NURS 497 Midterm 2 Exam - Complete Solutions (Answered) What are the 9 categories of the MSE? Thought process Thought content Mood & affect General appea... [Show More] rance Insight Judgement Perceptual functioning Cognitive functioning Speech & language What is common in mild to moderate anxiety? Solve simple problems Decreased concentration Executive functioning intact In control of behaviours What is common in severe anxiety? Unable to solve problems Lack of self control Limited understanding of what's happening in their environment What is the difference between suicide and self-harm? Suicide- intent to end life Self-harm- no intent to end life What age does the DSM 5 criteria for PTSD apply to? Individuals older than 6 What is included in part A of the DSM 5 criteria of PTSD? Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: -Directly experiencing the traumatic event -Witnessing, in person, the event as it occurred to others -Learning that the traumatic event occured to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must be violent or accidental. -Experiencing repeated or extreme exposure to aversive details of the traumatic event (ex. first responders collecting human remains, police officers repeatedly exposed to details of child abuse) Note: Criterion A4 does not apply to exposure through electronic media, television, movies or pictures, unless this exposure is work related. What is included in part B of the DSM 5 criteria of PTSD? Presence of one (or more) of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred: -Recurrent, involuntary and intrusive distressing memories of the traumatic event. Note: In children older than 6, repetitive play may occur in which themes or aspects of the traumatic event is expressed. -Recurrent distressing dreams in which content and/or effect of the dream are related to the traumatic event. Note: In children, there may be frightening dreams without recognizable content. -Dissociative reactions in which the individual feels or acts as if the traumatic event were recurring. Note: In children, trauma-specific reenactment may occur in play. -Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. -Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event. What is included in part C of the DSM 5 criteria of PTSD? Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occured, as evidenced by one or both of the following: -Avoidance of or efforts to avoid distressing memories, thoughts, feelings about or closely associated with the traumatic event. -Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event. What is included in part D of the DSM 5 criteria of PTSD? Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the traumatic event occurred, as evidenced by two (or more) of the following: -Inability to remember an important aspect of the traumatic event (typically associated with dissociative amnesia and not to other factors such as head injury, alcohol or drugs). -Persistent and exaggerated negative beliefs or expectations about oneself, others or the world. -Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame him/herself or others. -Persistent negative emotional state. -Markedly diminished interest or participation in significant activities. -Feelings of detachment or estrangement from others. -Persistent inability to experience positive emotions. What is included in part E of the DSM 5 criteria of PTSD? Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the event occured, as evidenced by two (or more of the following): -Irritable behaviour and angry outbursts typically expressed as verbal or physical aggression toward people or objects. -Reckless or self-destructive behaviour. -Hypervigilance. -Exaggerated startle response. -Problems with concentration. -Sleep disturbances. What is included in part F of the DSM 5 criteria of PTSD? Duration of disturbances (B,C,D and E) is more than a month. What is included in part G of the DSM 5 criteria of PTSD? The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. What is included in part H of the DSM 5 criteria of PTSD? The disturbance is not attributable to the physiological effects of a substance or another medical condition. PTSD prevalence Occupation: Emergency personnel are twice as likely to experience PTSD. It is estimated that 1/6 Canadian veterans experience PTSD. Gender: Women are twice as likely than men to be diagnosed with PTSD. What causes an increased prevalence in PTSD? Based on trauma Timing- when over the lifespan did it occur? Duration- over what time period did the trauma occur? Intensity- what is the impact? Other: layering of trauma, comorbities What are some biological factors that contribute to the development of PTSD? Genetic factors: -Evidence for an inherited component -Presence or pre-disposition of co-morbid and concurrent diagnoses (depression, acute stress disorder, personality disorder) -Predisposition to poor stress management Neurobiological factors: -Hypothalamus-pituitary-adrenal system (fight/flight) -GABA-benzodiazepine theory (benzodiazepine receptors are linked to receptors that inhibit the neurotransmitter GABA) PTSD Pathophysiology Receiving and processing stimuli: -Olfactory and tactile (received by amygdala) -Visual and auditory (received by thalamus and sent to amygdala) Amygdala communicates with hippocampus and thalamus What is the amygdala responsible for in PTSD? Quickly recognizing danger signals Determining the emotional importance that is assigned to a fearful experience Stimulates the hippocampus, so that the brain can recall memories and connect new experiences to previously stored memories What is norepinephrine responsible for in the stress response? From peripheral nerve endings Increased BP Decreased digestion Dilated pupils Dilated bronchial airways What is epinephrine responsible for in the stress response? From adrenal medulla Increased cardiac output Increased BG What is cortisol responsible for in the stress response? From adrenal cortex Suppressed inflammatory response Inhibits fibroblast proliferation and function Impacts immunity: decreased eosinophils, lymphocytes, macrophages What is vasopressin/ADH responsible for in the stress response? Increased water retention What are some psychological factors that can contribute to PTSD? Psychodynamic perspective- unconscious childhood conflicts form the basis for symptom development Behavioural perspective- anxiety is a learned response Cognitive perspective- result of thought and perceptual distortions What types of assessments do we need to perform when a patient has PTSD? MSE Risk assessment Physical assessment Family SeDOHs What would we expect to find in the general appearance category of the MSE for a patient with PTSD?
Appearance- self-care patterns may not be initially disrupted; as the illness becomes severe ADLs may become more difficult Behavior- becomes increasingly withdrawn and alienated from others and less able to maintain activities that support his/her health Cooperation- may become less cooperative and possible triggers increase What would we expect to find in the mood and affect category of the MSE for a patient with PTSD? Affect- may range from blunted to labile depending on triggers present. May not be appropriate to the context, as the individual may have exaggerated responses to what would be considered normal events Mood- usually rated moderate to low, as the individual is usually on "high alert" and trying to avoid actual or perceived harm. Mood and affect are usually congruent What would we expect to find in the speech and language category of the MSE for a patient with PTSD? Speech- rate, rhythm and inflection are dependant on the context. Volume is usually quiet Language- vocabulary, comprehension, and fluency are consistent with the individual's educational level What would we expect to find in the thought process category of the MSE for a patient with PTSD? Poverty of speech, somatization and may perseverate on the traumatic events, and present or potential triggers What would we expect to find in the thought content category of the MSE for a patient with PTSD? Delusions- need to distinguish between delusional thinking and distorted thinking Suicidal/homicidal ideation- reliving of a traumatic experience is often intense, and feels inescapable for the individual. As a result, the individual may have thoughts of killing themselves or his/her offender (with or without a plan) Thoughts of self-harm- common coping strategy and a significant risk Depressive cognitions- feelings of hopelessness, worthlessness, guilt (self-blame) and helplessness are common Anxious cognitions- may be worried and preoccupied that the offender will continue to harm What would we expect to find in the perceptual functioning category of the MSE for a patient with PTSD? Hallucinations- should not be confused with triggers and memories of the verbal interactions Illusions- not common Depersonalization- may occur Derealisation- may occur in severe cases Dissociation- may occur [Show Less]
