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Acute stress disorder (ASD) occurs within 1 month after exposure to an event
that involves actual or threatened harm or death to the self, significant others, or
other persons nearby, and in which the patient responds with fear, helplessness,
or horror. The individual must exhibit at least three dissociative symptoms during
or after the traumatic event: a sense of numbing, detachment, or an absence of
emotional response; reduced awareness of surroundings (dazed state); and
derealization, depersonalization, or amnesia for important aspects of the
traumatic event. This disorder lasts for 2 days to 4 weeks.
Posttraumatic stress disorder (PTSD) affects individuals who have
experienced traumatic events in a similar manner as the individual with ASD but
the symptoms last for 1 to 3 months (acute) or more than 3 months (chronic). The
onset of symptoms may also occur more than 6 months after the trauma.
After the traumatic event, the individual typically experiences anxiety
characterized by elevated autonomic responses (rapid pulse, increased blood
pressure, and increased respiratory rate), cognitive impairment, and altered
memory function. The individual persistently reexperiences the traumatic event
through intrusive and unwanted thoughts or nightmares and tries to cope by
suppressing emotional responsiveness. These behaviors are characteristic
symptoms of PTSD.
Pathophysiology
Recent research shows that severe psychological and physical trauma can cause
alterations in the neurobiological response to stress, even several years after the
original exposure or insult. These long-standing alterations may contribute to a
number of complaints and symptoms that are commonly experienced by
individuals with ASD or PTSD.
Neurobiological studies provide evidence for at least two relatively
consistent neurobiological alterations in chronic PTSD. Findings from
psychophysiologic, hormonal, receptor-binding, and I.V. challenge studies have
demonstrated repeatedly that reminders of the original trauma provoke
hyperresponsiveness of the sympathetic nervous system in individuals with
PTSD.
Additionally, findings of hypothyroid-pituitary-adrenal (HPA) axis
alterations in PTSD suggest increased responsiveness of this system. Low
baseline cortisol, along with heightened response to exogenous dexamethasone,
is consistent with an HPA axis that is extremely sensitive to the stress-mediated
hormones. These neurobiological findings are consistent with a behavioral
sensitization model of PTSD. Behavioral sensitization produces an increased
magnitude of response following repeated presentation of a particular stimulus
such as a traumatic event.
Complications
Substance abuse or dependence
Engaging in high-risk behaviors
Social isolation
Withdrawal from the family
Violent behavior
Suicide
Independent Help the patient to develop an These strategies can produce both
individualized relaxation program. physical and mental relaxation,
Demonstrate and rehearse such which may decrease the patient's
techniques as self-hypnosis, anxiety and induce sleep.
imagery, and muscle relaxation. Relaxation can reduce the
incidence of nightmares.
Collaborative Refer the patient to a support Exploring trauma-related
group concerned with similar nightmares and fears in a
traumatic events. supportive and understanding
environment can help diminish the
patient's feelings of isolation and
loneliness.
Collaborative In collaboration with the patient The patient may require short-term
and doctor, select, administer, and medication to decrease
monitor psychopharmacologic exhaustion, fatigue, or fear and to
medications to manage ASD or alleviate the symptoms that are
PTSD symptoms that are interring with their ability to sleep.
interfering with patient's sleep- Frequent assessments are
wake cycle. necessary to determine the
therapeutic response to the
medication and assist in adverse
effect management.
[Additional individualized
interventions]
Suggested NIC Interventions
Medication administration; Medication management; Security enhancement;
Sleep enhancement; Therapy group
Teaching checklist
Impact of intrusive thoughts or memories on anxiety level and daily
functioning
Strategies to diminish feelings of powerlessness
Value of participation in the care plan and decision making
Methods that facilitate sleep
Alternative coping skills
Available group, family, or marital support resources
Medication use, dosage, administration schedule, and possible adverse effects
Emergency contact information, including patient behaviors that indicate the
need for immediate assistance