PTSD Nursing Diagnosis and Nursing Care Plan

PTSD Nursing Care Plans Diagnosis and Interventions

PTSD NCLEX Review and Nursing Care Plans

It’s not uncommon for people to suffer from post-traumatic stress disorder (PTSD) after experiencing or witnessing a distressing event. As the name implies, PTSD is a condition and a trauma response to a potentially life-threatening event. 

Trauma survivors frequently suffer at first, but with time and good self-care, the vast majority of them are able to recover from their experiences.

PTSD Diagnosis is usually made possible if the symptoms remain for an extended period of time which may persist in months or even years and are usually disruptive to the individual’s normal activities.

Signs and Symptoms of PTSD Post Traumatic Stress Disorder

Symptoms of post-traumatic stress disorder (PTSD) can appear as soon as a month after a stressful experience, but they can also occur years later.

PTSD symptoms can be divided into four categories: intrusive memories, changes in the physical and emotional reactions, avoidance, and unfavorable changes in thinking and attitude.

  • Intrusive memories (e.g., unwanted painful recollections of the trauma, having painful flashbacks, or going over what happened as though it were happening again)
  • Changes in physical and emotional reactions (e.g., prone to being shocked or terrified, always keeping an eye out for potential threats, inability to fall asleep, angry outbursts, irritability, or aggressive conduct,
  • Avoidance (e.g., attempting to keep the terrible experience from coming to mind or being spoken, evading situations and places that bring up memories of the traumatizing experience)
  • Unfavorable changes in thinking and mood (e.g., self-doubt or dissatisfaction with own life or others, memory issues, such as forgetting essential details of the stressful experience, and trouble keeping close relationships)

Anxiety and PTSD

Patients with PTSD commonly suffer from different anxiety levels. Patients with mild anxiety demonstrate minimal to complete absence of physiological symptoms where their vital signs are within the normal range.

The patient comes off as calm and composed but may also detail their emotional states, such as nervousness or the feeling of having “butterflies in the stomach .”

The patient exhibits activeness with energetic facial expressions and tone for moderate anxiety, with occasional feelings of tension. Vital signs are normal or may partially become elevated.

In severe anxiety, the PTSD patient may exhibit increased autonomic nervous system function (e.g., increased vital signs, frequent and urgent urination, diaphoresis, muscle tension, and dry mouth.

The patient may suffer from chest pain and palpitations during this stage due to agitation and irritability. He/she may report feelings of being overwhelmed or overloaded. For the panic level of anxiety, the patient’s external appearance and demeanor reflect this, such as changes in behavior from combativeness to isolation and paleness.

In this stage, the increase in the autonomic nervous system results in the stimulation of the sympathetic neurotransmitter release.

Causes and Risk Factors of PTSD Post-Traumatic Stress Disorder

Stressful events in the patient’s life, including the degree of trauma they’ve experienced, are grounds for PTSD development. Other causes include:

  • Being predisposed to a risk factor including having a family history of mental illness
  • Individuals with temperamental traits
  • Brain activity and response to a traumatic event

These factors will likely determine the risk of developing PTSD after a traumatic event, and these include:

  • Suffering from severe or long-term trauma
  • Impacted mental health or having conditions such as anxiety or depression
  • Working in a career that exposes one to stressful occurrences (e.g., military personnel or first responders)
  • A lack of a strong family and social support system

Diagnosis of PTSD Post Traumatic Stress Disorder

  • Medical history. This is to confirm or identify prior exposure to a traumatic experience.
  • Physiological evaluation
  • Physical examination
  • Make use of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association.

Treatment for PTSD Post Traumatic Stress Disorder

The most common treatment includes the following:

  • Careful management of symptoms
  • Medications
  • Psychotherapy (often known as “talk” therapy) such as:
  • Cognitive therapy – for recognizing problematic cognitive patterns
  • Exposure therapy – helps the patient safely confront circumstances and experiences to acquire appropriate coping
  • Eye movement desensitization and reprocessing

Nursing Diagnosis for PTSD

Nursing Care Plan for PTSD 1

Fear

Nursing Diagnosis: Fear related to perceived threat or danger, secondary to PTSD as evidenced by verbalization of fearful feelings to a situation or condition, agitation, alertness, tension, increased heart and respiratory rate.

