PTSD – Pre-Clinical
Marquise Pruitt
a. Describe the clinical picture of PTSD
a. The clinical picture of PTSD for children is a decrease in play, repeating aspects of
the traumatic event while playing, social withdrawal, and negative feelings like
fear, guilt, anger, sadness, horror, shame, or confusion.
b. The clinical picture of PTSD in people older than 6 years:
a. Direct or indirect exposure to actual or threatened death, serious injury,
or sexual violence
b. Recurrent, involuntary memories, dreams, and/or flashbacks (longer than
a month)
c. Negative alterations in cognition and mood related to the traumatic
event (longer than a month)
d. Marked alterations in arousal and reactivity associated with the
traumatic event (longer than a month)
e. If the disturbances cause problems or distress in social, occupational, or
other important areas of functioning
f. If the disturbance is not attributed to the physiological effects of a
substance
b. Compare and contrast PTSD and acute stress disorder?
a. Acute stress disorder is diagnosed between 3 days and a month. They both begin
after a traumatic event, but ASD symptoms begin immediately after the event.
b. PTSD is diagnosed if problems persist longer than a month. PTSD symptoms
usually occur a month after a traumatic event but there can be months of delay.
c. Describe the role of therapeutic communication when working with individuals
diagnosed with PTSD; what specific techniques might be used?
a. When working with a person with PTSD a nurse should establish a therapeutic
relationship through empathy and acceptance.
b. The techniques used consist of the nurse assisting the person in managing their
arousal level. They also teach deep breathing, imagery, and mindfulness
exercises to manage anxiety.
d. What comorbidities or conditions might you expect see with PTSD?
a. Major depressive disorders, sleep disorders, and dissociative disorders.
b. Symptoms include chronic pain, migraines, anxiety, irritability, anger, self risk
behavior, threatening behavior, and changes in functioning.
e. Identify 3 medications used in the treatment of PTSD (classification, brand and generic
name, indication, dosages)
a. Sertraline
a. Classification: SSRI/antidepressant
b. Brand name: Zoloft
c. Indication: major depression, PTSD, obsessive-compulsive disorder, social
anxiety disorder, panic disorder, separation anxiety disorder,
premenstrual dysphoric disorder
d. Dosages: 25-50 mg/day – can increase to a maximum of 200 mg/day
b. Paroxetine
a. Classification: SSRI/antidepressant
b. Brand name: Paxil, Paxil CR, Brisdelle, Pexeva
c. Indication: major depressive disorder, Obsessive compulsive disorder,
panic disorder, generalized anxiety disorder, PTSD, premenstrual
disorders, social anxiety disorder
d. Dosages: 20 mg/day – if no improvement can be increased by 10 mg/day
weekly until desired response – maximum of 50 mg/day
c. Venlafaxine
a. Classification: second generation SNRI/ antidepressant
b. Brand name: Effexor, Effexor XR
c. Indication: Prevention/treatment of major depression, to treat
depression at end of life; Long-term treatment of generalized anxiety
disorder, panic disorder, social anxiety disorder
d. Dosages: 75 mg/day in 2 or 3 divided doses – may be increased to 150
mg/day – maximum of 225 mg/day
f. Name 3 nursing diagnoses that might apply to someone with PTSD
a. Ineffective coping
b. Risk for self- or other-directed violence
c. Anxiety
Post Conference
1. Overall Mental Status Exam: appearance, attitude, speech, mood, thought process &
content, orientation, cognition, insight
1. Appearance – direct eye contact, she was tense
2. Attitude – she was guarded
3. Speech – no issues with speech
4. Mood and thought process – stable mood and a full affect
5. Thought process and content– no presence of thought disturbances, obsessive
thoughts
6. Orientation – alert and oriented times 4
7. Cognition – intact
8. Insight – full awareness of illness and was willing to seek treatment
2. Psychosocial and medical history (review any orders, meds, labs, etc.)
3. Suicide assessment and prevention: what did she say? how did you respond?
1. She
4. Use of education and empathy (describe 2 of each)
5. Anxiety: nursing interventions, treatment options, clinical picture
6. PTSD: nursing interventions, treatment options, clinical picture
7. Identify 3 priority nursing diagnoses for this patient
8. Medications: what is she on, how much, and for how long; are they working?
9. What to include in aftercare plan and discharge teaching
10. Therapeutic communication: 3 challenges and solutions (what 3 specific techniques did
you use?)