PTSD/Trauma/Stress Response & Mental Health
Biological: Hormones & Genetics
Spirituality/Religion
Culture: Regional differences
Family, Friends, Community
Personality Traits
Health Practices and Beliefs
Environmental experiences
Economics
Define Somatic Symptom Disorder
a process by which psychological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impairment with or without a known general medical disease
Define resiliency
the ability to bounce back from stressful circumstances; being effective at regulating emotions
Does not mean unaffected by stressors
Define transference
the process whereby a person unconsciously and inappropriately displaces (transfers) patterns of behaviors and emotional reactions toward another person that originated in relation to significant figures in childhood
can provide quick, periodic anxiety relief.
Name 3 Stress Reduction Techniques
Reframing, Improving Sleep Patterns, Exercise (Aerobic), Lower/Eliminate Caffeine Intake, Engage in meaningful work, Spend time with loved ones
Assessment of Anxiety Level
Perceptual Field, Ability to Learn, Physical or Other Characteristics
Mood vs. Affect
Mood: what the patient says their mood is
Affect: what the patient appears to be
Can be congruent or incongruent
Three types of group therapy leadership
Autocratic Leader: exerts control over the group members and does not allow much interaction among the members
Democratic Leader: supports extensive group interaction in the process of problem solving
Laissez-Faire Leader: allows the group to behave any way they choose and does not attempt to control the direction of the group
Contraindications/Precautions of Benzodiazepines
can cause the development of dependence and tolerance; Frequently linked to rebound anxiety, dementia (esp. in older adults), higher mortality, fall risk
Symptoms of PTSD
T – Traumatic Event
R – Re-experience; flashbacks, nightmares, unwanted memories, and strong physical/emotional response
A – Avoidance; avoiding any causes of traumatic event recall
U – Unable to function; brain fog, memory issues, long term stress hormone effects
M – 1 Month
A – Arousal; state of hypervigilance, increased startle response
Two major components of OCD
a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that the person feels the urge to repeat over and over.
Difference between voluntary and involuntary admissions
sought by patient or patient's guardian through written application & right to leave at any time vs. made without patient's consent, necessary when a person presents a danger to self or others, unable to meet their own basic needs due to mental illness
Define Reaction Formation, Devaluation, Splitting
Reaction Formation: unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion.
Devaluation: occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others.
Splitting: the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
Drawback of Buspirone
This drug has a delayed response of 2 to 4 weeks and is not useful for acute episodes of anxiety
Describe the Stress Response
SNS sends signals to the adrenal glands which send adrenaline circulating into the body causing physiologic response. As the initial rush of epinephrine subsides, the hypothalamus stimulates the hypothalamus–pituitary–adrenal (HPA) axis. If the stress is prolonged, the hypothalamus releases corticotropin-releasing hormone (CRH), which in turn travels to the pituitary gland and triggers the release of adrenocorticotropic hormone (ACTH). ACTH then travels to the adrenal glands, stimulating the release of cortisol.
Treatments for OCD
Cognitive Behavior Therapy (CBT), and acceptance and commitment therapy (ACT); exposure and response prevention (ERP); Medications: first line SSRIs/SNRIs; Relaxation techniques; Anxiety PRNS: short term - Benzos, Antihistamines
Types of Groups Led by an RN
Medication Education Groups: allow patients to hear the experiences of others who have taken medication and to have an opportunity to ask questions without the fear of being judged; these groups also allow patients to learn to take the medications correctly.
Dual-Diagnosis Groups: focus on co-occurring psychiatric illness and substance abuse. The PMH-RN may co-lead this group with a dual-diagnosis specialist (master’s level clinician).
Symptom Management Groups: designed for patients to share coping skills regarding a common problem, such as cognitive distortions or substance use. New and alternate skills can be learned to help patients develop more effective strategies for reducing symptoms and preventing relapse.
Stress Management Groups: teach members about various relaxation techniques, including deep breathing, exercise, music, and spirituality.
Self-Care Groups: focus on activities of daily living, such as bathing and grooming.
Name the two SNRIs
Venlafaxine and duloxetine
Prazosin Indication
effective for lessening symptoms associated with PTSD and decreasing nightmares
Phases of the nurse-patient relationship
Orientation, Working, Termination
Care of Patients with Anxiety Disorders
- Establish a therapeutic relationship with the patient.
- Help the patient more fully understand the problem with active listening techniques like using broad openings, exploring, reflecting, and clarifying.
- Assist the patient with developing self-awareness of their verbal and nonverbal relief behaviors.
- Assist the patient with identifying possible solutions; a nurse can ask about past coping mechanisms or skills the patient has observed others using.
- Introduce new coping strategies or activities that may bring a reduction or relief to feelings of inner tension.
- Support the patient in carrying out the new plan and evaluate the effectiveness of the plan.
Name 5 Patient Rights
- to be treated with dignity
- to be involved in treatment planning and decision making
- to refuse treatment, including medications
- to request to leave the hospital, even against medical advice
- to participate in religious worship
- to lodge a complaint
- to keep personal belongings unless they are dangerous
- to send and receive mail and be present at any package inspections
- least restrictive means of treatment
- to choose or refuse visitors
- confidentiality regarding one's disorder and treatment
- to informed consent
- to communicate privately by telephone or in person
- right to vote
- right to legal counsel
- right to evaluation within the 72 hours after requesting discharge that might result in harm to self or others
Common Legal Issues in Psychiatric Nursing (Name 3)
Patient safety – suicide risks, elopement, miscommunication resulting in decreased patient safety
Defamation of character – social media, gossip, interviews (slander & libel)
Supervisory (vicarious) liability – inappropriate delegation of duties, lack of supervision, incomplete training
Intentional torts – Intentional acts that lead to the harm of others (defended by self-defense or protection of others)
Negligence or malpractice – carelessness, low standard of care
Assault – threatening harm if patients don’t comply
Battery – treatment without patient consent
False imprisonment – indefensible seclusion or restraint
Symptoms of Serotonin Syndrome
SHIVERS: Shivers, hyperreflexia & myoclonus, increased temperature, vital signs instability, encephalopathy (altered LOC), restlessness, sweating