Desired Outcome: The patient will demonstrate effective coping behavior.

Nursing Interventions for PTSDRationale
Employing open-ended questions, assess the type of fear as demonstrated by the patient.The use of open-ended questions initiates active listening and promotes the patient’s self-esteem since it gives them a sense of assurance that their concerns are being heard. Furthermore, the patient may have difficulty revealing their fear; hence having someone they could disclose information and feelings to is more helpful and patient-oriented.
Assess the patient’s external presentation of fear.Behavioral and verbal responses are beneficial indicators of fear. Examining the patient’s demeanor or coping strategies may serve as a basis for determining the appropriate intervention and care plan.
Deliberate the patient on the process and current situation. Help him/her identify reality from perceived threats to well-being.To promote assurance and maintain the patient’s ease.  
Assure the patient’s feelings by saying fear is a normal response to a given circumstance and situation (e.g., danger, loss of control, pain, fear, etc.). Empathize with him/her and avoid false reassurances.Being truthful imparts reassurance that fear is within the area of ordinary human experiences. It gives a comprehensible view of fear and solutions to resolve the problem. Empathizing with the patient promotes positive feelings and trust.
Ensure that the patient is accustomed to his/her environment. Give him/her periods of rest while maintaining a relaxing condition.Familiarizing the patient with his/her surroundings endorses comfort and ease, thereby reducing fear. Whereas giving them the periodic time of rest induces relaxation and improves the patient’s well-being. It should be noted that pacing the patient’s activities is necessary to conserve their energy.

Nursing Care Plan for PTSD 2

Anxiety

Nursing Diagnosis: Anxiety related to anticipation of harm, secondary to PTSD as evidenced by increased blood pressure, heart rate, lack of self-control, irrational or erratic behavior, and panic attacks. 

Desired Outcomes:

  • The patient will effectively verbalize feelings of anxiety.
  • The patient will perform relaxation activities to reduce anxiety.
Nursing Interventions for PTSD Rationale
Determine the patient’s anxiety level using Hildegard E. Peplau’s levels of anxiety: mild, moderate, severe, and panic.To obtain a baseline level of anxiety to aid with the planning process.
Assess the relevance of the patient’s cultural view, perspective and consider norms relating to anxiety or his/her view on a stressful situation.To determine the context of anxiety, especially if it is culturally mediated.
Support observations by asking the patient questions relating to his/her state or condition, such as: “Do you feel anxious right now?”Anxiety and its manifestation vary from each person. It is a normal response to external and internal stimuli; hence validating these observed responses is crucial in understanding individualized anxiety.
Assure the patient that he/she is not alone by asserting presence, communication, touch (with permission from the patient), and a positive approach.To provide the patient affirmation and support.  
Verbalize on the need to communicate and encourage the patient to openly express his/her needs, inquiries, clarifications, and questions.To validate the patient’s feelings and promote communication.
Encourage the use of affirmations or positive self-talk such as: “I’m not going to die because of anxiety,” “I can take it one step at a time,” “Right now, I just need to breathe and stretch,” “I don’t have to be flawless.”Psychological treatments focused on altering one’s thinking helps relieve anxiety by replacing negative self-statements with positive ones.

Nursing Care Plan for PTSD 3

Ineffective Coping

Nursing Diagnosis: Ineffective Coping related to a sudden change in status, secondary to PTSD, as evidenced by the inability to cope with reality, incapacity to perform day-to-day tasks, exhaustion, and self-destructive habits, such as binge drinking or use of drugs.

Desired Outcome: The patient will employ efficient coping methods in the event of unexpected events.

