PTSD (Post Traumatic Stress Disorder)

The defining characteristic of Post Traumatic Stress Disorder  (PTSD) is development of anxiety symptoms  following an excessively  distressing life event  that experienced with terror, fear, and helplessness. The event is serious, such as seeing one’s child killed, or involvement in a major earth quake, fire, flane crash, war, rape, or abuse.

Symptoms include:

§  Reexperiencing the traumatic event (recurrent recollection, flashbacks, dream of the event, or intense distress with events that resemble or represent the event)

§  Avoidance of stimuli, thoughts, or feelings associated with trauma (inability to recall aspects of the event, refusal to go to places that are reminders of the event)

§  Restricted responsiveness (general numbing, decreased affect, diminished interest, withdrawal from others)

Other common symptoms of post-traumatic stress disorder :

  • Anger and irritability
  • Guilt, shame, or self-blame
  • Substance abuse
  • Depression and hopelessness
  • Suicidal thoughts and feelings
  • Feeling alienated and alone
  • Feelings of mistrust and betrayal
  • Headaches, stomach problems, chest pain

PTSD may occur directly after the event or may not be diagnosed until several months or event years later. PTSD may occur at any age, including childhood.

Getting help for post-traumatic stress disorder (PTSD)

If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor. It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, post-traumatic stress disorder (PTSD) will only get worse. You can’t escape your emotions completely – they emerge under stress or whenever you let down your guard – and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.

Treatment for post-traumatic stress disorder (PTSD)

Treatment for post-traumatic stress disorder (PTSD) relieves symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, you’ll be encouraged in treatment to recall and process the emotions and sensations you felt during the original event. In addition to offering an outlet for emotions you’ve been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

Types of treatments for post-traumatic stress disorder (PTSD)

  • Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
  • EMDR (Eye Movement Desensitization and Reprocessing) – EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
  • Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems.
  • Medication. Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, but it does not treat the causes of PTSD.

Nursing Assessment

1.      Activity or rest

Ø  nightmare sleep disorder

Ø  hypersomnia

Ø  easy fatigue

Ø  chronic fatigue

2.      Circulation

Ø  increased heart rate

Ø  increased blood pressure

Ø  palpitations

Ø  hot

3.       Ego Integrity

Ø  Various levels of anxiety with symptoms that lasted for days, weeks, months

1.        Acute stress disorder that occurs 2 days – 4 weeks in 4 weeks of traumatic  events.

2.        Acute PTSD symptoms of less than 3 months

3.        Chronic PTSD symptoms more than 3 months

4.        Slowing awitan least 6 months after the traumatic event

Ø  Difficulty to seek help or moving the personal resources (share the experience of family members / friends)

Ø  Guilt feelings of helplessness isolation

Ø  Feeling ashamed of his own helplessness, demoralization

Ø  Feelings about the future is bleak or shortened

 

4.       Neurosensori

Ø  Cognitive impairment difficulty concentrating

Ø  High vigilance

Ø  Fear of excessive memory or persistent harping on an

Ø  Event will control the bad with the explosion of aggressive behavior can not be predicted or cause feelings (anger, resentment, hatred, hurt)

Ø  Behavior change (gloomy, pessimistic, think that the sad, iritabel), lack of confidence, depression, affective, feeling unreal, business life is not ignored anymore

Ø  Muscle tension, trembling, motor restlessness

5.      Pain or discomfort

Ø  physical pain because of injury may be exacerbated over the severity of injury

6.      Respiration

Ø  Respiratory frequency increased

Ø  Dispneu

7.      Security

Ø  Explosive anger that exploded

Ø  Violent behavior toward the environment or other individuals

Ø  Suicidal ideas

8.      Sexuality

Ø  loss of enthusiasm

Ø  impotence

Ø  disability to achieve orgasm

9.      Social Interaction

Ø  Avoid people / places / activities that cause the memory of trauma, decreased responsiveness, separation, emotional numbness psychic / isolate themselves from others

Ø  Significant loss of interest in significant activities, including job

Ø  Restrictions on the range of influence, there is no emotional response

10.  Teaching or studying

Ø  The occurrence of PTSD is often preceded or accompanied by disease / physical abuse

Ø  Alcohol or other drug abuse

 

