Foundations & Trauma Informed Care
At the client's pace. The client may not express trauma immediately ; the outward reaction may not match the severity of the event
What is the primary factor that separates a diagnosis of Acute stress disorder and Post traumatic stress disorder?
Duration.
It is all about timing. If symptoms persist beyond one month then it is PTSD!
These are the two types of detachment from reality: one involving detachment from one's own body and the other from one's surroundings
Depersonalization and Derealization
A child with this disorder is withdrawn and does not seek comfort from attachment figures, often because their needs were not met as an infant
Reactive Attachment Disorder (RAD)
This is the first line of treatment for PTSD
SSRIs:
Fluoxetine, Escitalopram, citalopram, sertraline
This acronym serves as a way to remember the focus of trauma-informed care interventions. CHEST. Can you tell me what these letters stand for in regards to trauma- informed care?
C: Collaboration/Respect
H: Hope
E: Empowerment/ Connection
S: Safety **
T: trauma not expressed immediately
These type of shared symptoms includes sustained high anxiety and sleep disturbances/ nightmares. Shared by both ASD and PTSD
Arousal, Cognitive, Emotional, Behavioral
high anxiety, sleep disturbances/ nightmares, flashbacks, intrusive thoughts, inability to remember certain or all aspects of trauma, depression, anger, survivor's guilt, numbing of responsiveness, aggression, substance abuse, relationship problems
What is the priority nursing action when a client begins to dissociate?
Ground techniques
A child with this disorder displays overly familiar behavior with strangers, such as climbing into the lap of an unfamiliar visitor.
Disinhibited Social Engagement Disorder (DSED)
You have a client who has been diagnosed with PTSD and also experiences chronic pain. What medication would you expect to administer to this client?
SNRIs
Duloxetine, venlafaxine
These are two "buckets" or sets of factors that determine an individual's response and adaptability to a traumatic event
Features of the traumatic experience: severity and duration, exposure to death, amount of control individual had over the occurrence, location of the trauma
Features of the individual: degree of ego strength, effectiveness of coping resources, outcomes of previous trauma/ stress, psychosocial developmental stage, demographic factors
Nursing intervention we would NOT want to do during an assessment where we push a client for a full, rapid retelling of their trauma. This should be avoided as it escalates anxiety and worsens dissociation
Focusing
This disorder is characterized by two or more distinct personalities within one individual
Dissociative Identity Disorder
This is the primary safety priority for a nurse caring for a child with DSED
Supervision near exits and elevators (prevent elopement with strangers)
STRUCTURE, CONSISTENCY, IMMEDIATE RESPONSIVENESS, and POSITIVE REINFORCEMENT
This alpha 1 blocker is specifically added to PTSD treatment plans to target nightmares
Prazosin (also be mindful of hypotension)
This common mistake involves assuming aa client is "fine" because they are calm or joking, but this is not an effective triage tool. What would you call the display of the client's behavior?
Outward Behavior
A PTSD screening is never complete until the nurse directly assesses for this specific priority?
Suicidal Ideation
Most dissociative disorders are rooted in these types of past expereinces
Childhood abuse or severe traumatic life events
What are the three elements of the environment required for pediatric recovery from attachment disturbances?
SAFETY, stability, and predictability
A nurse must verify a client's seizure history before they begin this specific type of eyes off trauma therapy
EMDR: Eye Movement Desensitization and Reprocessing
Recognize symptoms that are often associated with trauma history. Name some symptoms you would see:
Emotional dysregulation- anger, fear, and anxiety, Numbing, somatization (focusing on physical symptoms), misinterpretation of current events as dangerous, trauma induced hallucinations and delusions, intrusive thoughts and memories, guilt, hyperarousal, sleep disturbances, and flashbacks
Pharmacotherapy and Therapy:
Name the medications and treatments we can utilize for these patients
First line: SSRI
Nightmares: Prazosin
If needed: Beta blockers, and anxiolytics
EMDR: Eye movement desensitization therapy. Not used for those with seizures or dissociation
Because direct observation is a safety concern , the nurse must maintain this level of supervision until the client is reoriented to reality
Direct observation. 1:1
In order to build trust with a child who has an attachment disorder, what is the time frame to complete requests from that child in order to build trust?
IMMEDIATELY
These are two different IV antidotes used to treat serotonin syndrome versus neuroleptic malignant syndrome
IV cyproheptadine: SS
IV dantrolene: NMS