Posttraumatic Stress Disorder



Posttraumatic Stress Disorder (PSD) is defined as an experiencing of a traumatic event in either daytime reveries or dreams. Natural and / or mad-mad disaster are usually the stress experiences.

Symptoms:
The symptoms of Posttraumatic Stress Disorder are likely same as anxiety, depression and organic mental disorder. Assess the following symptoms when caring of posttraumatic stress disorder patients:

Beside of symptoms I mentioned above, psychosocial and cultural of the client should be assess too.
  • Feeling of detachment and guilt
  • Inability to feel emotions
  • Impulsive behavior
  • Anxiety of depression
  • Nightmares
  • Emotional lability
  • Acting out, reliving traumatic experience
Planning:
  • Safe and effective care environment
  • Physiological integrity (to reduce or eliminate physiological symptoms of stress)
  • Psychosocial integrity
Implementation:
There are four stages of implementation regarding Posttraumatic Stress Disorder patients:
  1. Recovery: to assist patient to realize that he/she is safe
  2. Avoidance: to provide support while patient attempts to suppress thought of traumatic experiences
  3. Adjustment: to assist patient to alter environment if needed.


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Abnormal Motor Behaviors



Abnormal motor behaviors are activities displayed by the mentally ill patient and occur as a result of a psychiatric disorder.

There are types of abnormal motor behaviors as I mention here:

Akathisia

  • Displaying motor restlessness and muscular quivering
  • Patient is unable to sit or lie quietly

Echolalia
Repeating the speech of another person

Echopraxia
Repeating movement of another person

Parkinson-like Symptoms
Making masklike faces, drolling, and having shuffling gait, tremors, and muscular rigidity

Waxy Flexibility
Having one’s arm or legs place in a certain position and holding that same position for hours

Dyskinesia
Impairment of the power of voluntary movement


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Abuse and Neglect: Shaken Baby Syndrome



Shaken baby syndrome (SBS) is a form of physical abuse that mostly caused by rigorous shaking. There are three risk factors of shaken baby syndrome: gender, financial stress, and mental-health problems.







Sign and Symptoms:

Nursing Interventions:
Assure and teach parent about age-appropriate play of the infants that will not cause injuries


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Abuse and Neglect: Child Abuse







Signs of Physical Child Abuse:
  • Unexplained bruise or welts
  • Unexplained burns
  • Unexplained fractures (multiple or in various stages of healing)
  • Unexplained lacerations or abrasions (mouth, eyes, and external genitalia)
  • Expresses fear of going home
  • Appears frightened of parents
  • Reports of being injured by parents
  • Exhibits extreme aggressiveness or withdrawal
  • Acts wary of contact with adults
  • Becomes apprehensive when other children cry
Signs of Physical Child Neglect:
  • Inappropriate dress
  • Always hungry
  • Poor hygiene
  • Uncared for medical or physical problems
  • Begging or stealing food
  • Abandonment
  • Early arrival and late departure from school
  • Fatigue
  • Listlessness
  • Reports lack of a caretaker
  • Delinquency

Why the parent becomes an abusive parent? Here are the risk factors that parent become an abuser:

  1. Under significant stress
  2. Abused as a child
  3. Deficient in social and financial resources
  4. Lack of impulse control
  5. Uses inappropriate coping skills
  6. Anger and hostility
  7. Ambivalent toward parenthood
  8. Mental illness
  9. Marital problems
  10. Lack of knowledge regarding children development
  11. Substance abuser

Nursing Interventions:
  • Assess the patient, family, and significant others about the signs of an impending crisis and effective problem solving techniques to manage crisis
  • Assess the patient, family, and significant others about the signs of abuse and neglect, and to access help immediately if abuse or neglect are suspected
  • Assess caregivers about coping strategies to prevent abuse and neglect


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Abuse and Neglect: Sexual Abuse






The case of sexual abuse may range from sexual harassment to molestation and rape.

Patients with rape usually deal with the consequences from physical injury, pregnancy and sexually transmitted disease, and rape trauma syndrome. The rape trauma syndrome includes high level of anxiety, difficulty making decision, flashbacks, violent dream, preoccupation with future danger, and problems with intimate relationships.

In the long-term, the victims of sexual abuse may experience posttraumatic stress disorder (PTSD). In this case, the sexual abuse victims:
  • Uses denial, repression, and suppression to cope with anxious feelings
  • Shows symptoms including flashback, intrusive memories of the event, hopelessness, depression, night-mares, and outbursts of anger and rage.

Nursing Interventions:

  • In children sexual abuse, assess for sexualized behavior characteristic: seductive behavior used to gain affection, unusual curiosity regarding genitalia, decreased personal boundaries, extreme reaction to bathing, extraordinary fear of the opposite sex, unwillingness to participate in age appropriate physical or social activity.
  • In the emergency department: gather evidence with permission of the victim following policies of facility and low enforcement.
  • Give the victim a control as much as possible during the assessment.
  • Treat physical injuries appropriately
  • Advice patient about potential for pregnancy and STDs
  • Encourage patient to discuss feeling about the assault
  • Provide the information about community services


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Abuse and Neglect: Elder Abuse






Elder abuse is the term that includes both abuse and neglect. It may be physical harm, sexual or verbal intimidation, emotional, or physical neglect, and or economic exploitation.

Elder victims are often reluctant to reveal abuse out of fear of abandonment or retaliation from abuser. The abusers are usually family member.
Signs and Symptoms of Elder Abuse:
  • Dehydration and malnutrition
  • Unexplained bruising, burns, or injuries
  • Oversedation
  • Unmet physical and medical needs
  • Bruises, wounds, and pressure ulcers
  • Fearfulness
  • Report of restraints or being locked in a room
  • Conflicting stories from client and caregiver or family member
Nursing Interventions:
  • Assess for signs of abuse or neglect
  • Treat and manage the existing injuries
  • Report abuse to appropriate authorities
  • Refer to community agencies (respite for caregivers, support groups for caregiver)


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Abuse and Neglect: Spouse / Partner Abuse



Spouse or partner abuse occurs as emotional, physical, economic, sexual, or combination. This abuse happens most frequently that a male on a female.

Victims of spouse or partner abuse are more likely to abuse alcohol or drugs and to commit suicide.

Attacks escalate in severity and frequency over time.

This kind of abuse usually follow a cycle or pattern: escalating tension, abuse, and then remorse (honeymoon period). In remorse pattern, the abuser apologizes and promises that it will never happen again, professes low for partner, often engages in romantic behaviors, and tension-building phase begins again.

The victim may leave the abuser, and this condition is most dangerous to both of them.

Nursing Interventions:
1. Identify possible victims, use SAFE question:

  • Stress/safety: Do you feel safe:
  • Afraid/abused: Are you ever afraid in your relationship?
  • Friend/family: Are they aware you have been hurt?
  • Emergency plan: Do you have a safe place to go and the resources you may need?
2. Refer to the appropriate resources such as police or legal aid, local shelters, and support groups.


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