Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
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Outline
Lesson Objectives for Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
- Understanding PTSD:
- Define Post-Traumatic Stress Disorder (PTSD) as a mental health condition that can develop after exposure to a traumatic event.
- Differentiate between the diagnostic criteria for acute stress disorder and PTSD.
- Identifying Triggers and Symptoms:
- Identify common triggers and symptoms associated with PTSD, including intrusive thoughts, flashbacks, hyperarousal, and avoidance behaviors.
- Recognize the impact of trauma on an individual’s mental and emotional well-being.
- Assessment and Screening:
- Understand the importance of comprehensive assessment and screening tools in identifying individuals at risk for or experiencing PTSD.
- Explore the role of trauma-focused interviews and standardized assessment tools.
- Trauma-Informed Care:
- Discuss the principles of trauma-informed care and its application in nursing practice.
- Highlight the importance of creating a safe and supportive environment for individuals with PTSD.
- Multidisciplinary Approach:
- Emphasize the need for a multidisciplinary approach in the management of PTSD, involving collaboration with mental health professionals, social workers, and other healthcare providers.
- Recognize the significance of patient and family education in the treatment and recovery process.
Pathophysiology for Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) doesn’t have a clear-cut pathophysiology like some medical conditions; however, it involves complex neurobiological and psychological processes. Here are five key points that capture aspects of PTSD
- Neurobiological Changes:
- Exposure to trauma can lead to alterations in the brain’s neurobiology, affecting areas such as the amygdala, hippocampus, and prefrontal cortex.
- The amygdala, responsible for emotional processing, may become hyperactive, leading to heightened emotional responses and fear conditioning.
- Changes in the hippocampus, involved in memory consolidation, can result in difficulties in processing and integrating traumatic memories.
- Hormonal Dysregulation:
- Trauma can trigger dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal cortisol levels.
- Persistent activation of the stress response system can contribute to symptoms such as hypervigilance, hyperarousal, and disrupted sleep patterns.
- Altered Neurotransmitter Function:
- Imbalances in neurotransmitters, particularly serotonin and norepinephrine, are associated with PTSD symptoms.
- Lower levels of serotonin, a neurotransmitter involved in mood regulation, may contribute to mood disturbances.
- Elevated levels of norepinephrine, associated with the “fight or flight” response, can contribute to heightened arousal and anxiety.
- Fear Conditioning and Memory Consolidation:
- Traumatic experiences can lead to maladaptive fear conditioning, where neutral stimuli become associated with fear.
- Impaired memory consolidation may result in fragmented, vivid, and intrusive recollections of traumatic events.
- Alterations in Brain Structure:
- Structural changes in the brain, including reduced volume in the hippocampus and prefrontal cortex, have been observed in individuals with PTSD.
- These alterations may contribute to difficulties in emotion regulation, cognitive processing, and the integration of traumatic memories.
It’s important to note that the pathophysiology of PTSD is complex and not fully understood. The interplay of genetic, environmental, and psychological factors contributes to the development and maintenance of PTSD symptoms. Additionally, individual responses to trauma can vary widely, and not everyone exposed to trauma will develop PTSD.
Etiology of Post-Traumatic Stress Disorder (PTSD)
- Exposure to Trauma:
- Direct Experience: Individuals may develop PTSD after personally experiencing or witnessing a traumatic event, such as combat, assault, natural disasters, or accidents.
- Indirect Exposure: Secondary trauma, through learning about traumatic events affecting others, can also contribute to the development of PTSD.
- Personal Vulnerability Factors:
- Genetic Factors: There is evidence suggesting a genetic predisposition to PTSD, with certain genetic variations influencing an individual’s susceptibility.
- Pre-existing Mental Health Conditions: Individuals with a history of pre-existing anxiety or mood disorders may be more vulnerable to developing PTSD after trauma.
- Severity and Nature of the Trauma:
- The intensity, duration, and nature of the traumatic event can impact the likelihood of developing PTSD.
- Interpersonal traumas, such as those involving intentional harm or betrayal, may be particularly associated with the development of PTSD.
- Lack of Social Support:
- Limited social support or a lack of a supportive network following a traumatic event may increase the risk of developing PTSD.
- Positive social support has been identified as a protective factor against the development of PTSD.
