Question

CASE DESCRIPTION: Peggy is a physically healthy divorced 28-year old Puerto Rican ICU nurse in Washington DC, who is also a member of the U.S. Army Reserves and a marathon runner. She presents to her primary care provider (PCP) for assessment of symptoms that began about a week after she returned from witnessing the 2013 Boston Marathon bombings a month ago where she also assisted her fellow runners who were injured. She appears anxious when describing her experience with the assistance efforts. Although she cries when describing the terror and chaos following the bombing and emergency care needed, she is methodical when describing her symptoms, including difficulty sleeping, nightmares, inability to concentrate, irritability, headaches, anxiety, and lack of energy - almost as if they are happening to someone else and not her. Peggy talked about her symptoms with her mother, who shared that she experienced similar symptoms after returning from the war in Vietnam where she served as a nurse. She explained to Peggy that such symptoms occurring in relation to a stressful experience are now identified as post-traumatic stress disorder (PTSD), and encouraged Peggy to see her PCP for evaluation. Among the PCP’s recommendations is a referral for psychotherapy and medication consultation, consideration of pharmacogenomic testing for guiding drug selection, and consideration of participating in clinical research to learn more about PTSD. Peggy’s Family History (as described in the case; all healthy unless otherwise noted) • Peggy: age 28, divorced 2 yrs ago (since divorce, headaches, anxiety, anger, lost weight, running helped improve symptoms); no children; c/o symptoms of PTSD; no prior hx of depression; runs 3 x week; difficulty coping after Boston marathon bombing; • Mother: Rosa, age 63, history of depression, served in the Vietnam War – difficulty returning back to normal (exhibited symptoms of PTSD), received counseling and took meds until 27, when symptoms resolved. Had some side effects when she took medication. • Father: Pete, age 65 • Siblings: one sister, Eva, age 26 • Maternal Grandmother: Louise, 83, depression at age 71, dementia • Maternal Grandfather: Edgar, 85, prostate problems • Paternal Grandmother: Mary, died at age 67, r/t diabetes • Paternal Grandfather: George, died at age 63, MVA • Ethnicity: o Maternal: Puerto Rican o Paternal: English • Religion: Catholic ** Peggy presents with symptoms of PTSD, but has not yet been officially diagnosed. Her mother had symptoms of PTSD after the Vietnam War, but PTSD wasn't identified yet as a disease. At that time, it was called “shell-shock”. Today, we would call it PTSD. For this case study, it is ok to include diagnoses in the pedigree and key, even if the person has not been “officially” diagnosed. Only include illnesses, not symptoms, in the key. 1) Describe the causes of PTSD. Explain the symptoms and categories of PTSD 2) Describe the risk factors of & the influence of personal/family history on PTSD. Is it hereditary? What genes are involved if any? Why or why not is Peggy at risk? 3) What protection does the Genetic Information Nondiscrimination act (GINA) provide? 4)Explain what protections and lack of protections are provided by GINA. What groups does GINA protect and not protect? What types of insurance does GINA not apply to 5) Does Peggy's family hx. exhibit any red flagsas defines by the F-GENES red flag list? What are the nursing implications? What should Peggy's nurse do next?

Answer 1

1PTSD can occur due to a any event which is stressful,frightening or due to a traumatic experience.It often happens when a traumatic experience occurs in a persons life and the shadows of the trauma persist throughout the life.Possible events are natural calamities,sexual abuse,road accidents or witnessing warzone.

Symptoms often occur atleast for a period of one month following the event,such as persistent fear,horror,anger,diminished interest ,feelings of detachment,negative beliefs,aggressive behaviour,hypervigilance,problems with concentration and insomnia.Some people experience headache,palpitations and panic attacks,avoidance to people,mood swings and behaviour changes.

Categories are normal stress response,acute stress disorder,uncomplicated PTSD,comorbid PTSD and complex PTSD.In Normal stress response ,a person who is exposed to a traumatic event achieve complete recovery within a few weeks.Acute stress disorder is a condition when the person is not able to recover from the traumatic experience for more than weeks characterized by unable to resume to work,basic self care and involve in relationships.Uncomplicated PTSD is repetitious experience of the event and even try to avoid stimuli associat ed with the trauma.Comorbid PTSD is quite common and is often linked with deresssion or substance abuse.Complex PTSD occurs in individuals who is exposed to prolonged traumatic experiences during childhood and often exhibits antisocial personality disorder and emotional as well as mental difficulties.

2 PTSD can occur at any age .The affected persons are mainly war veterans,children,people who have been exposed to physical abuse,accident or other serious events.Women tend to develop PTSD than men.Recently research studies held at the Psychiatric Genomics Consortium gives molecular evidence of the role of genetics in the risk of getting PTSD.Genetic predisposition of PTSD maybe transmitted through epigenetic means .it refers to the control of genes as they are turned on and off by the binding of chemicals secreted by the body ,which change with circumstance.Peggy is at risk ,because her mother also experienced PTSD,when she was exposed to Vietnam War.Thus the chromosomes of mother who survived the Vietnam War and experienced PTSD maybe modified by not by mutation but by chemicals that turn genes on or off.These changes maybe inherited,possibly increasing the risk of depression .

3 The act prohibit discrimination against employees on the basis of genetic information.

4 GINA gives protection to to the genetic information which include analysis of tumors,prenatal genetic testing and carrier testing.But it does not give protections on information related to sex,age or cholestrol tests or for blood tests such as CBC.It does not apply to members of the US military,Veterans who recieve health care through veterans administration,members using Indian Health Service,or employees enrolled in Federal Employees Health Benefits Program.GINA protect people who are discriminated by the health insurers on the basis of DNA information.it does not cover life insurance,,disability insurance and long-term care insurance.