Post on 01-Jan-2016
Chapter 16
Trauma, Stressor-related, and
Dissociative Disorders
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Clinical Picture Posttraumatic stress disorder in preschool children Reactive attachment disorder Disinhibited social engagement disorder
Trauma-Related Disorders in Children
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Epidemiology Comorbidity Biological factors
Genetic Neurobiological
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Trauma-related Disorders in Children (Cont.)
Psychological factors Attachment theory
Environmental factors Cultural considerations
Trauma-related Disorders in Children (Cont.)
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Assessment Developmental assessment
Nursing diagnoses Outcomes identification Implementation
Application of the Nursing Process
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A child has been traumatized by a history of violence. The nurse plans to assess the child’s mental health.
What are some things that should be assessed?
Case Study
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Interventions Advanced practice interventions Psychopharmacology Evaluation
Application of the Nursing Process (Cont.)
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What are some interventions the nurse could use with this child who has been traumatized?
Case Study (Cont.)
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Posttraumatic stress disorder (PTSD) Re-experiencing of the trauma Avoidance of stimuli associated with trauma Persistent symptoms of increased arousal Alterations in mood
Trauma-Related Disordersin Adults
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Adjustment disorder Precipitated by stressful event Debilitating cognitive, emotional, and behavioral
symptoms that negatively impact normal functioning Responses to stressful event may include
combinations of depression, anxiety, and conduct disturbances
Trauma-Related Disordersin Adults (Cont.)
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Epidemiology Comorbidity Psychological factors
Polyvagal theory
Trauma-Related Disordersin Adults (Cont.)
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Occur after significant adverse experiences/traumas
Individuals respond to stress with severe interruption of consciousness
Unconscious defense mechanism Protects individual against overwhelming anxiety
through emotional separation
Dissociative Disorders
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Depersonalization/derealization disorder Dissociative amnesia Dissociative identity disorder
Dissociative Disorders (Cont.)
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Epidemiology Comorbidity Etiology Biological factors
Genetic Neurobiological
Dissociative Disorders (Cont.)
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Psychological factors Environmental factors Cultural considerations
Dissociative Disorders (Cont.)
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Depersonalization—focus on self Derealization—focus on outside world
Depersonalization/Derealization Disorder
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Inability to recall important personal information Often of traumatic or stressful nature
Dissociative fugue
Dissociative Amnesia
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Presence of two or more distinct personality states
Each alternate personality (alter) has own pattern of Perceiving Relating to and Thinking about the self and environment
Dissociative Identity Disorder
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History Moods Impact on patient and family Suicide risk Self-assessment
Dissociative Disorders Assessment
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Interventions Psychoeducation Pharmacological interventions
Advanced practice interventions Somatic therapy
Evaluation
Dissociative DisordersImplementation
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1. A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient’s history?
A. Travel to a foreign country
B. Physical or sexual abuse
C. Thyroid dysfunction
D. Eating disorder
Audience Response Questions
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