- Neurobiological Factors:
- Alterations in the brain’s neurobiology, including changes in neurotransmitter levels and the functioning of the stress response system, can contribute to the development and persistence of PTSD symptoms.
Desired Outcome in the Management of PTSD
- Symptom Reduction:
- Alleviate and reduce the severity of PTSD symptoms, including intrusive thoughts, flashbacks, nightmares, hyperarousal, and avoidance behaviors.
- Improved Coping Mechanisms:
- Enhance adaptive coping strategies and resilience, enabling individuals to effectively manage stress and emotional distress without resorting to maladaptive behaviors.
- Enhanced Functioning in Daily Life:
- Improve overall functioning in daily life, including work, relationships, and social interactions, by addressing the impact of PTSD on various aspects of an individual’s life.
- Reintegration and Participation:
- Facilitate the reintegration of individuals into social, familial, and occupational spheres, promoting a sense of connection and engagement.
- Enhanced Quality of Life:
- Improve the individual’s overall quality of life by fostering a sense of safety, promoting positive mental health, and enabling the pursuit of personal goals and aspirations.
Post-Traumatic Stress Disorder (PTSD) Nursing Care Plan
Subjective Data:
- Irritability, easily agitated
- Difficulty sleeping, nightmares
- Lack of interest or pleasure in activities
- Feeling emotionally numb
- Easily startled or frightened
- Mood swings, outbursts of anger
- Difficulty communicating with others
- Impaired relationships
- Loss of memory
Objective Data:
- Alcohol or drug use since event
- Suicidal or homicidal ideations
- Self-mutilation or self-destructive behavior
Nursing Assessment for Post-Traumatic Stress Disorder (PTSD)
- Comprehensive Mental Health History:
- Conduct a thorough mental health assessment to gather information about the individual’s psychiatric history, including any pre-existing anxiety or mood disorders.
- Trauma History and Exposure:
- Explore the nature and details of the traumatic event(s), including the type of trauma, the duration, and the individual’s direct or indirect exposure.
- PTSD Symptomatology:
- Use standardized tools and interviews to assess for PTSD symptoms, including intrusive thoughts, flashbacks, nightmares, avoidance behaviors, and hyperarousal.
- Coping Mechanisms and Resilience:
- Evaluate the individual’s current coping mechanisms and resilience factors, including social support, adaptive coping strategies, and the ability to manage stress.
- Impact on Daily Functioning:
- Assess the impact of PTSD symptoms on various aspects of the individual’s daily life, including work, relationships, and self-care activities.
- Sleep Patterns:
- Inquire about sleep patterns and disturbances, such as nightmares or difficulty falling or staying asleep, as sleep disturbances are common in individuals with PTSD.
- Co-occurring Conditions:
- Screen for co-occurring conditions, such as substance use disorders, depression, or anxiety disorders, which may influence the course and treatment of PTSD.
- Safety Assessment:
- Evaluate the individual’s current safety, including any thoughts of self-harm or harm to others.
- Identify potential safety concerns and implement appropriate interventions as needed.
- Trauma-Informed Approach:
- Utilize a trauma-informed approach throughout the assessment, creating an environment that prioritizes safety, trust, and collaboration.
Continuous reassessment is essential as the individual’s needs may change over time. Additionally, building a therapeutic relationship and fostering open communication are key components of the nursing assessment for PTSD. Collaborating with the healthcare team, including mental health professionals, helps ensure a comprehensive and coordinated approach to care.
Implementation for Post-Traumatic Stress Disorder (PTSD)
- Psychoeducation:
- Provide comprehensive psychoeducation about PTSD, including information on symptoms, triggers, and the impact of trauma on mental health.
- Offer resources and educational materials to enhance the individual’s understanding of their condition.
- Cognitive-Behavioral Therapy (CBT):
- Facilitate access to CBT, a evidence-based therapeutic approach for PTSD, to help individuals identify and challenge maladaptive thought patterns and behaviors.
- Collaborate with mental health professionals to ensure consistency in therapeutic interventions.
- Pharmacological Interventions:
- Collaborate with the healthcare team, including psychiatrists, to assess the potential need for pharmacological interventions.
- Administer prescribed medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), as part of the treatment plan.
