Exam 3 Study Guide ALL SOLVED FALL-2022 LATEST SOLUTION 100% CORRECT GUARANTEED GRADE A+

Trauma & Stressor-Related Disorders & Dissociative Disorders (4-5 questions) What are the key areas of assessment for PTSD and Acute Stress Disorder? What are the differences? How might these symptoms manifest behaviorally? Nursing care for clients with PTSD- pharmacological and psychotherapeutic interventions. PTSD ● Clinical Picture (PTSD) Posttraumatic stress disorder in preschool children (6 yrs & younger) - Reduction in play, repetitive play involving aspects of the traumatic event, social withdrawal, negative emotions (fear, guilt, anger, horror, sadness, shame, confusion, detachment, irritability, aggression, sleep disturbances, hypervigilance, problems concentrating, self-destructive behaviors ● Grossly inadequate care(relationship trauma): Reactive attachment disorder (severe emotional inhibition, lack of bonding) - the child has a consistent pattern of inhibited, emotionally withdrawn behavior, and the child rarely directs attachment behaviors towards any adult caregiver. Disinhibited social engagement disorder (indiscriminate social behavior, no fear of strangers, unfazed) - usually willing to go off with people who are unknown to them. Assessment Clinical presentation varies dysphoria, fear-based re-experiencing, dissociation, etc. Disturbance is OVER ONE MONTH Intrusion (distressing, recurrent, involuntary memories, dreams, dissociative flashbacks; marked physio- or psychogicaldistress to internal or external cues) Avoidance Negative Alterations in Cognitions (inability to recall important aspects- dissociative amnesia-;persistent negative emotional state, anhedonia, detachment; exaggerated negative beliefs Alterations in Arousal (irritable, outbursts, self-destructive, hypervigilance, exaggerated startle, poor concentration, disrupted sleep) Nursing Care - PTSD ● Accept client, establish trust ● Stay with client during flashbacks ● Encourage verbalization about the trauma when the client is ready ● Discuss coping mechanisms ● Assess for maladaptive coping ● Assess for safety: self-destructive/suicidal ideation, behaviors ● Educate client and family ● Stay with the client during the flashback. Help them feel safe. Treatment of PTSD ● Evidence-based trauma focused psychotherapy: CBT, EMDR (Eye Movement Desensitization Reprocessing); Prolonged Exposure Therapy ● Pharmacotherapy and (SSRIs FDA approved Sertraline (Zoloft), Paroxetine (Paxil) ● Group Therapy ● Family/Marital Therapy The best Evidence supports the use of selective serotonin reuptake inhibitors or as you know it SSRIs-for PTSD –The FDA has approved 2 drugs Zoloft and Paxil –all other medications are used “off label” Phenelzine (Nardil) is a monoamine oxidase inhibitor that has been used with some success in PTSD A Serotonin norepinephrine reuptake inhibitor (SNRI) such as Venlafaxine (Effexor) may be used to decrease anxiety and depressive symptoms Tricyclic antidepressants (TCA’s) or Mirtazapine (Remeron) may be prescribed if SSRIs or SNRIs are not tolerated by the patient or do not work Medications that are historically used for medical conditions have a dual purpose- see below Clonidine (catapres) is a centrally acting A2 receptor agonist used to address hyperarousal intrusive symptoms . Prazosin (Minipress)Is an Alpha receptor antagonist used for nightmares and sleep disturbances Propranolol (Inderal) Is a beta blocker use for hyperarousal and panic The most difficult symptoms of these beta blockers, agonist antagonist are hypotension CBT therapy – EMDR - Psychopharmacology of PTSD ● Antidepressants - Paxil (Paroxetine) and Zoloft (Sertraline) FDA approved ● Augmenting Agents - Prazosin (for nightmares- alpha 1 antagonist) –can cause hypotension. - Trazodone (sleep) Complementary/Alternative Treatments ● Yoga ● Medication ● Acupuncture ● Mobile app: PTSD coach Acute Stress Disorder ● May develop after exposure to a highly traumatic event ● To be diagnosed with acute stress disorder, the individual must display 8 out of the following 14 symptoms. 1. Numbing 2. Derealization (a sense of unreality related to the environment) 3. Inability to remember at least one important aspect of the event. 4. Intrusive distressing memories of the event 5. Recurrent distressing dreams 6. Feeling as if the event is recurring 7. Intense prolonged distress or physiological reactivity 8. Avoidance of thoughts and feelings about the event 9. Sleep disturbances 10. Hypervigilance 11. Irritable 12. Angry or aggressive behavior 13. Exaggerated startle response 14. Agitation and restlessness ● ASD is diagnosed from 3 days to 1 month after the traumatic event. PTSD and Acute Stress Disorder in Children ● New onset of frightening dreams ● Express re-experiencing through play ● May not manifest fearful reactions at the time of the exposure ● Wide range of emotional and behavioral changes ● Avoidance and/or preoccupation ● Irritable or aggressive behavior ● Reckless behaviors Children- chronic, complex trauma: what are the neurobiological mechanisms that get activated during repeated exposure to fear and stress? What systems & hormones are involved? What types of events can elicit these stress responses? ● Exposure to violence and trauma, the parasympathetic response triggers a hyperarousal state resulting in dissociation. ● Dissociation is a disconnection of thoughts, emotions, sensations, and behavior connected with memory. ● The episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating cortisol, resulting in either too much or too little cortisol ● When a threat is perceived the unmyelinated ventral vagus responses are activated. The attending sympathetic arousal symptoms of rapid heart rate and rapid respiration prepare the person for flight or fight responses (norepinephrine) What is a dissociative fugue? What types of events may precipitate this phenomenon? Dissociative Fugue Occurs when the patient leaves home to escape from a stressful event during which the patient temporarily assumes a new identity. Usually a dissociative fugue is precipitated by traumatic events. ● Subtype of Dissociative Amnesia – specifier ● Pt. finds self in strange, distant place unaware of how they got there; sudden, unexpected travel; wandering ● Fugue state: rarely call attention to selves ● May assume a new identity (rare) ● Usually brief (hours, days) ● Recovery spontaneous (rare reoccurrences); after a few weeks to a few months, may remember identity, then become amnesic for the time spent in fugue state Characteristics and differences between Dissociative Amnesia and Dissociative Identity Disorder. What are the guiding principles for treatment for all Dissociative Disorders? What is the goal for treatment and how do we approach? Nursing diagnoses and interventions? Dissociative Amnesia ● Inability to recall important autobiographical information, usually of a traumatic nature, that is too extensive to be explained by ‘normal’ forgetting ● Different from neurological damage, which is permanent; memory storage or retrieval is prevented ● DA: Information is available, but not accessible;potentially reversible ● Localized or selective; generalized amnesia is rare; frequently unaware of memory problems (or partially aware) ● Usually short term 1-5 days; ( 75%) reaction to severe stress ● Recovery generally quick and complete but predisposed to amnesia in future traumas Dissociative Identity Disorder ● Formerly known as Multiple Personality Disorder ● Presence of 2 or more distinct personalities, one personality dominates pt.’s thinking and behavior ● May be unaware of other personalities (alters); each alter thinks, perceives, & relates to self & environment differently ● Transitions from one personality to another during stress; may be dramatic or subtle; shifts are minutes to months ● One alter blocks access & response to traumatic memories; the other is fixated on these memories ● Cause: severe psychological, physical, and/or sexual abuse in early childhood (repression) ● Alters may be pleasure seeking & non-conformist Dissociative Experiences Scale ● Assessing memory: