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Post-Traumatic Stress Disorder (PTSD) Nursing Guide

Writer: Edward Bartels, RN, BSN, MICN

PTSD Overview

This course is intended as a Quick Reference for post-traumatic stress disorder and will cover an overview as well as nursing considerations utilizing the nursing process.

PTSD ICD-10 Code: F43.1

Etiology and Epidemiology 

PTSD Definition

Post-traumatic stress disorder or PTSD, is a condition that presents disabling psychological and physiological effects because of exposure to traumatic events. Common forms of trauma which may lead to PTSD include: 

  • Personal life-threatening event 
  • Law enforcement or combat operations 
  • Unexpected death of a loved one 
  • Severe injury or illness to a loved one 
  • Sexual assault 
  • Physical assault by a partner or caregiver 

PTSD can result in significant impairment to an individual’s functional and cognitive wellness. Prevention of long-term effects and worsening debilitation requires early diagnosis and treatment. Although the actual pathophysiologic genesis of PTSD is primarily unknown, studies are suggestive that PTSD may parallel several neurotransmitter disruptions including (DynaMed, n.d.): 

  • Hypothalamic-pituitary-adrenal axis 
  • Endocannabinoid system 
  • Noradrenergic/norepinephrine system 
  • Serotonergic system 
  • Opioid system 
  • Glutamatergic system 
  • GABAergic system 

Individuals at any age may be impacted by an event leading to PTSD. In the U.S., PTSD is twice as common in woman than men (DynaMed, n.d.). In the U.S. and Europe, the lifetime prevalence within the general population runs from 5% to 10% (Mann & Marwaha, 2021). 

Lifetime Prevalence estimates are typically higher in: 

  • Veterans of combat 
  • Survivors of severe disasters 

Long standing wars of many years has resulted in PTSD rates amongst military veterans to rise markedly and steadily. 

Risk factors for PTSD include: 

  • Gender 
  • Personal near-death experience 
  • Physical injury or disfigurement from a traumatic event 
  • Surviving a severe disaster either natural or man made 
  • Surviving direct trauma: 
    • Sexual 
    • Physical 
    • Torture 
  • Child abuse 
  • Poor support systems following a trauma 
  • Comorbidity of life stressors present during severe trauma 
  • Preexisting behavioral health issues 
  • Maladaptive trauma response 
  • Peripartum maternal morbidity 
  • Racial, cultural, and ethnic factors 

PTSD Diagnosis 

Diagnosis of PTSD requires a detailed history with specific attention given to the severity and nature of any traumatic circumstances or events. Clinicians must be aware of the potential that a person may withhold all or part of the event. Inquiries should be made about: 

  • Depressive or anxiety symptoms 
  • Suicidal ideation or previous attempts 
  • Substance abuse 
  • Access to firearms 

Children and teens may also experience stress induced PTSD. Teens will typically have symptoms similar to or variations of those seen in adults. Children however, particularly those less than 6 years of age may demonstrate (National Institute of Mental Health, 2019): 

  • A return to bed wetting 
  • Inability to or forgetting how to converse 
  • Acting out the precipitating event at playtime 
  • Separation anxiety 

PTSD is listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders used by behavioral health specialist (Mann & Marwaha, 2021). Diagnostic criteria from this source include: 

  • Criterion A: Stressor exposure: 
    • Direct exposure 
    • Witnessed 
    • Leaned about 
    • Indirect exposure 
  • Criterion B: Intrusion symptoms: 
    • Recurrent, involuntary, or intrusive thoughts 
    • Nightmares 
    • Dissociative reactions and flashbacks 
    • Prolonged exposure through reminders 
    • Vital sign changes 
  • Criterion C: Avoidance efforts: 
    • Memories and thoughts 
    • People, places, or activities 
  • Criterion D: Negative alterations in mood: 
    • Inability to recall the events 
    • Distorted or negative beliefs 
    • Distorted cognition 
    • Persistent fear, guilt, shame, or anger 
    • Loss of interest in previously enjoyable activates 
    • Alienation, estranged, and detached from others 
  • Criterion E: Alterations in arousal and reactivity: 
    • Increased irritability with outbursts 
    • Self-destructive behaviors 
    • Hypervigilance 
    • Difficulty concentrating 
    • Sleep disturbances 
  • Criterion F: Duration: 
    • Persistence of symptoms in criterions B, C, D, and E greater than 1 month 
  • Criterion G: Functional impairment in life areas 
  • Criterion H: Disturbance not related to substance abuse, meds, or medical illness 