DIFFERENTIAL DIAGNOSIS

  • GENERALIZED ANXIETY DISORDER. The hyperarousal symptoms described in teh D criteria set are similar to those present in generalized anxiety disorder buL than disorder lack a traumatic origin and tehe intrusive symptom found in criteria B. Nonethelss, if any anxious patient presents with ready startle, remain on guard, and does not respond to teh usual measures for generalized anxiety disorder, the clinican should consider a diagnosis of PTSD.
  • DEPRESSION. Depressive features of reduced interest, estrangement, numbing poor consentration, and insomnia occur in PSTD. Intrusive trauma-bound symptom are not a feature of depression. However, after eksposure to trauma , post traumatik reactions are seen, and the clinician needs to adress the traumatic component. Polysonographs and neuroendocrinr studies may help in defferential diagnosis of PSTD and major depressive disorder.
  • PANIC DISORDER. Panic attacks resembels the autonomic hyperactivity in PSTD (chriteria D). O distinguish teh two, the interviewer should establish whether the panic attacks are related to the tarauma or to reminders of it.
  • OBSESIVE-COMPULSIVE DISORDER . PSTD and obsesive-compulsive disorder both share the occurrence of repetitive, distressing recollections, images, or thoughts. To distinguish bertween the two disorder, the clinical must obtain a careful history, asking about the occurrence of the trauma and establishing wheter the intrusive phenomena are thematically linked to the event.
  • DISSOCIATIVE DISORDERS. Flahsbacks, nimbing, and amnesia may suggest dissociative disorder. When those symptomms are prominent or presenting features, the clinical must elicit a clear history of the additional intrusive, avoide, and hyp a rarousal features that occur in PSTD but not in dissociative
  • BORDERLINE PRERSONALITY DISORDER. The dignosis of borderline personality disorder is often made when PSTD is a more appropiate diagnosis or, at least, a necessary concomitant diagnosis. A clinical who makes the diagnosis of borderline personality disorder must inquire further into possible early trauma and ensuing symptom.
  • MEDICAL DISORDER. After a patient sustains a head injury, the clikical must evaluated the degre of any brain damage and its possible contribution to some of the symptoms. Close colaboration with a neurologist in advisable.The clinical should also clarify the role of alcohol or psychoactive substance intoxication and withdrawal, since those disordr can aggravate PTSD symptoms.
  • FACTITIOUS DISOORDER. PSTD must sometimes be distinguised from fastitinguisted ftom factitious disorder. Helpful clues are corroborative evidence that trauma did occur and that the patient is usually sistressed about the trauma and often reluctant at first to discuss its details. Factitious symptoms often vary in response to the immediete environment.

Nursing Priority

1.      Providing security for client / others.

2.      Helps clients increase self-esteem and feelings of re-gain control over feelings / actions.

3.      Encourage the development of assertive behavior, rather than aggressive behavior.

4.      Improve the understanding that what happens on the current situation can significantly due to the action itself.

5.      Assist client / family to learn healthy ways to cope / adapt realistically to changes and events that have passed.

PLANNING

 

 

 


EVALUATION
• Evaluation of outcome criteria is a critical method that determines:

  1. Client (individual, family, community) progress and response to treatment
  2. Effective use of the nursing process
  3. Acountability for the nurse’s standards of care

• Evaluation is dynamic and may be used at any stage of the nursing process.

REFERENCES

Clinton, Michael.Nelson, sioban.1995. Mental Health and Nursing Practice.Sydney : PRENTICE HALL

Fontaine, Karen Lee. 1995.Mental Health Nursing.Menlo Park : Addison Wesley Longman, Inc.

Fortinash, Holoday Worret.2007. Psychiatric Nursing Care Plans fifth edition.St.Louis, Missouri : Mosby Elsevier

Fortinash, Katherine M. 1995.Psychiatric Nursing care Plans—2nd ed.St.Louis, Missouri : Mosby

Kaplan, I.Harold.,Saddock J.,Benjamin.1995.Comprehensive textbook of Psychiatry/VI.Baltimore, Maryland : Williams & Wilkins

Stuart & Sundeen.1995. Principles and practice of Psychiatric Nursing. St.Louis, Missouri : Mosby

Vacarolis, Elizabeth M. 1994.Foundations of Psychiatric-Mental Health Nursing.Philadelphia, Pennsylvania : W.B. Saunders Company

Yosep,I.2010. Keperawatan Jiwa. Edisi Revisi. Bandung: Refika Aditama

 

 

 

 

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