Captone PTSD

8/17/2019 Captone PTSD

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Post-Traumatic StressDisorder

Katherine CaseyNURS 360 PMHProfessor Chat


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Patient Data

44 year old female

5’8”, 196 lbs, !" #9$8, %&er'ei()t

*e(al status !+4

"ncome as)ier and recei&es SS"

.ood / 0uid intae 1223 of meals, 1223 of liuids

ladder / bo'el status ontinent

Slee attern

&( 5 )ours total7ni()t

Diculty fallin( aslee and )as been 'ain( u more freuentlylately d7t increased ni()tmares

&( 2 min-1 )our disrution

2-# nas7day, a&( 12-2 min, afternoon


3/30

:eason for +ositali;ationPatient told )er syc)iatrist s)e )ad an

increased desire to slit )er roerty mana(er’st)roat and 'anted t)e olice to s)oot )erafter'ards so s)e could (o to )ea&en$

rran(ements 'ere made to )a&e atient !+4to


4/30

Patient’s descrition of

illness7issuesPatient )as felt increasin(ly deressed o&er t)e

last mont) after bein( se=ually )arassed andt)reatened by )er roerty mana(er$

:eorts )yer&i(illance, increased ni()tmares,

an=iety, and deressed mood$

ecame si(ni>cantly into=icated one ni()t andaccidentally called )er roerty mana(er instead

of anot)er man to come to )er lace to )a&eintercourse 'it) )er$

T)e ne=t day, t)e atient reali;ed ')at )adoccurred and felt se=ually &iolated$


5/30

Patient’s descrition ofillness7issues continued

Since t)e incident, t)e atient reorted )erroerty mana(er )as been se=ually )arassin()er and continuin( to inaroriately touc))er$

S)e informed ot)er eole in t)eir comle=about t)e situation, ')ic) e&entually (ot bacto )im$

+e t)en t)reatened )er to ee uiet and s)ereorted bein( afraid )e 'ill brea into )er)ome and )urt )er$

S)e 'ants to mo&e out, but is unable to do sodue to >nancial roblems$


6/30

Patient’s descrition of

illness7issues continuedPatient also su?ers from multile incidents of

se=ual abuse startin( at a(e 12$

ttemted to o&erdose on cocaine, but failedat a(e #2$

%lder sister recently assed a'ay a year a(o,')ic) is addin( to )er 'orsenin( deression$


7/30

=is=is 1 PTSD, !DD, Polysubstance buse,

n=iety Disorder

=is # @o dia(noses or conditions

=is D! Tye 1, +T@, le(ally blind

=is 4 Strained relations)i 'it) family,>nancial roblems, dru(->llednei()bor)ood7comle=, sister assed a'ay ayear a(o

=is 5 52-41 Suicidal and )omicidal ideation


8/30

DS! A for PTSD

A. Exposure to actua or threatene!!eath" serious in#ury" or sexua$ioence in one %or &ore' of thefoo(in) (ays*

+. ,irecty experiencin) thetrau&atic e$ent%s'.

-. itnessin)" in person" the

e$ent%s' as it occurre! to others.

3. /earnin) that the trau&atice$ent%s' occurre! to a cosefa&iy &e&er or cose frien!. 1ncases of actua or threatene!

!eath of a fa&iy &e&er orfrien!" the e$ent%s' &ust ha$eeen $ioent or acci!enta.

2. Experiencin) repeate! or extre&eexposure to a$ersi$e !etais ofthe trau&atic e$ent%s' %e.)." rst

respon!ers coectin) hu&anre&ains4 poice o5cers

Patients S7S

1$ Patient )as

e=eriencedmultile traumatice&ents >rst )andBse=ual abuse, rae,recent t)reat by )erroerty mana(erC$


9/30

DS! A for PTSD ontinued8. Presence of one %or &ore' of thefoo(in) intrusion sy&pto&s associate!(ith the trau&atic e$ent%s'" e)innin)after the trau&atic e$ent%s' occurre!*

+. Recurrent" in$ountary" an! intrusi$e!istressin) &e&ories of the trau&atice$ent%s'.

-. Recurrent !istressin) !rea&s in (hich thecontent an!9or a:ect of the !rea& arereate! to the trau&atic e$ent%s'.

