Post Traumatic Stress and the Nursing analysis - Part 2

Post Traumatic Stress and the Nursing analysis - Part 2

Emotional Responses vs. Responsive Pathology
It is prominent for an attorney to note that the key to decree either or not a client is malingering to heighten the inherent damage award is to spin the therapeutic encounters. There must be a paper trail showing the process of pathology and attempts to aid the client in development improvements through thought, speech and action. Therefore it is imperative to understand the assorted conditions that ensue from a response to trauma and how they are treated.

The pathology and rehabilitation of the Post Traumatic Stress Responses
As mentioned in the last issue, trauma is a sudden event that alters the procedure of a person's life. The convert can be temporary or permanent and affects every aspect of being. All goals and expectations industrialized over a lifetime are abruptly stripped away with nothing to look transmit to except pain and anguish. If that weren't enough, the road to saving is fraught with obstacles, i.e. Harmful coping mechanisms and responses such as flash backs, recurrent nightmares, intrusive thoughts, sleep deprivation, persisting pain, alterations in body image, self esteem and social relationships, loss of independence, lower frustration tolerance, irritability, inappropriate startle responses to coarse sounds and alterations in danger perception. Additionally, as mentioned previously, most of us have experienced a traumatic event at on time or other and all human beings caress assorted emotional responses. However, given how the legal theory has evolved, it is now crucial to be able to distinguish between resolvable responses and responsive pathology. Accordingly, we now turn our concentration to insight the dynamics of how legitimate therapists will recognize and decree those responses, so that the attorney can know when there is legitimate evidence of pathology indicating an extended duration of pain and suffering that meets legal threshold requirements.

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Flash Backs
Among all of its splendid functions the human brain is a flawless recording device. All input stimuli such as sound, light, color, wind, thermal changes, wetness, dryness, movement, etc. Are recorded in the brain's memory cells and remain for the duration. The faultiness of human memory is in the quality to recall. Nonetheless, everything that reaches the brain through the five senses gets recorded. Thus, one of the problems with trauma is that when there is an splendid sudden input of stimuli the brain records it exactly as it occurred with a larger-than-normal overlay. Hence, just as a disk as a limit to how much facts it will hold, the memory cell can only hold a finite whole of "data". So more cells are employed to hold the memory of an event that generated more than the usual whole of stimuli to which the someone was accustomed. Therefore, the brain kicks into an "auto-replay" mode and stays there. This phenomenon is called a "flash back".Accordingly, habitancy who caress flash backs spin reliving the incident over and over again, with the frequency and timing of the repetitions being unpredictable. Thus this response regularly keeps the victim from being able to carry out his or her usual activities. Most patients that I have spoken to said that it's like being hooked up to a virtual reality computer and being stuck in a programming loop. This condition differs from having recurrent nightmares in that by definition, it only occurs when the outpatient is awake. Consequently, this trauma response is very disturbing and requires some coaching in how to deal with it. It most cases this natural phenomenon is self correcting of a brief duration of time.

Recurrent nightmares
Recurring nightmares are more of an insidious problem than flashbacks because they are occurring at a time when we relinquish operate over our bodies. Aside from the many spiritual and psychological interpretations of dreams, they are most often a manifestation of thoughts and desires occurring during the former day. This is why we often find ourselves doing things in our dreams that we would never think of doing for real. By the same token, the victim, who regularly has morbid thoughts about separate inherent scenarios related to the incident, will often relive the occurrence, while dreaming, in ways that are much worse than what truly happened.On the other hand, the horror itself is of no consequence. The actual problem is in how the someone responds to it after waking up. Most habitancy awake from such episodes with a high level of stress with increased heart, respiratory rates, blood glucose levels and blood pressure. There is some publish of adrenalin and other hormones that are supposed to be triggered only when there is danger. The usual emotional response to the dream is feeling upset and attractive in more idea about the traumatic incident. Hence, the key to resolution is learning that such dreams must be disregarded as being of no point and are a mere reflection of what a someone was reasoning of during the day. Therefore, if we subscribe to this theory as truth, we know that reducing the whole of time one spends reasoning about the incident will sell out the frequency and intensity of the nightmares.

Obsessive Thoughts
Obsessive or intrusive thoughts are the means by which the harmful emotional reactions perpetuate. The idea process gives rise to all of the above mentioned emotional responses i.e. Anger, anxiety, depression, etc. In the dichotomy of the human condition (emotion versus intellect), the negative emotional component of the mind-body has equal passage to the reasoning apparatus of the brain. Hence thoughts often emanate from this negative side. Additionally, negative feelings such as anger, sorrow and anxiety have a natural tendency to dissipate just as boiling water turns to steam and empties itself from the vessel. Therefore, it takes a essential exertion to perpetuate those harmful responses. Moreover, as part of the natural human condition, there is a negative component of every human that has an schedule to achieve immediate gratification at any cost and it does not have the capacity to weigh in with the unintended consequences. This "side" is perpetually at war with the intellect which fights to mouth operate in view of the unwanted consequences of transforming impulses into action. Hence every decision is an sass to the ask "Should I or shouldn't I?"

