Case Study Posttraumatic Stress Disorder (PTSD), RAPID Reasoning STUDENT, Marcus Jackson, 34 years old, Latest Questions and Answers with Explanations, All Correct Study Guide, Download to Score A

Posttraumatic Stress Disorder (PTSD) RAPID Reasoning STUDENT Marcus Jackson, 34 years old Primary Concept Mood and Affect Interrelated Concepts (In order of emphasis) 1. Stress 2. Coping 3. Anxiety 4. Clinical ...

Posttraumatic Stress Disorder (PTSD) RAPID Reasoning STUDENT Marcus Jackson, 34 years old Primary Concept Mood and Affect Interrelated Concepts (In order of emphasis) 1. Stress 2. Coping 3. Anxiety 4. Clinical Judgment History of Present Problem: Marcus Jackson is a 34-year-old African American male who served four combat tours of duty in Iraq and Afghanistan. He came to the Veterans Administration (VA) today for an outpatient appointment because he has not slept more than two hours a night for the past week. This is his fourth clinic visit over the past year with the same symptoms: inability to sleep, nightmares, increasing anxiety, and isolation. Every time he falls asleep, he relives the bombing and has flashbacks of bloody body parts that he witnessed after the explosion. He states that he is more aware of noises and any loud noise such as fireworks and or cars backfiring causes him extreme anxiety. His medications for PTSD have not been helping control his anxiety. He has been spending more time in his room watching TV and avoids spending time with his wife and children. Today he told his wife he should have died and not his friends. His primary care provider encouraged voluntary admission and his wife brought Marcus to the emergency department of the closest VA hospital so he can be admitted. Personal/Social History: During his last tour in combat, Marcus’ best friend drove over an IED. The explosion killed everyone in the vehicle. During the blast, Marcus was hit with shrapnel in his left leg, stomach, and left eye. These injuries left him blind in his left eye. He has had multiple surgeries to his abdomen, and six reconstruction surgeries to his leg. He walks with a limp and continues to complain of severe pain in his left leg. He was given a medical discharge from the Marines because of the extensive nature of his injuries and is receiving disability. Marcus is married with three children from six to twelve years of age. He has been married to his wife, Ariel, for fourteen years. While in the service, his family moved six times and endured four combat tours of duty. Each time he returned home from combat, his wife noted that he has no history of physical aggression and has been more agitated and had more trouble sleeping with frequent nightmares. Marcus reports he used to drink “a lot” but decided two years ago that alcohol was making everything worse. Reports he has not had a drink for the past 1 ½ years. Denies other drug use. © 2016 Keith Rischer/www.KeithRN.com This study source was downloaded by 100000831988016 from CourseHero.com on 12-19-2021 06:02:06 GMT -06:00 https://www.coursehero.com/file/80615562/PTSDdocx/ Cassandra Braithwaite What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance:  Served 4 combat tours in Iraq and Afghanistan  Has not slept more than 2 hrs a night for the past week  4 th clinic visit in the past yar for the same symptoms: insomnia, nightmares, increasing instances of anxiety  Relives bombing and has flashbacks of bloody body parts  Loud noises cause him extreme anxiety  Avoids spending time with wife and kids  Tells his wife that he should have died and not is friends  Significant past trauma causes PTSD  Exhaustion and sleep deprivation only increase PTSD symptoms  His current plan of care it manage his sleep issues is not working. Will need to be reevaluated and a new plan implemented  Marcus experienced significant trauma. This is a symptom of PTSD  This is good information to know, as Marcus will benefit from a less stimulation environment. Need to educate him on avoiding loud environments  He would need medications to help reduce his anxiety  Social isolation and feeling guilty for living will only make his depression worse and contribute to suicidal ideations RELEVANT Data from Social History: Clinical Significance:  Married with 3 kids  Lost his best friend in an IED explosion  Has had extensive reconstructive surgeries and is now blind in one eye and walks with a limp  No hx of aggression, but has increased agitation  Was medically dc’d from the Marines  Denies drinking or drug use  Has a good support system, kids may cause added stress and be exhausting which can increase his agitation  Significant loss/grief or guilt may be the cause of depression or make it worse  Low self-esteem or not being able to do things he once used to can increase suicidal thoughts.  Increasing agitation without a proper outlet for relieving symptoms can cause increasing depression/suicidal thoughts  Having to leave the Marines against his will can be a significant and unexpected life change that can have negative effects on his mental health.  