Trauma, Stressor-Related, and Dissociative Disorders
When discussing the symptoms of posttraumatic stress disorder (PTSD), the nurse correctly states: "The symptoms can occur almost immediately or can take years to manifest." "PTSD causes agitation and hypervigilance, but rarely chronic depression." "PTSD is an emotional response that does not cause significant changes in brain chemistry." "When experiencing a flashback, the patient generally experiences a slowing of responses."
"The symptoms can occur almost immediately or can take years to manifest." The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. p. 302
An appropriate intervention for stage 2 of the staged model of trauma treatment is: Engaging in memory work Reinforcing social skills training Providing a predictable environment Role-modeling problem-solving skills
Engaging in memory work Appropriate interventions for stage 2 of the staged model of trauma treatment include reducing arousal and regulating emotion through symptom reduction; engaging in memory work while reducing arousal; finding comfort from others; tolerating affect; integrating disavowed emotions and accepting ambivalence, overcoming avoidance; improving attention and decreasing dissociation; working with memories; and transforming memories. p. 300
The nurse is caring for a patient with dissociative amnesia disorder. The patient gets extremely aggressive due to anxiety and causes physical harm to him or herself and to others. Which nursing intervention does the nurse follow to reduce anxiety and aggression in the patient? The nurse lets the patient make decisions on major issues. The nurse frequently observes the patient by visiting the patient's room. The nurse reminds the patient about the happy moments of the patient's life. The nurse prepares a schedule and instructs the patient to follow it regularly.
The nurse frequently observes the patient by visiting the patient's room. The nurse frequently observes the patient to provide a protective environment by reducing the stressors. The nurse should not frequently remind the patient of past events, as it can cause severe panic and anxiety in the patient. The nurse should not be demanding or compel the patient to follow a schedule, as it can create anxiety in the patient. The nurse should help the patient in major decision-making, as the patient has reduced cognitive levels and reduced decision-making ability. It helps to lower the patient's stress and prevents the patient from making unwise decisions. p. 311, Table 16.2
Which statement supports the existence of a comorbid condition characteristically associated with posttraumatic stress disorder (PTSD)? "Controlling my anger is a big problem for me." "I don't have any really good friends, just acquaintances." "Marriage doesn't work for me; I've been divorced three times." "My partner is always upset because I can't seem to keep a job." "I wish my parents were still alive; they loved and cared about me."
"Controlling my anger is a big problem for me." "I don't have any really good friends, just acquaintances." "Marriage doesn't work for me; I've been divorced three times." "My partner is always upset because I can't seem to keep a job." Difficulty with interpersonal, social, or occupational relationships nearly always accompanies PTSD, and trust is a common issue of concern. Common presenting symptoms include threatening or aggressive behavior. Communicating the sadness of losing loved ones is not necessarily associated with PTSD. p. 303
A patient who was rescued from a bomb blast has symptoms of chronic depression, irritation, and insomnia. During the discharge teaching, the nurse teaches care management guidelines to the patient's parents. Which statement of the nurse is appropriate to be included in the teaching? "Don't allow the patient to consume alcohol." "Give the patient a cup of coffee if he or she reports having a headache." "Don't allow the patient to do deep breathing and aerobic exercise." "Dreaming about the traumatic event is not a normal response of illness"
"Don't allow the patient to consume alcohol." A patient who has been rescued from a bomb blast has experienced trauma. Symptoms of trauma include chronic depression, irritation, and insomnia. During trauma, the patient has reduced attention, so the patient must avoid consumption of alcohol. Alcohol reduces the patient's ability to pay attention and causes impaired memory and motor coordination in the patient. The patient with trauma may have insomnia. Therefore, coffee must be avoided as it is a stimulant and may worsen sleep difficulties. The patient must be encouraged to do deep breathing and aerobic exercise for relaxation. The patient's parents must be informed that dreaming about the traumatic event is a normal response to illness. p. 304
A patient is diagnosed with disturbed personal identity. What signs and symptoms do the nurse expect to find in the patient? Amnesia Disorganization Substance abuse Ineffective coping Feelings of unreality
Amnesia Feelings of unreality The signs and symptoms of disturbed personal identity are feelings of unreality and amnesia of the traumatic event. These patients usually assume different identities to escape from the reality of the traumatic event. Substance abuse and disorganization are the symptoms of ineffective role performance. Ineffective coping is a symptom of anxiety self-control. p. 310, Table 16.1
If a patient diagnosed with a disorder resulting from trauma is within the window of tolerance, there is: Hypervigilance related to the environment. Avoidance of stimuli associated with the trauma. Evidence of accurate and meaningful self-disclosure. Balance between sympathetic and parasympathetic arousal.