Nursing Interventions for PTSD Rationale
Examine the patient’s perceptions of effective coping in light of his/her cultural ideas, norms, and values.Cultural opinions of normal and abnormal coping behavior may influence the patient’s behavior.
Observe the patient for signs of ineffective coping and assess its causes, such as sadness, low self-esteem, a lack of problem-solving abilities, a lack of support, or a recent change in living circumstances.To better grasp the patient’s current circumstances and assist the patient in coping efficiently, situational elements must be addressed.
Communicate compassionately and employ empathetic listening.When the patient’s feelings are acknowledged and understood, it creates a supportive environment that aids in coping.
Demonstrate an attitude of tolerance and understanding. Embody a sense of peace by saying, “I accept you.” Be wary of false pledges.It is critical to have an open line of communication with the patient to build a successful and honest connection. False reassurances do nothing for the patient and only alleviate the care provider’s distress by providing false confidence.
Through continuity of treatment, establish a working connection or relationship with the patient.A long-term partnership or even maintaining a relationship with the patient over time builds trust, lessens feelings of loneliness, and may make it easier to cope.
Promote the patient’s self-awareness relating to his/her positive attributes.Patients may be unable to perceive their strengths when they are in a crisis. Encouraging self-awareness or the patient in recognizing his/her strengths helps arbitrate their assets to good use.
Refer the patient to a therapist.Providing a referral for counseling helps the patient learn to function with the system. It would also allow the patient to acquire problem-solving and coping skills.

Nursing Care Plan for PTSD 4

Insomnia

Nursing Diagnosis: Insomnia related to difficulty maintaining normal sleep, secondary to PTSD as evidenced by sleep deprivation, general exhaustion, weakness, difficulty focusing and recalling information.

Desired Outcome: The patient gets the amount of sleep he/she needs and will appear to have a rested appearance.

Nursing Interventions for PTSD Rationale
Evaluate the patient’s sleeping habits in a typical setting and note the following: the amount of sleep, position, sleep schedule, sleep position, depth, length, and any sleep interruptions.People can have different sleeping patterns. It’s essential to look at these factors to get a basic sense of the patient’s problematic sleeping habits.  
Assess the patient’s understanding of the underlying causes of their sleep issues and discuss possible solutions to make the relief and healing process more attainable.The patient may be able to shed light on the current issues he/she may be experiencing, such as anxiety or fear about a particular situation in life. This information will be used to decide the best course of action for the patient.
Encourage the patient to avoid big meals, coffee or smoking before bedtime and inform them of the proper dietary and fluid intake guidelines.For patients, it is best to avoid eating large meals right before bedtime. Caffeine-rich beverages such as coffee, tea, chocolate, and cola affect the neurological system. This could make it difficult for the patient to unwind and sleep. Similarly, alcohol induces drowsiness and may help one fall asleep more quickly, but it also disrupts the patient’s deep sleep and keeps him/her awake throughout the rapid eye movement (REM) phase.   Allowing the patient to attain a good peaceful rest helps divert negative emotions and feelings during the day.
Encourage the patient to perform relaxing and calming activities (e.g., taking a warm bath or listening to peaceful music) before bedtime.Preparing the mind and body for sleep is made easier by these activities, which offer both relaxation and diversion to patients with insomnia. 

Nursing Care Plan for PTSD 5

Hopelessness

Nursing Diagnosis: Hopelessness related to the inability to control the situation, secondary to PTSD as evidenced by decreased appetite, decreased reactivity to stimuli, a lack of drive, inability to take the initiative, and lack of participation in the treatment or care.

Desired Outcomes:

Nursing Stat Facts
Nursing Stat Facts
  • The patient will actively participate in the care.
  • The patient will demonstrate improved appetite and overall well-being.
  • The patient will verbalize having a sense of hope and control.
Nursing Interventions for PTSD Rationale
Examine the patient’s comprehension of the situation, as well as his/her self-confidence and abilities.The patient tends to believe that the danger is greater than their ability to manage it. Realizing the patient’s understanding of the situation helps identify areas of concern.
Examine the patient’s demeanor, including his/her willingness to eat, sleeping habits, or his/her general well-being and routine.Loss of hope may reveal deviations from the patient’s normal behavior patterns; either the patient may have a reduced energy level, a diminished appetite, or both. Patients may sleep more or suffer from sleeplessness as a result of their treatment.
Encourage the patient to have a good mental attitude, dissuade negativity, and prepare him/her for unpleasant or unexpected outcomes.A shift in the patient’s typical behavior may worry their family. Attaining the essential information and data on the patient’s current situation helps relieve their worry that information is being kept from them.
Assist the patient in evaluating his/her options and setting attainable goals.To re-establish a sense of hope in the patient, goals should be mutually agreed upon to ensure that they are attainable.
Recommend self-help groups to the patientThese organizations or self-help groups foster a sense of belonging. It allows the patient to recognize the support of others, thereby increasing his/her hope and self-esteem.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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