that help to process through those things and make sense of it is so helpful.
So, again, our #1 priority is going to be safety – clients with PTSD are at high risk for self-harm or suicidal ideations, so we want to promote positive, healthy coping strategies, and assess their mood/affect. Look for things like helplessness or hopelessness that may indicate depression and a risk for self-harm.
So let’s recap. Post-traumatic stress disorder occurs after a trauma of any kind and clients start to relive that trauma over and over through dreams, flashbacks, nightmares, and a general anxiety. It really affects their daily life, whether because of sleeping issues, anxiety, or being on edge and hypervigilant all the time. We want to help them find positive coping strategies and connect them with therapy and support group resources. And we always put safety first and assess that risk for self-harm.
So those are the basics of PTSD, be sure to check out the Patient Story (which is actually a collection of patient stories) and the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!
References:
- DSM V Criteria https://www.brainline.org/article/dsm-5-criteria-ptsd
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