{
  "name": "Post-Traumatic Stress Disorder",
  "slug": "ptsd",
  "url": "https://nursingplex.com/care-plans/ptsd",
  "category": "Mental Health & Psychiatric",
  "summary": "Trauma re-experiencing and hyperarousal; trauma-informed care and coping skill building.",
  "nursing_diagnoses": [
    "Post-trauma syndrome",
    "Anxiety",
    "Disturbed sleep pattern"
  ],
  "overview": [
    "Post-traumatic stress disorder (PTSD) develops after exposure to actual or threatened death, serious injury, or sexual violence — through direct experience, witnessing, learning it happened to a close family member/friend, or repeated exposure to aversive details (e.g., first responders). Core symptom clusters include intrusion (flashbacks, nightmares, distressing memories), avoidance of trauma reminders, negative alterations in cognition and mood (guilt, detachment, distorted blame), and marked alterations in arousal and reactivity (hypervigilance, exaggerated startle, irritability, sleep disturbance) persisting more than one month and causing significant functional impairment.",
    "PTSD is common among combat veterans, survivors of assault or abuse, disaster survivors, and healthcare/emergency workers, and it frequently co-occurs with depression, substance use disorders, and suicidal ideation. The neurobiology involves a hyperactive amygdala, reduced hippocampal volume affecting memory processing, and dysregulated cortisol response, which together explain why trauma memories feel perpetually present rather than safely stored as past events.",
    "Nursing care prioritizes safety assessment (particularly suicide risk), creating a trauma-informed, non-retraumatizing care environment, supporting evidence-based psychotherapy (trauma-focused CBT, EMDR) and pharmacotherapy, teaching grounding and coping skills, and helping the patient and family understand PTSD as a treatable physiological response to trauma rather than a personal weakness."
  ],
  "key_facts": [
    {
      "label": "Symptom clusters",
      "text": "Intrusion, avoidance, negative cognition/mood changes, and hyperarousal, present more than one month."
    },
    {
      "label": "First-line psychotherapy",
      "text": "Trauma-focused cognitive behavioral therapy and EMDR (eye movement desensitization and reprocessing) have the strongest evidence base."
    },
    {
      "label": "First-line medications",
      "text": "SSRIs (sertraline, paroxetine) are FDA-approved for PTSD; prazosin can specifically target trauma-related nightmares."
    },
    {
      "label": "Neurobiology",
      "text": "Amygdala hyperactivity, reduced hippocampal volume, and dysregulated HPA-axis cortisol response underlie symptoms."
    },
    {
      "label": "High-risk populations",
      "text": "Combat veterans, sexual assault survivors, first responders, and refugees have elevated prevalence."
    }
  ],
  "nursing_priorities": [
    "Assess for suicidal ideation, self-harm, and safety risk at every encounter.",
    "Create a trauma-informed environment that minimizes retraumatization triggers.",
    "Support the patient through flashbacks or dissociative episodes safely.",
    "Facilitate access to evidence-based trauma-focused therapy.",
    "Manage co-occurring substance use, depression, or anxiety.",
    "Teach grounding, relaxation, and coping strategies for hyperarousal symptoms.",
    "Support sleep and address trauma-related nightmares.",
    "Educate family/support system on how to respond supportively."
  ],
  "assessment": {
    "subjective": [
      "Reports of intrusive memories, flashbacks, or nightmares related to the trauma",
      "Avoidance of people, places, or activities that are reminders of the trauma",
      "Feelings of detachment, numbness, guilt, or persistent negative beliefs about self/world",
      "Reports of feeling constantly 'on edge,' easily startled, or unable to relax",
      "Difficulty falling or staying asleep",
      "Expressions of hopelessness or thoughts of self-harm",
      "Reports of irritability, anger outbursts, or relationship strain"
    ],
    "objective": [
      "Hypervigilance, exaggerated startle response observed during interaction",
      "Evidence of dissociation (blank stare, disorientation) or flashback episodes",
      "Avoidance behaviors noted during history-taking or care (e.g., refusing certain exam positions/procedures reminiscent of trauma)",
      "Restricted affect or emotional numbing",
      "Signs of poor sleep: fatigue, dark circles, irritability",
      "Evidence of substance use as a coping mechanism",
      "Score elevations on standardized PTSD screening tools (e.g., PCL-5)"
    ],
    "related_factors": [
      "Exposure to combat, assault, abuse, disaster, or serious accident",
      "Repeated or vicarious trauma exposure in occupational settings",
      "Lack of social support following the traumatic event",
      "Pre-existing mental health conditions increasing vulnerability",
      "Neurobiological dysregulation of the fear/stress response system",
      "Ongoing environmental triggers or unresolved safety threats"
    ]
  },
  "goals": [
    "The client will remain safe from self-harm throughout the plan of care.",
    "The client will demonstrate use of at least one grounding or coping technique during periods of distress.",
    "The client will report a decrease in intrusive symptoms and improved sleep quality over time.",
    "The client will engage in trauma-focused therapy and/or pharmacotherapy as recommended.",
    "The client will identify trauma triggers and develop a personalized safety/coping plan.",
    "The client and family will verbalize understanding of PTSD as a treatable condition."
