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Megan Bruhn

on 24 November 2014

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Transcript of MILITARY NEWS

I - V
GAF Score = 42
After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.
The Axis
Diagnosis Criteria
Global Assessment of Functioning
Exposure to traumatic event-Client has had exposure to an extreme traumatic stressor where he was injured and members of his unit killed.

Exhibiting fear and agitation to others that are trying to help him.

Recurrent distressing dreams or recollection of events- Client is unable to sleep and wakes in a panic.
Experiencing increased arousal prowling in yard and difficulty sleeping.

Experiencing hypervigilance, telling the nurse he believes someone is in his home.
Monday, November 24, 2014
Vol XCIII, No. 311
Signs & Symptoms
PTSD: The War Within
Serious symptoms OR serious impairment in one of the following: social, occupational, or school functioning. "
Reliving the event

Avoiding situations

Negative changes in values and beliefs
disinterest in activities, shame, guilt, fear

jittery or always alert
Occurs after a traumatic event

War exposure
Sexual/physical abuse or assault
Serious accident (MVA)
Natural disasters
Axis I: PTSD
Axis II: None
Axis III: Neurological r/t head injury and insomnia
Axis IV: Exposure to war and death, lack of support
Axis V: 42
Case Study:
Adam is a 25 year old Iraq war veteran who returned to the United States after sustaining a head injury while on patrol by a road side bomb. Several members of his unit were killed. A neighbor called the police because of “odd” behavior and reports that he has seen Adam in his fatigues prowling around the yard. Adam is brought to the ER where he is highly agitated and yelling that everybody must get out. The ER physician orders some medication to help Adam calm down and after some time Adam is able to tell the Psychiatric Triage Nurse that he has had difficulty sleeping, wakes frequently during the night feeling panic and believes that someone is in his home.
Case Study Evidence for Score:

Prowling around the yard
Highly agitated, yelling that everybody must get out.
Admits difficulty sleeping, waking frequently
Panic and paranoia
Nursing Diagnosis
Anxiety r/t
Exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Psychological stress associated with traumatic event

sleep deprivation from nightmares
Ineffective Coping r/t

Distancing from support

Disinterest in the present

Extreme anxiety

Patient outcomes and Goals/Interventions
Identify anxious feelings

Vocalize feelings about control of anxious feelings

Establish a tolerable anxiety level for 0-5

Recognize ineffective coping strategies

Utilize new effective coping strategies
Provide a calm environment

Develop a trusting and therapeutic relationship

Identify triggers of anxiety

Identify ineffective coping skills

Teach stress relieving skills
guided imagery, meditation,
deep breathing, and journal writing

Develop a support system/refer and encourage use of support groups and therapy sessions

Next Week in: Mental Health Today
"The Life of a Student Nurse"
Written and Edited by:





Prolonged Exposure (PE) Therapy
1. Education
2. Breathing
3. Real World Practice
4. Talking through the trauma
1. Zoloft, Paxil

75-300mg/day (max: 400mg/day)
S/E: >BP/HR, dizziness, somnolence, dry mouth, N&V, sweating
Serious: suicidality
20-60mg/day (max: 80mg/day)
S/E: headache, nausea, anxiety, insomnia, sexual dysfunction
Serious: Serotonin syndrome
7.5-45mg/day (max: 45mg/day)
S/E: anticholinergic (drying!), somnolence, >appetite/weight gain

National Center for PTSD
US Dept. of Veteran Affairs
Max: 20mg/day
S/E: dizziness, fainting, headache, drowsiness, palpitations
Cognitive Behavioral Therapy
"Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress."
(prazosin HCl)
"What cannot be talked about cannot be put to rest. And if it is not, the wounds will fester from generation to generation."
-- Bruno Bettelheim
Full transcript