Nursing Care Plan | NCP Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that develops after a frightening ordeal involving physical harm or the threat of physical harm or death. First diagnosed in soldiers, it is now recognized in civilian survivors of rape or other criminal assaults, natural disasters, plane crashes, train collisions, industrial explosions, acts of terrorism, child abuse, or war.

The experience of Posttraumatic Stress Disorder (PTSD) has sometimes been described as like being in a horror film that keeps replaying and cannot be shut off. It is common for people with PTSD to feel intense fear and helplessness, and to relive the frightening event in nightmares or in their waking hours. Sometimes the memory is triggered by a sound, smell, or image that reminds the sufferer of the traumatic event. This reliving of the event is called a flashback. People with PTSD are also likely to be jumpy, easily startled, or to go numb emotionally and lose interest in activities they used to enjoy. They may have problems with memory and with getting enough sleep. In some cases they may feel disconnected from the real world or have moments in which their own bodies seem unreal. Many people with PTSD turn to alcohol or drugs in order to escape the flashbacks and other symptoms, even if only for a few minutes.

Posttraumatic Stress Disorder (PTSD) can develop in almost anyone in any age group exposed to a sufficiently terrifying event or chain of events. The National Institute of Mental Health (NIMH) estimated in 2007 that about 7.7 million adults in the United States have PTSD. One study found that 3.7 percent of a sample of teenage boys and 6.3 percent of adolescent girls had PTSD. It is estimated that a person’s risk of developing PTSD over the course of his or her life is between 8 and 10 percent. On average, 30 percent of soldiers who have been in a war zone develop PTSD. Women are at greater risk of PTSD following sexual assault or domestic violence, while men are at greater risk of developing PTSD following military combat. PTSD is more likely to develop after an intentional human act of violence or cruelty such as a rape or mugging than as a reaction to an impersonal catastrophe like a flood or hurricane. PTSD can develop in therapists, rescue workers, or witnesses of a frightening event as well as in those who were directly involved.

Nursing Care Plan Signs and Symptoms

The causes of Posttraumatic Stress Disorder (PTSD) are not completely understood. It is unknown why some people involved in a disaster develop PTSD and other survivors of the same event do not. For example, after terrorists destroyed the World Trade Center in New York City on September 11, 2001, a survey was conducted in November of 988 adults living close to the site. Researchers found that only 7 percent had been diagnosed with PTSD following the events of September 11; the other 93 percent were anxious and upset, but did not have PTSD. One theory proposed by a neurobiologist is that people who develop PTSD have lower blood levels of cortisol, a stress hormone, even before the traumatic event. Cortisol appears to prevent or minimize the imprinting of frightening memories involved in flashbacks. Another theory is that trauma causes changes in certain parts of the brain involved in the processing of memory and emotion.

Factors that influence the severity of Posttraumatic Stress Disorder (PTSD) include:
• The nature, intensity, and duration of the traumatic experience. For example, someone who just barely escaped from the World Trade Center before the towers collapsed is at greater risk of PTSD than someone who saw the collapse from a distance or on television.
• The person’s previous history. People who were abused as children, who were separated from their parents at an early age, or who have a previous history of anxiety or depression are at increased risk of PTSD.
• Genetic factors. Vulnerability to PTSD is known to run in families.
• The availability of social support after the event. People who have no family or friends are more likely to develop PTSD than those who do. The symptoms of PTSD usually emerge within three months of the frightening event, although in some cases they may take several years to develop. A person must have the following symptoms for at least a month to be diagnosed with PTSD:
• Flashbacks
• Difficulty sleeping; having nightmares about the event
• Trying to avoid reminders of the event
• Emotional numbness, inability to enjoy previously pleasurable activities
• Anger and irritability
• Memory problems and having difficulty concentrating
• Being unusually jumpy and easily startled; this type of symptom is called hyperarousal
• Intense feelings of shame or guilt
• Feelings of unreality, such as someone feeling that one’s body isn’t real or that the outside world isn’t real
• Hopelessness about the future
• Self-destructive behavior, such as drinking too much or taking drugs

Nursing Care Plan Diagnosis

The diagnosis of Posttraumatic Stress Disorder (PTSD) is based on the patient’s history, including the timing of the traumatic event and the duration of the patient’s symptoms. There are no laboratory or imaging tests that can detect PTSD.

Nursing Care Plan Treatment

Treatment for Posttraumatic Stress Disorder (PTSD) usually involves a combination of medications and psychotherapy. If patients have started to abuse alcohol or drugs, they must be treated for the substance abuse before being treated for PTSD. The medications are given to help patients sleep better, to improve their memory and ability to concentrate, and to feel less irritable or fearful. In addition to tranquilizers and antidepressants, some drugs that were originally developed to treat epilepsy appear to help some patients with PTSD. The doctor may need to try several different types of medications before finding the one that works best for an individual patient.

The types of psychotherapy that may be used include individual therapy, group therapy, family therapy, and relaxation techniques. Some patients are also helped by hypnosis, art therapy, pet therapy, or music therapy. Patients with PTSD are not hospitalized unless they are threatening to commit suicide or harm other people. Alternative therapies that have been reported to help people with PTSD are acupuncture, therapeutic massage, meditation, and prayer. In addition, Native Americans are often helped to recover by participating in traditional tribal rituals for cleansing memories of war and other traumatic events.

Prognosis
The prognosis of Posttraumatic Stress Disorder (PTSD) is difficult to determine because patients’ personalities and the experiences they undergo vary widely. A majority of patients get better, including some who do not receive treatment. One study reported that the average length of PTSD symptoms in patients who get treatment is thirty-two months, compared to sixty-four months in patients who are not treated. Factors that improve a patient’s chances for full recovery include prompt treatment, early and ongoing support from family and friends, a high level of functioning before the frightening event, and an absence of alcohol or substance abuse. About 30 percent of people with PTSD never recover completely, however. A few commit suicide because their symptoms get worse rather than better.

Nursing Care Plan Prevention

Posttraumatic Stress Disorder (PTSD) is impossible to prevent completely because natural disasters and human acts of violence will continue to occur. In addition, it is not possible to tell beforehand how any given individual will react to a specific type of trauma. Prompt treatment after a traumatic event may lower the survivor’s risk of developing severe symptoms.

The Future
It is possible that further research into the effects of trauma on memory and other mental functions will lead to new options in treating PTSD.