You are working the afternoon shift in an inpatient psychiatric ...

[madam-professor]

You are working the afternoon shift in an inpatient psychiatric unit. the patients are in the day room watching a movie when suddenly someone starts yelling
 
  you and other staff rush to the day room to find
  J.J., a 48-year-old male patient, crouched in the corner behind a chair, yelling at the other patients, Get
  down. Get down quick. you and the other staff are able to calm J.J. and the other patients and take J.J. to
  his room. He apologizes for his outburst and explains to you that the movie brought back memories of
  the Gulf War. He had forgotten where he was and thought he was in combat again. He describes to you
  in detail the memory he had of being ambushed by the enemy and watching several of his comrades be
  killed. you remember hearing in report that J.J. is a Gulf War veteran admitted with posttraumatic stress
  disorder (Ptsd).
 
  What are common causes of PTSD, and what is the most likely cause of J.J.'s condition?
 
  Name three criteria that must be present for a diagnosis of PTSD.
 
  What is the difference between PTSD and acute stress disorder?
 
  Which symptom(s) of PTSD did J.J. most likely experience?
 
  What therapeutic measures can be done to help J.J. during your shift this afternoon?

Question 2

After 3 weeks, you are providing discharge teaching for J.M. you ask her whether she is ready to go home. J.M. states, I'll be so glad to get out of this place. I'm so fat and ugly
 
  I need to lose 10 pounds. I bet I can
  do it in just a couple of days. Otherwise, I don't want to live anymore.
 
  What will you discuss with the physician before any further discharge teaching or plans?
 
  You report J.M.'s statements to the physician. What actions do you expect the physician to take?
 
  What medications would be indicated for J.M. to assist with resolution of both her anorexia
  nervosa and her depression?
 
  Which statements by J.M. would indicate successful treatment? Select all that apply.
  a. When you say I look 'healthy' I feel fat.
  b. Lately I've been feeling a little better about things.
  c. It's up to me to take care of my body by eating enough food.
  d. I just have to stay skinny to feel good.
  e. I am looking forward to going out with my friends again.

[meganmoser117]

Answer to Question 1

Common causes of PTSD are military combat, detention as a prisoner of war, natural disasters
(floods, tornadoes, earthquakes), and events that led to serious physical injury (plane, automobile,
train accidents; bombing; mugging, assault, rape; being held hostage). The most likely cause of J.J.'s
condition is his having served in the Gulf War and having seen his fellow soldiers killed.

 The person has to have had exposure to a traumatic event that involved actual or threatened death
or serious injury or the threat to physical integrity of self or others.
 The individual's response to the trauma must include intense fear, helplessness, or horror.
 The individual experiences dissociative symptomsthat is, numbing, detachment, derealization,
and depersonalization.
 Reexperiences of the trauma through recurrent images, thoughts, dreams, delusions, or flashbacks
are associated with distress.
 There is marked avoidance of stimuli that arouse recollections of the trauma.
 Reexperiences cause marked anxiety or increased arousal.
 The duration of the disturbance is longer than 1 month.

The criteria for acute stress disorder are similar to those for PTSD, except that the symptoms occur
during or immediately after the trauma, last for at least 2 days, and resolve within 4 weeks after the
conclusion of the event. If the symptoms persist longer than 4 weeks, the diagnosis would change
to PTSD.

A flashback

 Reassure him that he is safe, that he had a flashback, and that he is not in danger.
 Treat the incident as understandable, and remain calm.
 Provide a quiet environment free from external stimuli as much as possible.
 Provide protective care to prevent future harm to staff or the patient.
 Offer J.J. an anxiolytic to help reduce his anxiety or, later in the evening, a hypnotic agent to help
him sleep. If one is not ordered, call the physician and request an order for one if the patient
accepts the offer for one.

Answer to Question 2

 J.M. is possibly depressed and suicidal.
 J.M. hasn't made any internal psychological changes.
 J.M. hasn't gained any insight into the seriousness of her illness.
 J.M. might relapse and is at risk for losing some or all of the weight she has gained.
 J.M. is at risk for further ECG changes; electrolyte imbalances; and complete blood count,
endocrine, and urinalysis abnormalities.
 J.M. is at risk for chronic anorexia nervosa.
 J.M. might be at risk for an early death.

 She will not be discharged until the depression lessens.
 She will be placed on suicide precautions.
 She might be placed on an antidepressant or other medication.

There are no drugs approved for the treatment of anorexia nervosa. Selective serotonin reuptake
inhibitors (SSRIs) may be used to elevate her depressed mood and can stimulate her appetite. If
she is experiencing high levels of anxiety, anxiolytics, such as benzodiazepines, may be ordered for
short-term use. Some patients might benefit from atypical antipsychotic drugs, such as olanzapine
(Zyprexa), for improving mood and decreasing resistance to weight gain.

Answers: b, c, e