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Choose either a specific anxiety disorder or a specific mood disorder.Using current and evidence-based references briefly describe the condition, including:
2) With reference to the Clinical Reasoning Cycle:
. Provide a rationale for the inclusion of each element in the MSE
iii) Deficits in nursing knowledge or skills that may hinder success of the actions
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Post traumatic disorder is a kind of anxiety disorder, which is also considered as the primary cause of injuries in the soldiers. This disorder mainly affects those, who have gone through some kind of traumatic event. Traumatic events could be any kind of life threatening events that have occurred such as terrorist attack, rape, physical assault, natural calamity, or a serious accident (Bryant, 2011). In some individual the reaction of stress and anxiety is prolonged that could lead to Post traumatic disorder (PTSD). This paper will review the complications and prevalence of PTSD and will discuss the important medication associated with it.
Aetiology of PTSD
The people, who are at highest risk of Post Traumatic Stress Disorder, are those, who have been exposed to or witnessed the extreme traumatic stressors in their life. These stressors could be physical and sexual assault, intentional events of violence, disasters and accidents and even military actions. The people, who have witnessed the threat to their own life or to the life of others during hospitalization, such as complex situations during girth of child, anesthesia, or any events of medical negligence are also at the risk of PTSD (Scott et al, 2015). This disorder is considered as unique among the other functional psychiatric disorders, where it occurrence is considered to be the result of the external causative factors (Bryant, 2011). But, earlier it was believed that people with some kind of mental illness, or unstable personality are likely to develop the symptoms of PTSD. Different new studies in the field made it clear that even a normal person can develop the symptoms of PTSD if exposed to traumatic events. The traumatic event is considered as the event that must have actual threat to life, threat to physical integrity and threat to serious physical injury. Some of the studies also state that people with low intelligence, gender identity as a woman and prior exposure to trauma can suffer from PTSD. However scientific studies are being carried out to find out that why some people develop PTSD, while others do not. Studies are also including studies of brain and genetic effects (Scott et al, 2015).
Incidence of PTSD
According to the reposts of Australian Bureau of Statistics (2013), around 800,000people from Australia suffer from post traumatic stress disorder at any given time. According to the figures obtained, it is the second most common mental health problem in the country. The problem of PTSD often goes undiagnosed in children and teenagers. The high rate of PTSD are found among women, which is almost twice as that of its incidence in males. 15%-20% of people, who have suffered potentially traumatic events (PTE), are inclined to develop PTSD (Brown, 2013). The incidence of Post traumatic Stress disorder are also found in females, people with low education, and people living in poor areas. Post traumatic stress disorder is highly prevalent in the Australian society and major reasons are high rate of depression and anxiety and substance abuse. The people, who are vulnerable also, develop the symptoms of PTSD. Some of the studies even reveal that PTSD symptoms can be found in people with past history of mental illness, childhood trauma and any kind of head injury (Bryant, 2011). Some of the occupations are also responsible for development of PTSD, such as Military services, disaster management etc. Post traumatic stress disorder can occur at any age, but if often remains undiagnosed (Scott et al, 2015).
Predisposing factors of PTSD
Post traumatic stress disorder is an anxiety disorder. People from every age group can develop symptoms of PTSD, however some people are more likely to develop the symptoms and different risk factors are associated with it. People, who have history of being exposed to a focal trauma, are at risk of developing post traumatic stress disorder (TheAustralian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder, 2015). The prior history of trauma or chronic stress is very potent risks factors. This is mainly very risky, when it has been faced in the early age. Another important predisposing factor is prior experience of any kind of assault (Hendler & Admon, 2016). The history of the family instability and lack of social support is also associated with risk of PTSD. Gender is considered as a salient predisposing factor. Women are more likely to develop PTSD in comparison to men, because there is huge difference in types of event they face. Women are often victims of physical and sexual assault. The higher risk of post traumatic stress disorder in females is due to vulnerability to assaultive violence (Hendler & Admon, 2016). Other than these, some more factors responsible for PTSD are low education and low income. Even divorced and widowed are also at the risk of developing PTSD. One of the other risk factor is also considered as ethnic minority (Spinhoven et al, 2014).