- Promoting Self-Care and Coping Skills:
- Assist the individual in developing and implementing self-care strategies, including relaxation techniques, mindfulness, and healthy coping mechanisms.
- Encourage the adoption of positive lifestyle habits, such as regular exercise and adequate sleep.
Nursing Interventions and Rationales
- Assess vitals and perform nursing assessment
Determine baseline for vitals and assess for underlying or accompanying medical conditions
- Assess client for suicidal or homicidal ideations
To ensure safety of the client and others.
- Assess anxiety level
Determine severity of condition and course of treatment or therapy
- Establish trust with the client
- Listen to what the client is saying
- Behave in a calm manner
Especially when a client has a high level of anxiety, establishing trust can help the client calm down and make treatment more effective
- Provide extra time for care and allow client extra time to respond to questions
Clients often have difficulty communicating due to racing thoughts or inability to concentrate. Avoid rushing the client and allow them more time to answer or respond to promote security and instill a sense of value.
- Encourage client to express emotions in a safe environment
Allows the client the freedom to acknowledge their feelings and release any repressed emotions that may be exacerbating their distress. A safe environment should be free from actual or perceived judgement and physical or perceived danger.
- Encourage client to verbally identify current ineffective coping techniques
Helps the client understand their current behaviors that may be preventing effective healing or treatment.
- Encourage client to write about the traumatic event
Allows provider to better understand the nature of the client’s condition and anticipate triggers that may cause symptoms. Also allows client and provider to periodically review evolution of emotions toward the traumatic event
- Encourage client to keep a journal of stressors and emotional reactions to those stressors
Helps client identify triggers that prompt anxiety or symptoms and evaluate the outcomes of those reactions.
- Teach visualization and relaxation techniques such as deep breathing and imagery
Helps client learn to manage anxiety that accompanies flashbacks or environmental stressors and triggers
- Administer medications appropriately and monitor for side effects or dependance
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that have proven to be effective for chronic management of symptoms.
- Provide calming and reassuring environment
Clients with PTSD are often fearful. Providing a calm, relaxing environment can help lessen or relieve anxiety and promote a feeling of safety.
- Facilitate access to community resources using Case Manager or Social Worker
Support groups and other community resources such as service animals, etc., can provide support that the client needs to function in their daily lives.
Evaluation for Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
- Symptom Reduction:
- Assess changes in the frequency and intensity of PTSD symptoms, comparing baseline symptoms to those observed after interventions.
- Utilize standardized assessment tools to quantify improvements.
- Therapeutic Engagement:
- Evaluate the individual’s engagement and participation in therapeutic interventions, noting any challenges or barriers.
- Assess the therapeutic relationship and address any concerns to enhance collaboration.
- Functional Improvement:
- Monitor improvements in daily functioning, including work, relationships, and social interactions.
- Evaluate the individual’s ability to engage in meaningful activities and pursue personal goals.
- Medication Adherence and Response:
- Monitor medication adherence and assess the individual’s response to pharmacological interventions.
- Collaborate with the healthcare team to adjust medications as needed based on therapeutic efficacy and side effects.
- Long-Term Resilience and Coping:
- Assess the development and utilization of long-term coping strategies and resilience factors.
- Explore the individual’s ability to navigate stressors and challenges without a significant exacerbation of PTSD symptoms.
References
- https://www.professional-counselling.com/support-files/dsm5-ptsd-symptoms.pdf
- https://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp
- https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
- Post-Trauma Syndrome: PTSD is characterized by distressing symptoms related to a traumatic event. This diagnosis addresses the emotional and psychological impact of trauma.
- Anxiety: Patients with PTSD may experience chronic anxiety and hypervigilance. This diagnosis emphasizes the need for anxiety management.
- Ineffective Coping: PTSD can affect an individual’s ability to cope with stress and triggers. This diagnosis focuses on coping strategies and support.
Transcript
Let’s take a look at the care plan for post-traumatic stress disorder, also known as PTSD. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of PTSD, also subjective and objective data and nursing interventions and rationales included in the care plan.
