Nursing Care Plan for Post-Traumatic Stress Disorder (PTSD)

Pathophysiology

Post-traumatic Stress Disorder (PTSD) is a condition that develops when a person has been exposed to a serious situation such as a natural disaster, serious accident, death of a loved one or life-threatening event. This condition causes debilitating symptoms that, depending on the severity, can negatively affect relationships, communication and daily activities. PTSD affects all ages from childhood to senior adult and symptoms may flare up without any known trigger. Aside from emotional difficulty, clients may experience physical manifestations such as chronic pain and headaches and can lead to drinking and drug addictions as well as physical abuse.

Etiology

Diagnostic Criteria:

  • Exposure to death, threatened death, serious injury or actual or threatening sexual violence. Direct exposure (personally witnessed), repeated exposure, or indirect exposure (i.e. first responders, child victim advocates, law enforcement, etc.)
  • Intrusion or persistently re-experienced stressors in at least one of the following ways: recurrent memories, traumatic nightmares, flashbacks, prolonged distress following traumatic reminders, significant physical symptoms after exposure to stressors
  • Avoidance of distressing trauma-related stressors after the event in at least one way
  • Negative alterations in mood and cognitions that began or got worse after the initial event. Must include 2 of the following: Inability to recall key features of the event, persistent or negative beliefs, persistent distorted blame, persistent negative emotions, significant lack of interest, feeling of alienation, inability to experience positive emotions
  • Alterations in reactivity since the traumatic event. Must include 2 of the following:  aggressiveness, self-destructive behavior, hypervigilance, exaggerated startle response, difficulty concentrating, sleep problems
  • Duration of symptoms must be greater than one month
  • Functional impairment from symptoms
  • Attribution – not related to medication, substance use or other medical illness

Desired Outcome

Client will be able to identify triggers. Client will learn and utilize positive coping strategies. Client will demonstrate control of emotions and relaxation techniques. Client will be free from injury.

Post-Traumatic Stress Disorder (PTSD) Nursing Care Plan

Subjective Data:

  • Irritability, easily agitated
  • Difficulty sleeping, nightmares
  • Lack of interest or pleasure in activities
  • Feeling emotionally numb
  • Easily startled or frightened
  • Mood swings, outbursts of anger
  • Difficulty communicating with others
  • Impaired relationships
  • Loss of memory

Objective Data:

  • Alcohol or drug use since event
  • Suicidal or homicidal ideations
  • Self-mutilation or self-destructive behavior

Nursing Interventions and Rationales

  1. Assess vitals and perform nursing assessment

  2. Determine baseline for vitals and assess for underlying or accompanying medical conditions

  3. Assess client for suicidal or homicidal ideations

  4. To ensure safety of the client and others.

  5. Assess anxiety level

  6. Determine severity of condition and course of treatment or therapy

  7. Establish trust with the client

    • Listen to what the client is saying
    • Behave in a calm manner
  8. Especially when a client has a high level of anxiety, establishing trust can help the client calm down and make treatment more effective

  9. Provide extra time for care and allow client extra time to respond to questions

  10. Clients often have difficulty communicating due to racing thoughts or inability to concentrate. Avoid rushing the client and allow them more time to answer or respond to promote security and  instill a sense of value.

  11. Encourage client to express emotions in a safe environment

  12. Allows the client the freedom to acknowledge their feelings and release any repressed emotions that may be exacerbating their distress. A safe environment should be free from actual or perceived judgement and  physical or perceived danger.

  13. Encourage client to verbally identify current ineffective coping techniques

  14. Helps the client understand their current behaviors that may be preventing effective healing or treatment.

  15. Encourage client to write about the traumatic event

  16. Allows provider to better understand the nature of the client’s condition and anticipate triggers that may cause symptoms. Also allows client and provider to periodically review evolution of emotions toward the traumatic event

  17. Encourage client to keep a journal of stressors and emotional reactions to those stressors

  18. Helps client identify triggers that prompt anxiety or symptoms and evaluate the outcomes of those reactions.

  19. Teach visualization and relaxation techniques such as deep breathing and imagery

  20. Helps client learn to manage anxiety that accompanies flashbacks or environmental stressors and triggers

  21. Administer medications appropriately and monitor for side effects or dependance

  22. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that have proven to be effective for chronic management of symptoms.

  23. Provide calming and reassuring environment

  24. Clients with PTSD are often fearful. Providing a calm, relaxing environment can help lessen or relieve anxiety and promote a feeling of safety.

  25. Facilitate access to community resources using Case Manager or Social Worker

  26. Support groups and other community resources such as service animals, etc., can provide support that the client needs to function in their daily lives.


References

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