3. ,issociati$e reactions %e.)." ;ashac


10/30

DS! A for PTSD ontinued

C. Persistent a$oi!ance of sti&ui

associate! (ith the trau&atice$ent%s'" e)innin) after thetrau&atic e$ent%s' occurre!" ase$i!ence! y one or oth of thefoo(in)*

+. A$oi!ance of or e:orts to a$oi!!istressin) &e&ories" thou)hts"or feein)s aout or coseyassociate! (ith the trau&atice$ent%s'.

-. A$oi!ance of or e:orts to a$oi!

externa re&in!ers %peope"paces" con$ersations" acti$ities"o#ects" situations' that arouse!istressin) &e&ories" thou)hts"or feein)s aout or coseyassociate! (ith the trau&atic

e$ent%s'.

Patients S7S

#$ Patient a&oids7triesto a&oid all of )er

re&ious se=ualabusers as 'ell as t)elaces )er traumatice&ents too lace$


11/30

DS! A for PTSD ontinued,. Ne)ati$e aterations in co)nitions an!&oo! association (ith the trau&atic e$ent%s'"

e)innin) or (orsenin) after the trau&atice$ent%s' occurre!" as e$i!ence! y t(o %or&ore' of the foo(in)*

+. 1naiity to re&e&er an i&portant aspect ofthe trau&atic e$ent%s' %typicay !ue to!issociati$e a&nesia'.

-. Persistent an! exa))erate! ne)ati$e eiefs or

expectations aout onesef" others" or the(or! %e.)." ?1 a& a!"@ ?No one can etruste!"@ ?he (or! is co&petey!an)erous@'.

3. Persistent" !istorte! co)nitions aout thecause or conseBuences of the trau&atice$ent%s' that ea! the in!i$i!ua to a&ehi&sef9hersef or others.

2. Persistent ne)ati$e e&otiona state %e.)." fear"horror" an)er" )uit" or sha&e'.

>. Mar


12/30

DS! A for PTSD ontinuedE. Mar


13/30

DS! A for !DDA. i$e or &ore of the foo(in) sy&pto&s ha$eeen presente! !urin) the sa&e -(ee< perio!

an! represente! a chan)e fro& pre$iousfunctionin)* at east one of the sy&pto&s iseither %+' !epresse! &oo! or %-' oss of interestor peasure.+. ,epresse! &oo! &ost of the !ay" neary

e$ery !ay" as in!icate! y either su#ecti$ereport or oser$ations &a!e y others.

-. Mar


14/30

DS! A for !DD ontinued8. he sy&pto&s cause cinicaysi)nicant !istress or i&pair&entin socia" occupationa" or otheri&pair&ent areas of function.

C. he episo!e is not attriute tothe physioo)ica e:ects of a

sustance or to another &e!icacon!ition.

,. he occurrence of the &a#or!epression episo!e is not etterexpaine! y schi=oa:ecti$e!isor!er" schi=ophrenia"schi=ophenifor& !isor!er"!eusiona !isor!er" or otherspecie! an! unspecie!schi=ophrenia spectru& an! other

psychotic !isor!ers.

Patients S7S

$ Patient )as

e=ressed diculty infunctionin( at 'or$

$ Patient’ssymtoms are not r7tto a substance or

medication condition$

D$ Patient )as ne&er)ad a manic eisodeor )yomaniceisode$


15/30

=is """ onditions

+. ,M ype + Exercise 30 &in a !ay 2 !ays out of the (ee


16/30

!edications1$ Cona=epa& %Konopin' +.> &) once !aiy 8en=o!ia=epines" ar)et Sx* Anxiety

Reco&&en!e! ran)e* + &)9!ay %&ay reBuire up to 2 &)9!ay' Hi)h Current SE* ,ro(siness" se!ation

-. ,uoxetine %Cy&ata' 60 &) once !aiy SNR1" ar)et Sx* ,epression Reco&&en!e! ran)e* 2060 &)9!aiy Max Current SE* Iccasiona nausea

3. /e$othyroxine +>0 &c) once !aiy hyroi! Preparations" ar)et* Hypothyroi!is& Reco&&en!e! ran)e* D>+-> &c)9!ay %+.> &c)9. Pra=osin + &) once !aiy Peripheray Actin) Antia!rener)ics9Antihypertensi$es Reco&&en!e! ran)e* + &) once !aiy Me!iu& Current SE* Iccasiona !i==iness9orthostatic hypotension


17/30

!edications ontinued6' ria&terene9Hy!rochorothia=i!e D>9>0 &) once !aiy

,iuretics" ar)et Sx* HN

Reco&&en!e! ran)e*

ria&terene* +00 &) t(ice !aiy" o(er !oses in co&o pro!ucts

Hy!rochorothia=i!e* +-.>+00 &)9!ay in +- !i$i!e! !oses %not to excee!

