UNRS 310Psychiatric Nursing Care Plan
Trauma, Stressor-Related and Dissociative Disorders
1. Identify diagnostic criteria related to onset and duration of ASD and PTSD.
● ASD
- 3 days but for not more than 1 month following the traumatic event
● PTSD
- acute→ symptoms last less than 3 months
- chronic→ symptoms last 3 months or more
- Delayed onset→ at least 6 months has elapsed between
trauma and occurrence of symptoms
2. Describe clinical manifestations of trauma- related (ASD, PTSD, adjustment disorder)
and dissociative disorders.
● ASD
- Feelings of detachment, anxiety, irritability, sleep disturbance, and anorexia
● PTSD
- S/S: re-experiencing, avoiding stimuli associated with trauma, persistent symptoms
of increased arousal,
- Alteration in cognition and mood: anxiety, amnesia, anger, exaggerated beliefs,
self blame, distortions, detachment
● Adjustment disorder
- Caused by a stressful event
- Debilitating cognitive, emotional, and behavioral symptoms that negatively
impact normal functioning
- Response to this stress may include: depression, anxiety, and conduct disturbances
- ex) dealing with the death of a spouse
3. Describe neurobiological changes that occur with trauma.
- Limbic pathways
- Increased cortisol levels : shrinks brain size and hinders thinking, increases blood
sugar and insulin level, increased aging process, interferes with brain cell production
- Comorbidity: depression, anxiety, substance abuse
- Parasympathetic response triggers a hyperarousal
state with dysregulation of hypothalamic-pituitary
adrenal axis → results in DISSOCIATION
4. Compare and contrast the difference between disinhibited social engagement disorder and
reactive attachment disorder in children.
→ both disorders result from lack of attachment in early ages
, UNRS 310Psychiatric Nursing Care Plan
● Disinhibited social engagement
- Very friendly and confident
- They are willing to go off with strangers and demonstrate no fear of them
- They create these “attachments” by not actually attaching to anyone
● Reactive attachment disorder
- Inhibited and emotionally withdrawn behavior
- They make no attachment toward caregivers and are not comforted by them
when distressed
- Results from lack of bonding and care in the first 8 months
5. Identify dissociative disorders including depersonalization/derealization disorder,
dissociative amnesia, dissociative fugue and dissociative identity disorder.
● Depersonalization
- Focus is one one’s self ( uncomfortable feeling being aware of self and
mental status)
● Derealization
- Focus on the outside world feeling like surroundings are unreal or distant
- May feel mechanical, dreamy and detached from body
● Dissociative amnesia
- Inability to recall personal or important info typically of a traumatic nature
- localized→ patient cannot remember any events from the
period
- selective→ patient can remember some but not all of the
event
● Dissociative fugue
- Unexpected inability to recall ones identity or information about some or all
of the past
● Dissociative Identity disorder
- The presence of two or more distinct personalities that recurrently take control
of behavior
6. Identify communication principles when speaking with trauma related disorder.
- Establish trust and safety
- develop appropriate language
- Teach relaxation
- Promote feelings through art and play
- Family involvement
- Coordinate multidisciplinary team
Allow the patient to manage their own arousal level (provide a safe and predictable
environment) , make sure communication is nonjudgmental
7. Identify medications to treat anxiety, flashbacks, hypervigilance and nightmares.
● Anxiety
- Sertraline (zoloft) & paroxetine (paxil) → SSRI
warn for discontinuation syndrome
- Inderal (propranolol) → for after trauma
● Flashbacks
- Minipress (prazosin) → this is an antihypertensive med
Trauma, Stressor-Related and Dissociative Disorders
1. Identify diagnostic criteria related to onset and duration of ASD and PTSD.
● ASD
- 3 days but for not more than 1 month following the traumatic event
● PTSD
- acute→ symptoms last less than 3 months
- chronic→ symptoms last 3 months or more
- Delayed onset→ at least 6 months has elapsed between
trauma and occurrence of symptoms
2. Describe clinical manifestations of trauma- related (ASD, PTSD, adjustment disorder)
and dissociative disorders.
● ASD
- Feelings of detachment, anxiety, irritability, sleep disturbance, and anorexia
● PTSD
- S/S: re-experiencing, avoiding stimuli associated with trauma, persistent symptoms
of increased arousal,
- Alteration in cognition and mood: anxiety, amnesia, anger, exaggerated beliefs,
self blame, distortions, detachment
● Adjustment disorder
- Caused by a stressful event
- Debilitating cognitive, emotional, and behavioral symptoms that negatively
impact normal functioning
- Response to this stress may include: depression, anxiety, and conduct disturbances
- ex) dealing with the death of a spouse
3. Describe neurobiological changes that occur with trauma.
- Limbic pathways
- Increased cortisol levels : shrinks brain size and hinders thinking, increases blood
sugar and insulin level, increased aging process, interferes with brain cell production
- Comorbidity: depression, anxiety, substance abuse
- Parasympathetic response triggers a hyperarousal
state with dysregulation of hypothalamic-pituitary
adrenal axis → results in DISSOCIATION
4. Compare and contrast the difference between disinhibited social engagement disorder and
reactive attachment disorder in children.
→ both disorders result from lack of attachment in early ages
, UNRS 310Psychiatric Nursing Care Plan
● Disinhibited social engagement
- Very friendly and confident
- They are willing to go off with strangers and demonstrate no fear of them
- They create these “attachments” by not actually attaching to anyone
● Reactive attachment disorder
- Inhibited and emotionally withdrawn behavior
- They make no attachment toward caregivers and are not comforted by them
when distressed
- Results from lack of bonding and care in the first 8 months
5. Identify dissociative disorders including depersonalization/derealization disorder,
dissociative amnesia, dissociative fugue and dissociative identity disorder.
● Depersonalization
- Focus is one one’s self ( uncomfortable feeling being aware of self and
mental status)
● Derealization
- Focus on the outside world feeling like surroundings are unreal or distant
- May feel mechanical, dreamy and detached from body
● Dissociative amnesia
- Inability to recall personal or important info typically of a traumatic nature
- localized→ patient cannot remember any events from the
period
- selective→ patient can remember some but not all of the
event
● Dissociative fugue
- Unexpected inability to recall ones identity or information about some or all
of the past
● Dissociative Identity disorder
- The presence of two or more distinct personalities that recurrently take control
of behavior
6. Identify communication principles when speaking with trauma related disorder.
- Establish trust and safety
- develop appropriate language
- Teach relaxation
- Promote feelings through art and play
- Family involvement
- Coordinate multidisciplinary team
Allow the patient to manage their own arousal level (provide a safe and predictable
environment) , make sure communication is nonjudgmental
7. Identify medications to treat anxiety, flashbacks, hypervigilance and nightmares.
● Anxiety
- Sertraline (zoloft) & paroxetine (paxil) → SSRI
warn for discontinuation syndrome
- Inderal (propranolol) → for after trauma
● Flashbacks
- Minipress (prazosin) → this is an antihypertensive med
