Pathophysiology - Anxiety Disorder: Post Traumatic Stress Disorder - Nursing Care Assessment Answer

December 13, 2018
Author : Andy Johnson

Solution Code: 1AAGE

Question: Anxiety Disorder: Post Traumatic Stress Disorder

This assignment is related to ” Pathophysiology” and experts atMy Assignment Services AUsuccessfully delivered HD quality work within the given deadline.

Pathophysiology - Nursing Assignment

Assignment Task

Choose either a specific anxiety disorder or a specific mood disorder.Using current and evidence-based references briefly describe the condition, including:

  • Aetiology
  • Incidence
  • Predisposing factors

2) With reference to the Clinical Reasoning Cycle:

  • Outline the elements of a mental state examination specific to this condition, and 3 problems typically associated with patient deterioration

. Provide a rationale for the inclusion of each element in the MSE

  • Identify two medications that may be used to manage this condition. Include the rationale for administration to a patient with the specific condition. Briefly discuss at least two key nursing considerations (for each medication) when caring for a patient receiving this medication.

  • Identify nursing actions for this condition derived from either recovery-focused practice or trauma-informed care. Include in your discussion:

  1. i) A brief overview of recovery-focused practice or trauma-informed care
  2. ii) Goals for use of the identified actions for the chosen condition

iii) Deficits in nursing knowledge or skills that may hinder success of the actions

  1. iv) Clinical and environmental barriers to effective implementation
  2. v) Methods by which these barriers can be overcome

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Solution:

Introduction

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:

  • Behavior and Appearance: Behavior involves the examination of the patient’s gestures, gait, mannerism, and activity level. The patient of Post traumatic stress disorder may display inappropriate behavior and may also display bizarre body postures. Any kind of obsessive behavior found in patient condition can hinder the basic functional activities (Carniaux-Moran, 2008).
  • Mood and Affect: mood is considered as the emotional state of a person and expression of this state is called as affect. It is important to observe the depth, fluctuation and range of emotional expressions (Carniaux-Moran, 2008). It is important to examine mood and affect, as some of the depressed patients may display depression and some may not display depression even when they are depressed.
  • Speech: Examining the rate, style, tone and amount of speech is also important for mental health examination because individual suffering from PTSD may display obscure speech patterns, illogical or irrelevant speech pattern, and other oddities of speech (Carniaux-Moran, 2008).
  • Thought Process and Content: It is important to identify abnormality in the though content. This is important to identify problems of hallucination, delusions and suicidal thoughts and homicidal thoughts. This is because the active suicidal thoughts may require immediate psychiatric care for the patient to ensure patient’s safety (Carniaux-Moran, 2008).
  • Impulse Control: Impulse control is the ability of a person to control feelings and emotions. It is important to examine as impulse control will determine the patient’s potential for acting upon violent and suicidal thoughts (Carniaux-Moran, 2008).

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.

  • Patient must be encouraged to take medication every day according to the prescription. Medication must not be stopped abruptly. Stopping the medication abruptly will result in withdrawal symptoms that can affect patient’s condition.
  • Such medication may have negligible or no side effects. However, it is important to monitor the condition of patient. If there are any signs of side effect than practitioner should be immediately informed, so that it can be changed with other medication or drug (Bernardy & Friedman, 2015).

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:

  • The quantity of the drug must be controlled. If the quantity of the drug is causing severe side effects than it can be reduced with concern of the practitioner.
  • The patients taking this medication may also face increased weight issues. Patient’s weight must be regularly monitored and can be changed if required (Bernardy & Friedman, 2015).

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.

  1. Safety is promoted through safe environment, which enhance physical and psychological well-being.
  2. Transparency and trustworthiness while providing quality treatment. All the decisions are shared in order to maintain trust among patient, family and professionals (NCTIC, 2013).
  3. Encouraging support of peers to encourage better service delivery.
  4. Mutuality and Collaboration of care providers and care receivers in order to improve outcomes.
  5. Empowerment, voice and choice to promote quality, strengthen choices and individualized approach.
  6. Promotes understanding of cultural, historical and gender issues to serve patients in better way.

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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