>0 &)9!ay'

Max

Current SE* None

C 1nsuin NPH9Re)uar Hu&an Rec %No$o/1N D0930' 1n# >> units efore rea


18/30

*abs!P, '7 di?erential, and urine screenin(

bnormal *abs

G ount B$82-12$82=12BC7u*C H 1#$54 +i()

bs @eutro)ils B1$56-6$#2=12BC7u*C H 8$26 +i()

Dru( Screenin( .indin(s

@e(ati&e for ** dru(s Bet)anol, am)etamines,barbiturates, ben;odia;eines, cocaine,met)adone, oiates, o=ycodone7o=ymor)one,PP7P)encyclidine, and T+C

Elucose :eadin(s B@: I 2-99 m(7d*C

61 *o' B17#9716 P!C

3D /o( B17#9716 41# P!C

#29 +i() B17#9716 514 P!C


19/30

!ental Status J=am 8eha$ior*

,resse!* Patient !resse! in cean hospita top an! pants an! is

(earin) o(n sippers. Hair is neaty tie! in a rai!.

Motor 8eha$ior* Patient exhiits no unusua physica &o$e&ents. Seep Pattern* Patient )ets approxi&atey > hours seep tota per

ni)ht an! reports (a


20/30

!SJ ontinued Sensoriu&*

Recent Me&ory* 1ntact ae patient ein) ae to reca (hat she ate for

rea


21/30

!ore bout t)e Patient

Spirituaity* Cathoic

Consi!erations r9t ethnicity or rei)ion* No consi!erations

Stren)ths* S&art" outspo


22/30

De&elomental *e&el

BJrisonCAccor!in) to patients a)e" she shou! e in the

Fenerati$ity $s. Sta)nation sta)e. A!uts achie$e)enerati$ity y creatin)9nurturin) thin)s that (i outast

the&" )i$in) ac< to society" an! !oin) thin)s thatenet future )enerations. his is !one throu)h raisin)their chi!ren" ein) pro!ucti$e at (or


23/30

P bl i + it l T


24/30

Problems in +osital T=Plan

1$ +arm re&ention

#$ !ood stabili;ation

$ !edical otimi;ation

Disc)ar(e Plan

• "nitiate follo' u assessment after disc)ar(e• ontinue to )a&e atient see social 'orer

@ursin( "nter&entions Performed• 11 to assess mental status• T! H 9, !oderate :is Precautions• urns Deression )eclist H #8, !oderate Deression


25/30

Prioriti;ed Patient @eeds+. P* Ris< for suici!e

E* Patient has $erai=e! an increase! !esire to sit her property &ana)ersthroat an! (ants the poice to shoot her after(ar!s so she can )o to hea$en.

S* Encoura)e patient to ta< aout her feein)s" continue to &onitor patientssuici!a i!eation !aiy" as< the patient to a)ree to si)n a nosuici!e contract or$era nosuici!e contract" initiate onetoone super$ision aroun! the coc


26/30

Prioriti;ed Patient @eedsontinued

3. P* Moo! staii=ation

E* Patient reporte! increasin)y (orsenin) sy&pto&s of PS, an! M,, o$er thepast &onth as e$i!ence! y hyper$i)iance" increase! ni)ht&ares" anxiety" an!!epresse! &oo!.

S* Encoura)e patient to ta< aout her feein)s" a!&inister sche!ue!anti!epressant an! antianxiety &e!ications" pro$i!e patient teachin) on the!i:erent reaxation techniBues an! ho( to perfor& the& %!eep reathin)"&e!itation" pro)ressi$e &usce reaxation'" instruct patient to en)a)e in 30&inutes of exercise9!ay for 3> !ays9(ee< to assist (ith &oo! i&pro$e&ent"e!ucate patient on the i&portance of )ettin) a!eBuate seep" an! encoura)epatient to expore other types of therapies" such as )roup an! fa&iy therapy" tohep i&pro$e her sy&pto&s of PS,.