Balance between sympathetic and parasympathetic arousal. Many psychiatric disorders have trauma as a precipitant. Treatment strategies are designed to modulate arousal so that the person is able to stay within a window of tolerance. Window of tolerance means there is balance between sympathetic and parasympathetic arousal. Hypervigilance is associated with dominance by the sympathetic nervous system. Avoidance of stimuli associated with the trauma is a common assessment finding for persons diagnosed with disorders resulting from trauma. Self-disclosure is a psychosocial phenomenon. p. 300
According to attachment theory, relationship disorders are related to trauma associated with: Culture or religion Siblings or strangers Caregivers or parents Insufficient food or shelter
Caregivers or parents Attachment patterns or schemas are formed early in life through interaction and experiences with caregivers, and this relationship is embedded in implicit emotional and somatic memories. p. 298
A patient is diagnosed with depersonalization disorder. Which symptom should the nurse expect the patient to report during the interview? Inability to recall one's identity. Inability to recall important personal information. Feeling of being an observer of one's own body. Sudden unexpected travel away from current locale.
Feeling of being an observer of one's own body. Dissociative disorders are characterized by severe interruptions in the consciousness caused by a defense mechanism to adverse experience or trauma. As a result, the patient is most likely to report body image distortions which indicate feelings of unreality. Inability to recall important personal information is a characteristic feature of dissociative amnesia. Sudden unexpected travel away from the current locale and the inability to recall one's identity are symptoms of dissociative fugue. p. 307
The nurse is caring for a child who has witnessed a car accident and does not remember anything that took place during the accident. Which therapy does the nurse adopt to help the child regain memory of the car accident? Psychopharmacological therapy Cognitive and behavioral therapy Dialectical developmental psychotherapy Eye movement desensitization and reprocessing therapy
Eye movement desensitization and reprocessing therapy Eye movement desensitization and reprocessing (EMDR) is an evidence-based therapy. It is an eight-phase protocol by which the child is encouraged to recollect the traumatic event by using stimulations such as audio tones. In cognitive-behavioral therapy, the nurse teaches stress management techniques to the child. In psychopharmacological therapy, medications are prescribed to the patient to treat the pathological changes caused due to stress. In dialectical developmental psychotherapy, emotion regulation techniques like meditation and deep breathing are taught to the child. p. 301
What information should the nurse give to the family of a patient who has had a dissociative episode? Brief periods of psychotic behavior may occur Dissociation is a method for coping with severe stress Dissociation suggests the possibility of early dementia Ways to intervene to prevent self-mutilation and suicide attempts
Dissociation is a method for coping with severe stress Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. p. 307
What does the nurse know about risk factors in posttraumatic stress disorder (PTSD) in children? There are no specific risk factors; anything can cause PTSD. Good social support can help build a child's resilience to PTSD. PTSD is a genetic condition, which comes from one or both parents. All people are born predisposed to PTSD because of brain chemistry.
Good social support can help build a child's resilience to PTSD. Environmental factors can cause certain children to be more susceptible to PTSD. Therefore, children with good social support are more resilient when faced with PTSD triggers. There are environmental, biological, and psychological risk factors for PTSD. It is not accurate that all people are born predisposed to PTSD because not everyone has the same neurobiological makeup. PTSD is not a genetic condition, although there may be genetic factors that put children at higher risk of getting PTSD.