Significant because “self-medicating” by abusing alcohol and other drugs can complicate his treatment and any pharmacological therapies he may need Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment: T: 98.2 F/37.3 C (oral) Provoking/Palliative: Movement provokes, always present. Goal is 5/10 P: 92 (regular) Quality: Ache R: 18 (regular) Region/Radiation: Left leg BP: 118/70 Severity: 5/10 O2 sat: 98% RA Timing: Continuous What VS data are RELEVANT that must be recognized as clinically significant to the nurse? RELEVANT VS Data: Clinical Significance:  Pain (Movement provokes and is always present, 5/10; continuous ache in his L leg)  All other v/s  Chronic 5/10 pain means he may need help controlling it. May also help him control some of the symptoms he’s having if it’s causing him problems with his abilities to relax and sleep.  v/s are all relevant and important to help assist in guiding his treatment © 2016 Keith Rischer/www.KeithRN.com This study source was downloaded by 100000831988016 from CourseHero.com on 12-19-2021 06:02:06 GMT -06:00 https://www.coursehero.com/file/80615562/PTSDdocx/ Cassandra Braithwaite Current Assessment: GENERAL APPEARANCE: Appears anxious, body tense, tired (dark circles under his eyes) RESP: Breath sounds clear with equal aeration bilaterally, non-labored respiratory effort CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks NEURO: Alert & oriented to person, place, time, and situation (x4), flat affect, inability to fall asleep and stay asleep– averaging only two hours a night, nightmares, flashbacks while awake GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all four quadrants Reports poor appetite with no weight loss. GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact SUBSTANCE USE: Last use of alcohol 1 ½ years ago. Denies use of other drugs Mental Status Examination: APPEARANCE: Casually dressed; facial scars noted; cooperative with interview MOTOR BEHAVIOR: Walks with a limp. No abnormal motor activity noted. SPEECH: Speech is of normal tone and cadence. MOOD/AFFECT: Anxious affect. Patient states, “I feel nothing” most of the time, but also states that he “flies off the handle” a lot. Reports he “startles easily” to environmental noises. THOUGHT PROCESS: Linear and logical THOUGHT CONTENT: Denies delusions when assessed; somewhat guarded in responses, but no evidence of paranoia. Admits to intrusive thoughts about his time in combat. Expresses excessive guilt that “good men died” and “I wasn’t able to help.” Also states he sometimes thinks he should have died with “his patrol.” PERCEPTION: States he has periods of time in which he has visions (flashbacks) of being back in Iraq during the IED blast; also reports that sometimes he just sees “flashes” of body parts. INSIGHT/JUDGMENT: Recognized symptoms as part of PTSD diagnosis but states “There is probably nothing that can be done to help.” Judgement intact. COGNITION: Oriented x3. Has some memory problems associated with the exact events during the IED blast. Possible TBI? Reports current difficulty concentrating at times. INTERACTIONS: Tends to stay to self SUICIDAL/HOMICIDAL: Stated that he thinks he should have died instead of the men in his unit. Denies current suicide ideation and has no plan. Denies homicidal ideation. © 2016 Keith Rischer/www.KeithRN.com This study source was downloaded by 100000831988016 from CourseHero.com on 12-19-2021 06:02:06 GMT -06:00 https://www.coursehero.com/file/80615562/PTSDdocx/ Cassandra Braithwaite What assessment data are RELEVANT that must be recognized as clinically significant to the nurse? PHYSICAL Assessment Data: Clinical Significance:  Anxious, body appears tense  Inability to sleep or stay asleep. Flat affect, flashbacks while awake, nightmares  No alcohol or drug use  Approach Marcus calmly and do not startle  All of these are clinically significant signs of PTSD  Good sign that he is not “self-medicating” and making his current condition worse. Relevant to know so that any meds prescribed won’t cause any dangerous interactions if mixed with alcohol and/or other drugs Mental Status Examination:  Cooperative with the interview  He states he “feels nothing” most of the time but “flies off the handle” a lot  Admits to intrusive thoughts about his time in combat and expresses guilt  Reports of difficult concentrating  Denies suicidal thoughts but said he should have died instead  Shows a willingness to get better and will likely adhere to his plan of treatment  His mood is unstable, and may be a safety risk to himself and/or others  The significant amt of trauma he has experienced, and his thoughts of guild and combat may cause MDD and make his PTSD worse  Inability to concentrate may also be a s/s of his PTSD  Although he denies suicide ideation, this is an unhealthy thought that may later manifest itself into something worse. His mood is unstable and suicide precautions should be put into place Lab Results: Basic Metabolic Panel (BMP:) Current: High/Low/WNL? Sodium (135–145 mEq/L) 138 WNL Potassium (3.5–5.0 mEq/L) 4.6 WNL Glucose (70–110 mg/dL) 88 WNL Creatinine (0.6–1.2 mg/dL) 1.1 WNL What lab results are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Lab(s): Clinical Significance:  Sodium  Potassium  Glucose  Creatinine  s/s of hyponatremia can cause an altered personality, lethargy, and confusion  Potassium deficiency is linked to mood changes and mental fatigue  Disorder of glucose control, suc