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Lecture: Management Of Post Traumatic Stress Disorder (PTSD) By Nurse Dedrey Ogunnoiki @dedrey_nrs
Date Posted: 14/Dec/2017
The anchor for the Nursingworld Nigeria Lecture yesterday the 13th of December 2017 by 8pm was Nurse Dedrey Ogunnoiki with the twitter handle: @dedrey_nrs. 
 
Nurse Dedrey: Good evening professional colleagues, you're welcome to tonight's lectureOur topic of discussion tonight is MANAGEMENT OF POST TRAUMATIC STRESS DISORDER (PTSD)
 
OVERVIEW OF POST TRAUMATIC STRESS DISORDER
PTSD is a disorder that develops in some people who have experience a shocking, scary, dangerous or life threatening event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoided it. This “fight-or-flight” response is a typical reactions meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.
 
DEFINITION
PTSD is a debilitating mental disorder that follows an experience or witness of an extremely traumatic, tragic or terrifying event. It can affect those who personally experience the trauma, those who witnessed it or those who tried to manage the situation (e.g boko haram victims, fire fighters, military personnel etc)
 
CAUSES OF PTSD
* Actual or threatened death
* Traumatic memories or experiences
* Threat to psychological integrity
* Serious physical injury
* war, torture, rape, sudden death of loved ones
* Natural disasters, terrorist attacks, car/plane crash, child abuse
* biochemical changes in brain etc
 
CLINICAL MANIFESTATIONS
Symptoms may develop after a period of latency usually 6 months to one year after the trauma or events. These manifestation may include:
 Anger, irritability, insomnia, shame, self blame, guilt, dissociation, anorexia, hypervigilance, avoidance, substance abuse, self mutilation, feeling of mistrust or betrayal, depression, hopelessness, suicidal thoughts/suicide etc
 
Types of post traumatic stress disorder
* Acute PTSD - This subsides after a duration of few weeks to 3 months
* Chronic PTSD - symptoms persist more than three months
* Delayed PTSD - this  progresses from months to years and decades after the event
PATHOPHYSIOLOGY
Stress is an essential and normal physiological response to the environment and greatly influences memory. Stress is the number one risk factor in the development of PTSD, and prominent memory disturbances are a central feature of this disorder. Pathophysiological research to date has focused on areas of the brain associated with processing fear and memory. These areas are the hippocampus, the amygdala, and the medial prefrontal cortex, including the anterior cingulate gyrus (which is a part of the limbic system involved with the processing of emotions and the regulation of behavior as well as regulating autonomic motor function). Both the hippocampus and amygdala are key elements in human memory. The hippocampus is responsible for the processing and storage of short-term memory, and the amygdala is responsible for activities that include emotion and moods and appears to modulate all reactions to events that are important to survival.
 
Diagnosing PTSD
Diagnosing PTSD can be relatively difficult, considering that quite often, victims of traumatic events who consequently develop PTSD are undiagnosed or misdiagnosed with other mental disorders. According to a  study, only 2-11% of patients have been officially diagnosed with PTSD and, what is even more interesting, less than half of these people have received appropriate treatment. (Meltzer, Averbuch, Samet, 2004)
In order to correctly identify individuals who have developed PTSD, victims of traumatic events should be encouraged to self-report about any past trauma. However, there are several factors that can influence why  individuals do not feel like reporting about traumas. One reason is due to the social stigmatization that follows a mental health diagnosis. 
 
Additionally, some people perceive reporting a mental health disorder or  trauma as equal to admitting weakness or an inability to handle their problems independently.
The above is just an overview of what PTSD - Post Traumatic Stress Disorder entails. Now let's focus on the the main topic which is the nursing management
 
NURSING MANAGEMENT OF PTSD
The main treatments for people with PTSD are psychotherapy, medications or both. Everyone is different, and PTSD affects people differently so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.
 
NURSING INTERVENTIONS 
This may include:
HISTORY TAKING/ASSESSMENT: nurses should perform a thorough history and assessment of a patient’s physical health. Nurses should utilize the DSM-V criteria to assess these symptoms. By asking pointed questions about their history and physical health, it can be easier to determine whether or not their symptoms are exaggerated or if a patient is underplaying their severity.
 
CREATING THERAPEUTIC MILIEU: This involves establishing Trust and communication with a patient in therapeutic environment  through various techniques, which include developing trust, listening, normalizing responses, and reframing.
* Establish rapport with client to gain his trust. It is important that the nurse should accept client’s current level of functioning. And the nurse must also be consistent, positive, honest as well was adapt a nonjudgmental attitude when working with the client.
* Provide time and opportunity for client go express his feelings. It is essential that nurse should detect an ongoing grieving process and help client to find conclusion.
* To manage outbursts of anger, assist client to identify sources of emotions. Assist client in regaining control.
* Assist client in using displacement whenever he is angry by providing things he can manipulate or destroy suchlike as clay.
* After every outburst, discuss with the client how his anger escalates.
* Desensitize client to his memories of traumatic event.
* Remind patient that setbacks in the process of treatment are not failures but an expected part of the therapy.
* Encourage client to accept forgiveness from self and others.
* Refer client to other sources of support such as community organizations and support groups
 
PSYCHOTHERAPY
Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery. Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs. Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT. 
 
CBT can include:
Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
 
Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way
 
MEDICATION 
The most studied medications for treating PTSD include antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific PTSD symptoms. For example, research has shown that Prazosin may be helpful with sleep problems, particularly nightmares, commonly experienced by people with PTSD.
 
LIKELY NURSING DIAGNOSIS FOR A PATIENT WITH PTSD
Nursing diagnoses that are appropriate to the patient suffering from PTSD include, but are not limited to includes:
* Hopelessness/powerlessness
* Ineffective coping
* Sleep pattern disturbance
* Dysfunctional grieving
* Impaired social interaction
* Ineffective relationships
* Impaired individual resilience 
* Risk for suicide
 
CONCLUSION 
PTSD is one of the unnoticed and debilitating mental illness that causes dysfunctional state or maladaptive response to stressors that is characterized by partial or complete disintegration of individual's personality. Nurses play such an integral role in noticing the symptoms of PTSD and are able to use some techniques and tools to support these patients. However, it is important to note that nurses are at the frontlines of meeting and caring for these patients. Therefore, it is imperative that nurses should acquaint themselves more on update courses and  research on PTSD.
 
REFERENCES
Keltner, N., Bostrom, C., McGuness, T. Psychiatric Nursing 6th Edition. 2012
Lippincott Williams and Wilikins Straight A’s in Psychiatric and Mental Health Nursing. 2006 http://www.rightdiagnosis.com/p/post_traumatic_stress_disorder/stats-country.htm

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