Therefore, the astute pro teaches the client to focus on good thoughts. Which begs the question, "How is it inherent to think only good thoughts with all of the hurt and anguish and with financial problems looming on the horizon?" Although it is no easy task, one can begin by taking inventory. Obviously, after a personal disaster, there are likely to be some permanent losses. So, what is the most logical thing to do first? Take stock of the remaining assets to see what there is to work with. The one certain thing that most habitancy overlook is, "I have survived. I am still alive." The survivor needs to be both happy and grateful for that one fact. This is a crucial element, because there can be no enlarge otherwise. The proximity or absence of this dynamic in any therapy session culminating in an expert's record is a good test for weeding out malingerers.

Sleep deprivation
Sleep deprivation is a response to a series of responses. Pain, anxiety, depression and anguish to name a few are all contributory to robbing a someone of his or her sleep. We all need a certain whole of natural slumber to function when things are going well. It becomes even more prominent when one is recovering from trauma. The lack of sleep interferes with curative on every level. Therefore, the road to saving must begin with getting restful sleep despite all of the factors that thwart it. This leaves the victim in a quandary because all of the mind-body responses that prevent sleep are intensified by the lack of it.Therefore, pro help is required in most cases, even when the corporeal injuries are relatively minor. However, most attending physicians will resort to prescribing drugs that induce sleep and the outpatient gets microscopic or no opportunity to verbalize. The current theory of curative care does not allow much time for verbal interaction with condition professionals. Even nurses, who are specifically educated for diagnosing and treating post traumatic responses rarely have the time to supply therapeutic counseling in institutional settings. Thus, most hospitalized trauma victims do not have passage to proper rehabilitation for negative sleep-depriving responses during the early part of their recovery.Consequently, it is left to family members, essential others and/or hidden therapists to supply a supportive environment. This requires spending the time needed to allow the outpatient to share his or her concerns and complaints. Although there are a few drug-free techniques for inducing sleep such as biofeedback, relaxing sounds and soothing music, the most effective leisure inducer is a reassuring voice.

Alterations in Self Image (Body Image and Self Esteem)
Alterations in body image and self esteem are frequent responses to trauma. The coarse denominator is how a someone defines his or her identity with regard to corporeal description, persona, earning capacity and role. We spend most of our lives constructing this social image and then setting up defenses to safe it. In view of that, trauma rips away all fortifications and the someone is left feeling vulnerable and alone. Thus, it is like "The someone that I know to be me has just vanished and the banged-up, helpless one lying in this bed is a total stranger!"

To search for this loss of self more closely, the above scenario begs the question, "Why does our personal identity idea that we worked so hard to construct over the years evaporate so easily? One microscopic jolt and poof! gone." The sass is that the self image is not reality. It is merely an illusion arising out of either an precise perception of feedback from others, self-deception or a combination of both. So it should be no surprise that in the occasion of a life-altering event, the someone we remembered ourselves to be is gone. We are now dealing with somebody different. Ah, but it is in fact such a shock that it takes months or years to adjust to the change. This is so because we all fail to remember two basic theory of life: first, we have no operate over the circumstances of our being; and second, we forget that, like the prices of gasoline and airline tickets, life field to convert without notice.Accordingly, the client had to come to understand that self-awareness is mere perception. Therefore, even when trauma occurs causing permanent injury there is no real alteration or loss of self at its core. There is only a perceived convert in the corporeal manifestation in response to the traumatic impact. Therefore, since the quintessential human being is spiritual in essence, a broken mirror changes the reflection, but the reflected object remains unscathed. This idea is the root of insight the incompatibility between impairment and disability.

Alterations in social relationships
Each private is a link to any communities such as family, work, school, social club, athletic team, political affiliations, and house of worship, etc. We play a role in each of these groups such as member, leader, child, parent, spouse, worker, boss, friend and so forth. When a someone becomes sick or injured, he or she is unable to fulfill the roles that had been established and the relationships change. regularly it translates to some form of role reversal between family members. The someone upon whom others depended is now dependent upon them.Consequently, there are a whole of emotional responses arising out of unfulfilled expectations, i.e. Frustration, anger, resentment and the like. Although some habitancy rise to the opportunity and are happy to supply the extra services needed to care for a loved one, most often relationships between family members deteriorate as a ensue of the emotional responses of the trauma patient. The usual complaint from the spouse or other family member is that the injured someone became irritable, nasty and sometimes verbally abusive. The deterioration of the family relationships is a consequence of inherent destructive behavioral impulses that exists in potentia all humans. These problems arise because the injured someone in such cases displays the characteristics of a self centered insensitive boor who needs to operate others. This is how many habitancy dealing with fear and anxiety.Therefore, the trauma outpatient who has victimized his or her family members must employ a incompatibility called "taking responsibility". This is a difficult idea to grab onto because the nature of the "sick role" is to be absolved of accountability. Thus the verbally abused family member takes the tongue lashing and tries to remain stoic until he or she loses it, strikes back and finally leaves convinced of the need for self preservation.