PTSD is a condition that develops when a person has been exposed to a serious situation, like a natural disaster, a serious accident, or life-threatening event. This condition, depending on the severity, can cause debilitating symptoms that can negatively affect relationships, communication, and even daily activities. PTSD affects all ages from children to senior adults with symptoms flaring up without any known trigger at all. Aside from emotional difficulty, these patients may experience physical manifestations, such as chronic pain, headaches, and even can lead to drinking and drug addictions as well as physical abuse.
Diagnostic criteria includes exposure to death, threatened death, serious injury, or actual or threatening sexual violence. Exposure can be direct exposure meaning personally witnessed, It can mean repeated exposure, or it can mean indirect exposure, like what we would see with first responders, child victim advocates, or even law enforcement. Intrusion or persistently re-experienced stressors in at least one of the following ways, including recurrent memories, traumatic nightmares, flashbacks, prolonged distress, following traumatic reminders also included in diagnosing PTSD.
Additional criteria includes negative alterations in mood and cognitions that began or got worse after the initial event, which includes two of the following:Inability to recall key facts or features of the event, persistent or negative beliefs, persistent distorted blame, persistent negative emotions, significant lack of interest, feeling of alienation, or inability to experience positive emotions. Also, alterations and reactivity since the traumatic event, which includes two of the following aggressive self-destructive behavior: hyper-vigilance, exaggerated startle response, difficulty concentrating, or issues with sleep. The duration of symptoms must be greater than one month. There must be functional impairment from symptoms, with symptoms, not being related to medication, mental illness or substance abuse. So, the desired outcome for a patient with PTSD will be to identify triggers, learn and utilize positive coping strategies, as well as demonstrate control of emotions and relaxation techniques, and the patient will absolutely be free from injury.
Let’s take a look at some of the subjective and objective data that your patient with PTSD may present with. Now remember subjective data are going to be things that are based on your patient’s opinions or feelings. A patient with PTSD may express irritability or being easily agitated, difficulty sleeping, or nightmares, mood swings, outbursts of anger, difficulty communicating with others, impaired relationships and loss of memory.
Objective or measurable data may include alcohol or drug abuse since the event, suicidal or homicidal ideation, self-mutilation or self destructive behavior.
Let’s take a look at the nursing interventions, which are super important to a care plan for a patient with PTSD. Assess vital signs and perform a nursing assessment, determine your patient’s baseline for vitals and assess for any underlying or accompanying medical condition. It is crucial to determine the safety of the patient as well as others, by assessing for suicidal and homicidal ideations. Assess the anxiety level in the patient to determine the severity of the condition and the course of treatment or therapy. Establish trust with the patient, meaning listen to what they have to say and behave in a calm manner. When a patient has a high level of anxiety, establishing trust can help them to calm down. PTSD patients often have difficulty communicating due to racing thoughts or inability to concentrate. Avoid rushing them and allow them more time to answer or respond to promote security and instill a sense of value. Allow the patient the freedom to acknowledge their feelings and release any repressed emotions that may be exacerbating with distress. A safe environment should be free from actual or perceived judgment and physical or perceived danger.
Encourage them to verbally identify current ineffective coping techniques, which helps the patient to understand their current behaviors that may be preventing effective healing or treatment. Also, encourage the patient to write about the traumatic event, which helps you as the provider to better understand the nature of the client’s condition and anticipate triggers that may cause symptoms. It also allows the patient and the provider to review the evolution of the emotions toward the event. Encourage the patient to keep a journal of stressors and emotional reactions to those stressors. Journaling can help the patient to identify triggers that prompted anxiety or symptoms and evaluate the outcomes of those reactions. Help the patient to learn, to manage the anxiety that can accompany flashbacks or environmental stressors or triggers like visualization and relaxation techniques, deep breathing, and imagery.
Medications like SSRI, selective, serotonin re-uptake inhibitors and SNRI, serotonin norepinephrine reuptake inhibitors are antidepressants that have proven to be effective for chronic management of symptoms. Patients with PTSD are often fearful, so providing a calm environment can help lessen or relieve anxiety and promote a feeling of safety. Support groups and other community resources like service animals can provide support that the patient needs to function in their daily lives. Facilitate this through community resources, using a case manager or a social worker.
Okay, guys, here is a look at the completed care plan for PTSD. We love you guys. Now go out and be your best self today and as always, happy nursing!
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