Mental State Examination of PTSD With Rational
Mental State Examination is very important to identify the level of PTSD. DSM-IV diagnostic criteria are used for the mental examination for PTSD, which includes the person, who has faced traumatic event, if the person is re-experiencing the trauma in different forms (thoughts, images, distressing dreams, psychological distress). Mental state examination is also essential for understanding the extent, frequency and symptoms of the disorder (Carniaux-Moran, 2008). The mental state examination includes:
Three Problems associated with Patient’s Deterioration
Safety: The patient suffering from PTSD may also suffer from co-morbidities of acute depression and anxiety, which can increase the risk of suicide and self destruction or even homicidal thoughts. Due to continued or fluctuating distress and potential to self harm increases. Thus, it can be a serious risk for patient’s safety. Such people require immediate urgent psychiatric care in order to ensure their safety (Acute Stress Disorder and Posttraumatic Stress Disorder, 2007).
Treatment: Providing a quality treatment for the patient of PTSD is very important. With deteriorating condition of the patient may require involvement of multiple practitioners like GP, psychiatrist, psychologist, and social/vocational rehabilitation consultants etc. Thus, it is very important to have effective communication and coordination among the healthcare professionals. Effective interventions are also essential (Acute Stress Disorder and Posttraumatic Stress Disorder, 2007).
Review of the Treatment: With deteriorating condition of the patient suffering from PTSD, it may appear that symptoms of the problem are resistant to change. In this case it is important to review that experience and skills of the practitioner are adequate for the treatment of the ongoing problem or not. It is also important to see if second opinion is required, and whether the intensity, setting and duration of treatment are apt Acute Stress Disorder and Posttraumatic (Sandica & Pop, 2014).
Important Medication
Antidepressants: Post traumatic stress disorder has co-morbidities such as anxiety and depression. With time, such problems can be increased. Thus, initial treatment of the PTSD must be based on reducing co-morbidities. Antidepressants are very helpful in reducing depression, anxiety and stress. This medication also helps to improve sleep and problem of concentration. The selective serotonin reuptake inhibitor (SSRI) medications are considered as the first and most effective medication. It includes drugs like, sertraline (Zoloft) and paroxetine (Paxil) (Jeffreys, 2009). These drugs are approved by FDA to be prescribed for PTSD patients.
Anti-anxiety: Anti-anxiety is another medication, which can be used for the patients of Post traumatic stress disorder. These drugs are helpful in providing short term relief from anxiety and stress and also prevent sever anxiety attack. These drugs have the potential of producing side-effects and addiction, thus they are not prescribed for a long time (Jeffreys, 2009).
Anti-depressant Medication
Nursing Intervention: SSRI’s medication is given to PTSD patients in order to control panic disorder, depression and also other mental disorders. This medication is essential to improve tolerability and safety for patient.
Anti-anxiety Medication
Nursing Intervention: Anti-anxiety medication can result into many side effects, such as sexual dysfunction, erection problems, impotency, anorgasmia, or nausea. Thus nurse requires supporting patient by:
Trauma Informed Care
Trauma is an interpersonal event, which may encompass physical or sexual abuse, military combat, neglect, violence, maltreatment, natural calamities, loss of loved ones, and other traumatic events. Trauma reduces the person’s capability to cope with stress and depressive events. According to SAMHSA (Substance abuse and Mental Health Services Administration), “Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives” (NCTIC, 2013). This approach is very important in the research of the trauma studies and effect of trauma on brain. According to this approach, it includes six key principles and goals, which can be used to treat the patient with Post traumatic stress disorder and for making trauma specific interventions.
Importance of Nursing Knowledge: Nursing knowledge and skills are very important for treating patients with post traumatic stress disorder. For providing quality care it is important that nurse should work in collaboration with other professionals and in partnership with patient and family. If nurse lack this approach and skill than it may impact the duty of care. Nurses must be experienced in Cognitive-behavioral therapy (CBT), so that they can help the patients in reducing negative thoughts, and in controlling fear. Lacking in such skills may result in ineffective care (Ogle, Rubin, & Siegler, 2013).
Clinical and Environment Barriers: Effective clinical environment is important for the patients of PTSD. Clinical and environment barriers such as lack o f support from family and peers, ineffective nursing care and safety loopholes can risk the patient’s life. These barriers may deteriorate the condition of the patient.
These barriers can be overcome by the proper and effective care and interventions. Through metal state examination, current condition of the patient can be evaluated. Nursing care plan, interventions and treatment could be proposed according to patient’s needs.
Conclusion
Post traumatic stress disorder is a kind of anxiety disorder that can affect individual from any age group. However, this mental disorder is found to be more prevalent in females than in males. The past history of traumatic events can lead to symptoms of Post Traumatic Stress Disorder. Paper reviewed the conditions and risks factors associated with PTSD and provided the overview of trauma informed care.
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