Which symptoms would lead a health care provider to suspect posttraumatic stress disorder (PTSD) in an adult patient? Mania Irritability Hypervigilance Difficulty concentrating Flashbacks of the accident Visiting the scene of the accident over and over Talking with strangers about the events of the accident
Irritability Hypervigilance Difficulty concentrating Flashbacks of the accident Flashbacks of the accident, hypervigilance, irritability, and difficulty concentrating are signs of PTSD. Visiting the scene of the accident over and over, talking with strangers about the events of the accident, and mania are not associated with signs of PTSD. p. 302
A young adult diagnosed with dissociative identity disorder was hospitalized with self-inflicted lacerations. When asked about these injuries, the patient responded, "I don't know what happened. I just looked down and they were there." What is the priority nursing intervention for this patient? Maintain continuous observation. Teach coping skills and stress management strategies. Offer alternative activities to provide distraction from current stressors. Clean and dress the wounds while maintaining a matter-of-fact manner with the patient
Maintain continuous observation. The lacerations indicate violence, directed at self, and therefore pose a risk to the patient's safety. Alternate personalities may pose danger to this patient. Continuous monitoring is the highest priority nursing action. Teaching the patient is important, but safety has a higher priority. This patient needs a simple, safe treatment environment rather than many activities. It is appropriate for the nurse to provide care in a compassionate manner. p. 311, Table 16.2
The nurse is assessing a young child for posttraumatic stress disorder (PTSD). What does the nurse include in the assessment? Bowel habits Motor function Blood pressure Speech patterns General appearance Characteristics of play
Motor function Speech patterns General appearance Characteristics of play Broad categories to assess for PTSD in children include the child's general appearance, motor function, speech patterns, and characteristics of play. Bowel habits and blood pressure do not provide information about PTSD, but may be part of a separate physical assessment. p. 299
The nurse provides care to a preschooler who has posttraumatic stress disorder (PTSD). Which behavior does the nurse expect from the child? Problems concentrating in school Social withdrawal from classmates and friends Statements from the child about "being a bad person" Increased fatigue and sleep with longer sleep patterns Repetitive play in which the theme of the traumatic event is expressed
Problems concentrating in school Social withdrawal from classmates and friends Statements from the child about "being a bad person" Repetitive play in which the theme of the traumatic event is expressed Preschoolers who have PTSD may exhibit behaviors that include repetitive play in which the theme of the traumatic event is expressed, social withdrawal, statements about being a bad person, and problems concentrating in school or elsewhere. Preschoolers with PTSD may experience decreased sleep with disrupted slumber, not increased sleep with longer sleep patterns. p. 296
The nurse is planning care for a patient diagnosed with a dissociative disorder. Which intervention is directed primarily towards minimizing the patient's anxiety level? Provide a simple, predictable daily routine. Teach and reinforce relaxation and deep breathing techniques. Work with the patient and involved parties to reestablish relationships. Allow the patient to progress at his or her own pace as memories are recovered. Provide support through empathetic listening during disclosure of painful experiences.
Provide a simple, predictable daily routine. Teach and reinforce relaxation and deep breathing techniques. Allow the patient to progress at his or her own pace as memories are recovered. The nursing interventions for dissociative disorders that are implemented primarily for the purpose of minimizing patient anxiety include providing a simple, predictable routine; allowing the patient to progress through therapy at his or her own pace; and teaching and reinforcing coping strategies that are stress-focused. All of the mentioned interventions are aimed at either minimizing or managing anxiety-producing stress in the early stage. Empathetic listening and the reestablishment of relationships serve to help the patient feel less alone or isolated. p. 311, Table 16.2
A mental health nurse plans care for four patients. These patients are diagnosed with reactive attachment disorder, disinhibited social engagement disorder, adjustment disorder, and acute stress disorder. The nurse will plan interventions designed to assist these patients to cope with: Feelings of guilt Self-care deficits Reactions to trauma Impaired social skills
Reactions to trauma The common feature of these disorders is exposure to trauma. Disorders included under the trauma umbrella include posttraumatic stress disorder, reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, and adjustment disorder. Feelings of guilt, self-care deficits, and impaired social skills represent problems that may or may not be present for patients diagnosed with these disorders. pp. 302, 307
When caring for a child with posttraumatic stress disorder, which intervention should the nurse include in the patient plan of care? Provide changeable environment. Help patient learn positive avoidance. Reduce stimulation of traumatic memories. Promote arousal to build tolerance to stress.