  ],
  "interventions": [
    {
      "title": "1. Safety assessment and crisis management",
      "points": [
        "Assess suicidal ideation, intent, plan, and access to means at every visit, since PTSD carries significantly elevated suicide risk.",
        "Develop a written safety plan collaboratively, including coping strategies, support contacts, and crisis line numbers.",
        "Remove or restrict access to lethal means when risk is identified, in collaboration with the family and treatment team.",
        "Recognize and safely manage dissociative or flashback episodes by speaking calmly, using the patient's name, and orienting them to the present environment.",
        "Avoid sudden touch or restraint during a flashback unless necessary for immediate safety, since this can be misperceived as a threat."
      ]
    },
    {
      "title": "2. Trauma-informed care approach",
      "points": [
        "Ask permission before physical exams or procedures and explain each step in advance to preserve the patient's sense of control.",
        "Avoid environments or approaches that mimic the original trauma (e.g., unexpected touch, restraints, being cornered) whenever possible.",
        "Use a calm, non-judgmental tone and validate the patient's experience rather than minimizing symptoms.",
        "Recognize that anger, distrust, or non-adherence may be trauma responses rather than personal defiance.",
        "Collaborate with the patient on care decisions to rebuild a sense of agency and control."
      ]
    },
    {
      "title": "3. Facilitating evidence-based treatment",
      "points": [
        "Refer to or coordinate with providers offering trauma-focused CBT, EMDR, or prolonged exposure therapy.",
        "Support adherence to prescribed SSRIs or SNRIs, discussing the typical 4-6 week onset of full benefit.",
        "Administer or teach about prazosin if prescribed specifically for trauma nightmares, monitoring for orthostatic hypotension.",
        "Screen for and address co-occurring depression, anxiety, and substance use disorders, since untreated comorbidities reduce treatment success.",
        "Encourage consistent attendance at therapy and provide encouragement without pressuring disclosure of trauma details before the patient is ready."
      ]
    },
    {
      "title": "4. Teaching coping and grounding strategies",
      "points": [
        "Teach grounding techniques (5-4-3-2-1 sensory technique, deep breathing, holding a cold object) to interrupt flashbacks or panic.",
        "Teach progressive muscle relaxation and paced breathing to reduce baseline hyperarousal.",
        "Encourage regular physical activity, which has evidence for reducing PTSD symptom severity.",
        "Support healthy sleep hygiene practices and address trauma-related nightmares as a treatment target, not just an inconvenience.",
        "Discourage use of alcohol or substances as a coping mechanism and offer healthier alternatives."
      ]
    },
    {
      "title": "5. Supporting family and social reintegration",
      "points": [
        "Educate family members on the nature of PTSD, common triggers, and supportive versus unhelpful responses.",
        "Encourage family therapy or support groups when relational strain is present.",
        "Connect veterans or first responders with peer support programs specific to their population.",
        "Help the patient identify and gradually re-engage with previously avoided but valued activities and relationships."
      ]
    }
  ],
  "patient_teaching": [
    "Understand that PTSD is a treatable medical condition resulting from the brain's response to trauma, not a personal weakness.",
    "Practice grounding techniques daily, not just during a crisis, so they become automatic when needed.",
    "Take prescribed medications consistently and report side effects rather than stopping abruptly.",
    "Attend therapy sessions consistently, even when it feels uncomfortable, since avoidance maintains symptoms.",
    "Identify personal triggers and develop a plan for managing them in daily life.",
    "Limit alcohol and avoid recreational drug use, which worsen symptoms and interfere with treatment.",
    "Know the warning signs of crisis and have a safety plan with emergency contacts readily available.",
    "Engage support systems and consider peer support groups for shared understanding and encouragement."
  ]
}