Management & Treatment of PTSD

Medications and psychotherapy provide the main avenues for PTSD treatment and management. Everyone reacts in their own way to traumatic events. Developing treatment strategies must take this into consideration. Additionally, individuals suffering from PTSD may have other previous and on-going problems which may impact or exacerbate PTSD and require concomitant treatment consideration for: 

  • Panic disorder 
  • Depression 
  • Anxiety 
  • Substance abuse 
  • Suicidal feelings 
  • Ongoing abusive relationship 

Medications to consider: 

  • Sertraline (Zoloft®) 
  • Paroxetine (Paxil®, Peeve®) 
  • Clonidine (Catapres®) 
  • Prazosin (Minipress®) 
  • Trazodone (Desyrel®) 
  • Risperadone (Risperadol®) 

Psychotherapeutic management focuses on: 

  • Exposure therapy: 
    • Helps one face their fears using imaging, writing, or revisiting the traumatic scene. 
  • Cognitive restructuring
    • Provides meaning to bad memories and brings a sense of realism to the circumstances. 

PTSD Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for Post- Traumatic Stress Disorder disease are listed below. 

Assessment 

Subjective data: 

  • Ease of agitation and irritation 
  • Nightmares and other sleeping issues 
  • Loss of interest in previously enjoyed activities 
  • Reporting feeling emotionally numb 
  • Startles or frightens easily 
  • Outbursts of anger and swings in mood 
  • Difficulty communicating 
  • Difficulty with interpersonal relationships 
  • Memory loss 

Objective data: 

  • New onset drug or alcohol use 
  • Suicidal or homicidal ideation 
  • Behaviors that are self-destructive or mutilating 

Nursing Diagnosis/Risk For 

  • Anxiety related to actual or perceived threat as evidenced by: 
    • Decreased attention span 
    • Hypervigilance 
    • Poor impulse control 
    • Feelings of hopelessness 
    • Apprehension 
    • Discomfort 
  • Fear related to physiological and cognitive symptoms of panic as evidenced by: 
    • Inability to cope 
    • Hypervigilance 
    • Startling or frightening easily 
  • Ineffective coping related to obsessive thinking as evidenced by: 
    • Inability to meet basic needs 
    • Confused role expectations 
    • Disordered problem solving 

Interventions 

  • Assess vitals 
  • Nursing assessment 
  • Assess for suicidal or homicidal ideations 
  • Check anxiety levels 
  • Establish a trusting relationship: 
    • Listen well 
    • Remain calm 
    • Allow extra time to answer questions 
    • Promote a safe environment 
  • Encourage open expression 
  • Help identify ineffective coping strategies in use 
  • Encourage journaling to record stressors and emotional reactions 
  • Teach visualization and relaxation techniques 
  • Administer medications as ordered 
  • Facilitate access to support resources 
  • Offer teaching to individual and family 
  • Refer to behavior/mental health professional 

Expected Outcomes 

  • Identifies triggers 
  • Utilizes positive coping strategies 
  • Demonstrates control of emotions and relaxation techniques 
  • Remains free from injury 

Individual/Caregiver Education 

  • Diagnosis and treatments 
  • Recognition of symptom progression 
  • Support resources available 
  • Take medicine as directed 
  • Report any medication side effects 
  • Call the provider or seek medical care if: 
    • There are questions or concerns about the condition or care 
  • Recommended follow-up with healthcare provider/behavior health professional 

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

Course Contributor 

The content for this course was created by Edward Bartels, RN, BSN, MICN. Ed has over 30 years of clinical and teaching experience, and his areas of expertise are emergency and critical care, skilled nursing, behavioral health, occupational health, and safety, and home care. Ed served in several senior nursing leadership roles including: Emergency Services Director, Physician Practices Director, and Administrative Director of Nursing at the executive level. Ed is certified in LEAN efficiency fundamentals and tactics, which he has successfully deployed over the years in multiple settings resulting in cost savings, improved quality, and patient safety. Ed is a certified clinical nursing instructor in North Carolina. He earned his Diploma in Nursing from St. Vincent's School of Nursing in Staten Island, New York, in 1990 and Bachelor of Science in Nursing from the University of North Carolina, Greensboro in 2006. Ed is retired from the U.S. Coast Guard with 34 years. 

Resources 

References 

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