PTSD: Signs and Symptoms (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:02 So, what are we going to see? Those are all the signs and symptoms that we end up seeing.

    00:09 But we want to think specifically, when you're interviewing your patient.

    00:15 What do you think you're going to hear from them? Well, one is they may tell you that they have some flashbacks, that they have nightmares.

    00:23 That they wake up in a sweat because that nightmare seems so real to them.

    00:31 They might say, "I suffer from panic attacks, I can't go over a bridge.

    00:35 I don't know why I can't go to the bridge.

    00:38 But I get to the bridge and I can't progress." I had a patient who we really had to work on her being able to go over a bridge related to her childhood trauma that was attached to traversing a bridge.

    00:55 Some may develop eating disorders, because remember, they have that sense of shame, and worthlessness.

    01:03 And therefore, if I could just disappear, if I could just starve myself to death, then this would all be okay. Nobody needs to know.

    01:14 Or if I eat and eat and eat, and I become enormous, nobody will want me, and I'll be safe.

    01:24 We have to remember that if we're seeing in children, these kind of anxieties, if we're seeing in children nightmares, we also might see some delays, developmental and cognitive delays.

    01:40 And with an inability to verbalize certain things, or even to recall some things that have occurred to them.

    01:53 The trauma survivors, many of them also might be encountering this idea of, let me self-medicate.

    02:01 Self-medication will make me feel better.

    02:04 And so substance use become substance abuse.

    02:09 And that is their attempt to eliminate the negative effects of PTSD without the understanding that they are now stepping into substance use disorders.

    02:23 One of the other things that I have noticed is when a patient is unable to say something, they are unable to tell me something.

    02:35 And I will ask them, so where do you feel that? And oftentimes, they'll say, "I feel it in my throat." And I'll ask them, "So what do you feel in your throat? Let's close our eyes just for a minute, and drop into the throat and describe to me what you see." By doing that I'm actually putting them present here now.

    02:59 Having them be with me talking to me, going into their prefrontal cortex, finding adjectives to describe what the feelings are, focusing on their throat, rather than on the memory, and being able to know that they are able to calm themselves, and they are able to remove, oftentimes, it's a boulder in their throat.

    03:24 And understand through therapy, that when they were children and powerless, opening their mouth and saying something about something could actually cause them more trauma, and they learn to not talk.

    03:39 They learned to not tell anybody, anything.

    03:43 Their throat, their body remembers, don't talk.

    03:49 But as an adult, we have to teach them new skills, and talking is no longer prohibited.

    03:58 So what are the signs and symptoms that we're looking at? One sign is when we see that they are becoming numbed, or they are dissociating.

    04:08 while they're telling us about experiences.

    04:12 We have to be really listening.

    04:15 Listening with our eyes as well as our ears, to their whole body response, to the story that they're telling us.

    04:25 If they suddenly start feeling sad and depressed while they're talking.

    04:30 If we noticed...

    04:33 that suddenly they're breathing more rapidly, that they seem to lose some color in their face, that they complain a little numbness and tingling and hard time breathing.

    04:46 If we know that they don't have asthma.

    04:48 They don't have lung disease, and they don't have a history of an MI, it maybe a panic attack.

    04:55 And we can ask them, "How does this feel to you? Does this feel like it anything you've experienced before? If it's a person who has trauma, they will say, "Oh yes, this is a panic attack." That's what I'm having.

    05:09 And you have the right to ask them.

    05:11 "So what exactly have you done in the past that has helped you to move through this? We will also hear them tell us about nightmares.

    05:23 It is not unusual for a person who has experienced trauma, to have that memory reactivated during sleep, and they will have nightmares.

    05:33 If you are a person who has ever experienced nightmares, you also may understand where the insomnia is coming from.

    05:42 They have a hyperactive fear.

    05:45 And that fear makes it very dangerous for them to be sleeping.

    05:51 Because even in sleep, they cannot avoid that level of trauma.

    05:58 What other symptoms do we see? Well, they may have intrusive or unwanted memories.

    06:04 And what do we mean by intrusive? Intrusive memories are the person who was in an abusive marriage who was invited to a wedding.

    06:14 They think everything is going to be fine.

    06:17 And then as they get out of their car to go into the place of marriage, they suddenly have these memories of the abuse they suffered as a married person.

    06:31 Now, they don't want this to happen to them.

    06:34 They're very happy for their friends who are getting married.

    06:37 But these thoughts, these memories come up without them being able to get rid of them intruding on what otherwise is a very joyous day.

    06:51 They also may be complaining of guilt, of being part of what happened to them, of not having been able to help other people.

    07:00 In fact, some of the nurses that I have worked with, who because they were sick with COVID in the very beginning of the pandemic, had a sense of guilt, that perhaps when they were first having the symptoms, and they thought it was the flu, way back in February and March of 2020, they have a sense of guilt that perhaps they were going about, and maybe they got someone sick, and they have a hard time shaking that idea.

    07:33 Even though it may not be true, even though there is nothing to do about it now, even though everyone that they love, care about, and know, made it through.

    07:44 That sense of guilt is intrusive, and it just comes on them all of a sudden.

    07:52 Sometimes there's a feeling of dread.

    07:55 An unmistakable feeling that something terrible is about to happen.

    08:03 And you don't know why you have this sense of dread.

    08:08 But you can't get over it.

    08:10 It's not like you can say "Oh, it's alright, it's fine.

    08:14 It's going away.

    08:15 I just realized I'm here, I'm safe. Everything is good." This is a sense of dread that's not based in reality of today.

    08:24 It is coming up from a memory from an experience.

    08:29 And it needs to be worked through both with therapy and oftentimes, with some medication.

    08:37 Also, as I said before, there is a sense of worthlessness because after all, bad things don't happen to good people, do they? So, if I have that sense of guilt, that it probably it was my own fault.

    08:52 And I'm worthless, what good am I, this impacts my future, and how I'm going to live my future and how I'm going to take care of myself and the people around me.

    About the Lecture

    The lecture PTSD: Signs and Symptoms (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Anxiety and Anxiety Disorders: GAD, Phobias, OCD, PTSD (Nursing).

    Included Quiz Questions

    1. Flashbacks
    2. Nightmares
    3. Dissociation
    4. Auditory hallucinations
    5. Visual hallucinations
    1. It can co-occur with eating disorders
    2. It rarely co-occurs with substance use disorders
    3. It often leads to advanced cognitive development in children
    4. It usually results in hypersomnia
    1. Panic attack
    2. Dissociation
    3. Feeling of dread
    4. Intrusive memory
    1. Sense of worthlessness
    2. Sense of guilt
    3. Feeling of dread
    4. Intrusive memory

    Author of lecture PTSD: Signs and Symptoms (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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