You are working the afternoon shift in an inpatient psychiatric unit. The patients are in the TV room watching a movie when suddenly someone starts yelling. You and other staff rush to the room to find L.L., a 48 year old male patient, crouched in the corner behind a chair, yelling at other patients: “Get down, quick, get down!” You and the other staff are able to calm L.L. and the other patients and take L.L. 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 L.L. is a Gulf War veteran admitted with Post Traumatic Stress Disorder. (PTSD)
1. What are common causes of PTSD, and what is the most likely cause of L.L’s condition? Discuss three criteria that must be present for a diagnosis of PTSD.
2. Discuss in detail, the difference between PTSD and acute stress disorder.
3. Which symptom(s) of PTSD did L.L. most likely experience?
4. What therapeutic measures can be done to help L.L. during your shift this afternoon? Give at least 4 measures.
While you are in L.L.’s room, he states that he would like to rest for a while, and he requests something to “calm his nerves.” You check his medication administration record and find the following prn medications listed:
PRN MEDICATIONS:
Acetaminophen: 650mg po every 4 hours as needed for pain scale of 4 to 6
Dulcolax suppository 1 pr daily prn for complaint of constipation
Lorazepam 1mg po every 6 hours prn for anxiety
Zolpidem 12.5 mg po at bedtime prn for insomnia
5. Which medication is most appropriate to give to L.L. ? Thoroughly explain your answer. Why? What classification is this medication? What is it’s mechanism of action to help with anxiety?
6. What are the adverse effects of long term use of benzodiazepine anxiolytics?
7. You notify L.L.’s psychiatrist about his reaction to the movie. She writes an order to start paroxetine daily. How does paroxetine differ from lorazepam?
Be thorough in your response and be sure to include the drug classification of paroxetine. Why is paroxetine used and not other drugs in this classification?
8. What are some potential side effects of paroxetine? BE SPECIFIC
L.L. asks you whether there are other things he can do, in addition to medications, to help his anxiety. He tells you that he has heard about relaxation therapy and wants to hear more about it.
9. What would you discuss with L.L. about relaxation therapy?
10. What other treatment modalities could L.L. be referred after his hospitalization to help treat his PTSD and related problems. Give at least three and briefly describe each one.