Question

Carl returned 6 months ago from his yearlong deployment to Afghanistan. After a difficult period of readjustment, he was diagnosed by the DVA psychiatrist with PTSD. He has been experiencing flashbacks, and he has almost nightly intrusive dreams of his combat experiences. He tried returning to his predeployment job as a computer technologist, but he had difficulty concentrating, was making mistakes, and had exaggerated startle responses to workplace noises. Today, his wife called 911 when she returned home from work and found him unresponsive on the bed and an empty container of alprazolam on the bedside table. After being stabilized in the emergency room, Carl was transferred to the psychiatric unit. The physician ordered sertraline 100 mg daily and lorazepam 1 mg tid and prn. The admitting nurse is preparing Carl’s care plan.

1. When the night nurse encounters Carl experiencing nightmares and calling for help, how should the nurse intervene?

2. Carl becomes angry with another patient on the unit over what channel to watch on TV. Carl clenches his fists and threatens to hit the other patient. How should the nurse handle this situation?

Answer 1

1. Disturbed sleep pattern related to nightmares as evidenced by the calling for help at thetime of incidence of nightmares

1. Assess the patient’s experiences in order to assess the extent of nightmares

2. Maintain a trust relationship with patient in order to provide better care

3. Acts in calm way to calm the patient. Because over stimuli increase the emotional stimulation

4. Provide him extra time to express his feeling of nightmare

5. Allow him to verbalize his nightmare experiences after providing safe environment. Safe environment able to convey his feeling and reduce his fear

6. Identify any triggers that increase his nightmare experiences. It helps nurse to identify triggers for helping the patient in treatment

7. Educate patient to do breathing exercises for 15 minutes to relax his mind

8. Motivate him to write it in a piece of paper. It helps to relax his mind

9. Assist him to understand trauma experiences to cope with trauma experiences

10. Provide him a safe environment in order to reduce nightmare

11. Identify his coping strategies in order to help to cope with nightmare and provide alternative coping strategy

12. Stay with patient until he recovers from nightmares experiences. It helps him to reduce fear and anxiety.

13. Check the medication orders to identify the medication were given as per order

14. Administer the lorazepam 1mg stat to reduce fear and anxiety and induce calmness and sleep in his mind

2. Inappropriate exaggeration of emotion related to anger as evidenced by the clenching of fist and threatens to hit on another patient

1. assess the situation of the patient to help patient to recover

2. remove the patient from the source

3. Shift him in a safe environment. safe environment helps him to reduce anger

4. Allow him to express his feelings of experiences. Verbal exposure releases some of anger and identify triggers that made him anger

5. Calm him down by showing calming behavior. Calmness reduce his anger

6. Keep in mind that never argues with patient. Even though patient committed the mistake. Because argument provokes the situation

7. Motivate him to do the breathing techniques slowly to relax his mind

8. Encourage him to write it in a piece of paper about the experiences after breathing exercises. Breathing exercises somewhat helps to control his anger

9. Instruct him to read it after writing the experiences to help the understand situation

10. Encourage him to do such a procedure for a several times a day to reduce his anger and cope with his situation

11. Encourage him to count number from 1 to 100 and use it when anger arises to reduce anger

12. Help him to find mistakes caused by him or other. If the mistake by him, encourage him to say sorry to other patient and if the mistake caused by the other patient, encourage him to say forgiveness