Reduce stimulation of traumatic memories. When caring for a patient with posttraumatic stress disorder, it is important to reduce stimulations that may remind the patient of the traumatic event. The patient should be taught relaxation therapies to alleviate arousal. The patient may tend to avoid any mention of the traumatic event. However, the patient should be helped to overcome avoidance to promote desensitization to the emotions related to the event. It is important to provide a safe and predictable environment rather than a changeable one to make the child comfortable. p. 300
A nurse is assessing a child who has witnessed violence at home. What should the nurse document when completing an admission genogram of the child? Relationships Investigations Family history Laboratory testing Family composition
Relationships Family history Family composition Assessment and data collection on a child is very important and may include several methods. These include interviewing, screening, testing, observing, and interacting with the patient. Relationships, family history, and family composition are documented in a genogram where information can be obtained about family relations and interactions. Testing and investigations are not related to creating a genogram. p. 299
A nurse is formulating nursing diagnoses after the assessment of a child. The nurse formulates the nursing diagnosis as "risk of impaired parent and child attachment." Which risk factors can be associated with this diagnosis? Poverty Separation Unstable home Parental conflict Anxiety with parental role
Separation Parental conflict Anxiety with parental role Separation can deprive the child of a protective, nurturing relationship and such children are at increased risk of impaired parent and child attachment. Parental conflict can affect the interactive process between the child and parent. Anxiety with the parental role can keep the parent under stress. Poverty and an unstable home are more related to impairment in social, cognitive, and behavioral development and increase the risk of delayed development. p. 300
While caring for a patient with emotional trauma, which nursing interventions must be employed during the first stage of the treatment plan? Teaching coping skills to the patient Improving the attention of the patient Enhancing problem-solving skills for the patient Stopping self-destructive behavior of the patient
Stopping self-destructive behavior of the patient The nurse follows a three-stage treatment plan while caring for a patient with trauma. In stage 1, the nurse encourages the patient to overcome self-destructive behavior to remain safe and to avoid suicidal intentions. In stage 2, the nurse follows the interventions for treating anxiety and stress, thereby helping the patient to improve attention. In stage 3, the nurse teaches coping skills to enhance decision-making ability and problem-solving skills in the patient. p. 300
Which statement concerning developmental assessment of a 5-year-old child is true? Generally, noted abnormal findings are considered to be permanent Stress-related behaviors that are identified may be managed by the nurse The Denver II Developmental Screening tool is appropriate for this age group A concern is whether the child is functioning at his or her current chronological age A specifically tailored tool should be used to evaluate this child's neuropsychological development
Stress-related behaviors that are identified may be managed by the nurse The Denver II Developmental Screening tool is appropriate for this age group A concern is whether the child is functioning at his or her current chronological age Developmental testing should be conducted for young children also because significant developmental delays may be present. The developmental assessment provides information as to whether the child is behaving and functioning at his or her current chronological age, or discovers areas where the child lags behind the norms and his or her peers. The Denver II Developmental Screening Test for infants and children up to six years of age is a popular assessment tool. The nurse working with parents may handle stress-related behaviors or minor regressions; serious psychopathology requires evaluation by an advanced practice nurse in collaboration with health care providers. For adolescents, tools may be tailored to specific areas of assessment, such as neuropsychological, physical, hormonal, and biochemical. Abnormal findings in the developmental and mental status assessments may be temporary. p. 300
The nurse is performing an assessment of a patient with severe depression. The nurse learns that the patient's spouse passed away a week ago. What does the nurse document in the patient's case report? The patient has adjustment disorder. The patient has acute stress disorder. The patient has posttraumatic stress disorder. The patient has borderline personality disorder.
The patient has adjustment disorder. Patients who have depression due to the loss of their partners usually have adjustment disorder. These patients may have intense longing for the partner, preoccupation with thoughts of the partner, and intense sorrow and emotional pain. The symptoms of adjustment disorder are mild when compared to acute stress disorder and posttraumatic stress disorder. Patients experience acute stress when they are victims of sexual assault or physical abuse. Posttraumatic stress can be caused by witnessing an accident or by a serious illness. Borderline personality disorder is believed to be tied to parental neglect in childhood. p. 307
A nurse is caring for an adult patient who has trauma-related disorder. The patient reports to the nurse that he has started using relaxation techniques and is sleeping better. How should the nurse interpret this behavior? The patient is feeling nervous. The patient is feeling less confident. The patient is able to manage anxiety. The patient has improved self-esteem.
The patient is able to manage anxiety. The patient's behavior shows that the patient is able to manage anxiety, which enables the patient to sleep better and use relaxation techniques. A patient who is nervous may not sleep properly or use relaxation methods. Using relaxation techniques and having adequate sleep will make the patient more confident. Positive behaviors like maintaining eye contact and positive talk about self indicates an improvement in the patient's self-esteem. p. 303
