Episode Details

1. Must-Know Diagnoses & Timeframes

• Acute Stress Disorder (ASD): Develops after a traumatic event; symptoms (reexperiencing, avoidance, hyperarousal) last 3 days to 4 weeks.
• Posttraumatic Stress Disorder (PTSD): Symptoms can be delayed and last >1 month. It is chronic, with symptoms often worsening during stressful periods.
• Adjustment Disorder: Reaction to stressful life events (e.g., financial, work) causing out-of-proportion difficulty coping. Successful adjustment or resolution occurs within 6 months.
• Dissociative Disorders: Subconscious defense mechanisms protecting the emotional self from horrific trauma. Includes Dissociative Amnesia, Dissociative Identity Disorder, and Depersonalization/Derealization.

2. PTSD Core Symptoms & Findings

• Intrusion: Reliving trauma via flashbacks, nightmares, and recurrent intrusive thoughts. In children, this may manifest as repetitive play expressing trauma themes.
• Avoidance: Avoiding people, places, or stimuli associated with the trauma.
• Negative Cognition/Mood: Guilt, self-blame, detachment, and an inability to experience positive emotions.
• Hyperarousal: Insomnia, hypervigilance, irritability, and an exaggerated startle response.

3. Priority Nursing Assessments & Red Flags

• Safety First: The absolute priority is assessing for suicide risk and self-mutilation.
• Comorbidities: High risk for substance/alcohol use disorders (often used to self-medicate or blot out memories) and severe depression.
• Behavioral Red Flags: Flashbacks and dissociative episodes where the patient completely loses touch with present reality.

4. Must-Know Nursing Interventions

• Grounding Techniques: The top priority during a flashback or dissociation. Use sensory input to reorient the patient to the present (e.g., "Do you feel your feet on the floor?", "Can you see me?").
• Physical Safety: NEVER grab or force a patient to move during a flashback; they may strike out defensively. Instead, ask them to change positions or walk to dispel the episode. Use supportive touch only if the patient previously consented.
• Therapeutic Communication: Validate feelings ("I know this is frightening, but you are safe now") and reorient by stating your name, the date, and location.
• Empowerment: Refer to the patient as a "survivor" rather than a "victim" to promote self-esteem, and help them identify a physical "safe place" to go when experiencing destructive thoughts.

5. Must-Know Medications & Therapies

• First-Line Meds: SSRIs (fluoxetine, paroxetine, sertraline) and SNRIs (venlafaxine) are the most effective.
• Targeted Meds: The atypical antipsychotic risperidone effectively targets hyperarousal. Benzodiazepines are widely used clinically but lack evidence of efficacy.
• Therapies: Outpatient therapy is primary. Modalities include Exposure Therapy (facing feared situations), Cognitive Processing Therapy (addressing guilt/self-blame), and Adaptive Disclosure (short-term CBT developed for the military).