2. P* 1ne:ecti$e copin)

E* Patient expresse! she uses acoho to cope (ith her feein)s of stress an!!epression at ti&es.

S* Encoura)e patient to ta< aout her feein)s (hen she !e$eops feein)s of

stress an! !epression" assess pre$iousy use! copin) &echanis&s y the patient inthe past" pro$i!e patient teachin) on the !i:erent reaxation techniBues an! ho(

harass&ent ae pt $erai=in) she


27/30

harass&ent ae pt $erai=in) she(ants to sit her property&ana)ers throat an! ha$e thecops shoot her after(ar!s.

S )oa Patient 'ill reort a decrease in )er suicidal ideation incomarison to ')en s)e 'as >rst admitted durin( my s)ift$

/ )oa Patient 'ill e=)ibit no suicidal ideation uon disc)ar(e$

"nter&entions

1C Pro&ide a safe en&ironment$

:ationale Suicide recautions are used to re&ent t)e atient from

actin( on sudden self-destructi&e imulses$ T)ese measures includeremo&in( otentially )armful obKects, suc) as electrical aliances,

s)ar instruments, belts and ties, (lass items, and medicationsBEulanic / !yers, #214, 18C$

J&aluation Safe en&ironment 'as ro&ided and otentially )armful

obKects remained out of atient’s reac)$


28/30

@ursin( are Plan

ontinued#C Pro&ide close atient suer&ision by maintainin( obser&ation or a'areness of t)eatient at all times$

:ationale T)e de(ree of suer&ision is de>ned by t)e de(ree of ris$ Suicide may be animulsi&e act 'it) little or no 'arnin( BEulanic / !yers, #214, 18C$

J&aluation %ne-to-one suer&ision 'as ro&ided and atient’s location 'as no'n at alltimes durin( my s)ift$

C Pro&ide oortunities for t)e atient to e=ress concerns, fears, feelin(s, ande=ectations in a nonKud(mental en&ironment$

:ationale T)e atient bene>ts from talin( about suicide t)ou()ts 'it) trusted sta?$Patients need t)e oortunity to discuss suicidal t)ou()ts and intentions to )armt)emsel&es$ Aerbali;ation of t)ese feelin(s may lessen t)eir intensity$ Patients also needto see t)at sta? members are oen to discussion of suicidal t)ou()ts BEulanic / !yers,#214, 18C$

J&aluation Patient 'as encoura(ed to discuss )er feelin(s of suicide oenly$ Patient&erbali;ed s)e 'ants to slit )er mana(er’s t)roat and )a&e t)e cos s)oot )er after'ardsso s)e can (o to )ea&en already$ Patient &erbali;ed s)e currently did not )a&e t)ou()tsof committin( suicide or self-)arm ')ile in t)e )osital durin( my s)ift$


29/30

@ursin( are Plan

ontinued

4C "nstruct t)e atient in t)e aroriate use of medicationsto facilitate )is or )er ability to coe$

:ationale Dru( t)eray may )el t)e atient mana(e underlyin()ealt) roblems suc) as deression BEulanic / !yers, #214,188C$

J&aluation Patient teac)in( 'as ro&ided on )er currentsc)eduled medication Dulo=etine BymbaltaC in re(ards to t)is

medication bein( used for t)e treatment of deression, t)eimortance of bein( med comliant, and t)at it may tae se&eral'ees or more for t)e medication’s full e?ects to ic in$


30/30

Lournal rticleMT)e Pre&alence of !ental +ealt) Disorders in a ommunity Samle of

.emale Aictims of "ntimate Partner Aiolence”

Study e=amined re&alence of PTSD, deression, and substance abuse

disorders in female &ictims of intimate artner &iolence B"PAC$

:esults s)o'ed 5$43 of t)e o&erall samle met criteria for PTSD, 56$43met criteria for deression, t)e rate of alco)ol deendence 'as 18$13,alco)ol abuse 'as $#3, substance deendence 'as 6$43, and substanceabuse 'as 6$43$

T)e more se&ere t)e )ysical, se=ual, or syc)olo(ical intimate artner&iolence 'as, t)e more se&ere and intense t)ose 'omen’s symtoms 'ere$

:esearc) also s)o's t)at &ictims of "PA are more liely to en(a(e insubstance use in an attemt to coe 'it) t)eir deression and trauma-related symtoms$

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Captone PTSD