Invasion of Privacy and Loss of Independence
Being injured all the time results in two major changes: Invasion of Privacy and loss of independence. My first professor in the nursing schedule that I attended said, "To learn to be a good nurse you must first learn what it's like to be a patient." Thus our first lesson was about invasion of privacy and embarrassment. The main highlights were that hidden functions and body parts were on display. In a teaching hospital, during grand rounds, the attending physicians accompany a group of eight or ten interns and residents (physicians-in-training) to see each assigned patient. Each physician conducts a corporeal test in front of his or her colleagues and educator and articulates the findings and rehabilitation plan. I have had many clients complain that it was like being on display in Macy's window.Although this scenario has its justifications, it cannot be interpreted as anything other than an invasion of privacy. The hospitalized someone has to give up his or her need for modesty and tolerate social uncovering in order to gain the therapeutic benefits of pathology and treatment. However, as well intentioned as it may be, the sudden unveiling of ones body in the proximity of any observers causes humiliation and embarrassment, which in turn results in increased stress and retards healing. This problem also occurs to a lesser degree in the doctorââ'¬â"¢s office and in the home.On the other hand, while the onus is on professionals and other care givers to remain sensitive to a person's need for dignity, many habitancy are able to block the stress-inducing embarrassment response. They simply make a decision to accept that in a curative setting habitancy have only a clinical interest and that the actions are all intended to advantage the patient. In fact, any bashfulness exhibited in such a setting would be a false modesty because the someone would be acting against his or her own interest.Regarding the loss of independence, this is intimately tied in with the invasion of privacy issues because injured habitancy have to rely on care givers to achieve hidden functions like using the toilet. The private regularly has to do this at the bedside and wait for some one else to carry it away and supply personal hygiene. Adjusting to this is more of a problem because, even when the embarrassment issues have been resolved, there regularly remains a strong resentment against depending on others for things that we regularly do without thought. What bothers some is the loss of operate and others harbor a fear of becoming a burden.One effective way that therapists help their clients cope with this dilemma is for the dependent someone to learn that he or she is development a contribution to the care giver's well being. habitancy want to feel needed. The dependency of other someone evokes the expression of love and instills a sense of purpose. Therefore, when one someone has a need that is fulfilled by other the receiver is truly development a larger contribution than the giver. Given this distinction, the dependent someone can learn to accept the services with a sense of joy and gratitude.

Lower frustration Tolerance
Frustration tolerance pertains to the distance of time that a someone is willing to wait for the fulfillment of wants and needs before having a temper tantrum. Regardless of the reasons, the actual behavior appears as though the affected someone has a license to be bad-mannered and belligerent. It can also be characterized as regressive and child-like. Furthermore, there is a host of negative consequences in causing damage to others and wrecking relationships as previously mentioned. This can be very costly.Another unpleasant reality is that trauma does not originate a new person. It merely strips away the facade and allows the subsurface well controlled objectionable traits to manifest in the mind-body. The injured someone with low frustration tolerance winds up screaming at those who are doing their best to supply service. Although this is undesirable behavior, in most cases it is not the usual escort of the victim and thus there is a way of bringing the animal back under control.

Irritability
Although there is some overlap between irritability and low frustration tolerance, the former does not necessarily involve giving oneself permission to be offensive. This symptom speaks more to the way the mind-body sass to stimuli such as light and sound. The soul, which is a spiritual entity, interacts with the corporeal world through the mind-body. When a someone becomes irritable in response to trauma or other source of mind-body changes, the mechanism for reaction to stimuli is in overdrive.For example, when we are awake and going about our mundane activities, conversations taking place in normal tones do not regularly cause a problem. However, if you have to listen to the same conversation while you are trying to sleep, that is a separate story. You will get angry and find yourself telling the perpetrators, "shut up!" The irritable someone reacts to normal conversations and other sounds in much the same way all of the time. Nevertheless, in most cases it is a temporary situation relieved by a quiet environment.

Instantaneous Conditioned Reflexes
To understand the nature of the instantaneous conditioned reflexes and how to decree them, we need understand the incompatibility that in response to stimuli, there are two types of action; that which is idea dependent and that which is not.For the mind-body, every stimulus invokes a response that results in a change. Thus, the soul's performance can be altered. For instance, if your car hits a pothole that knocks the front wheels out of alignment, your steering will be affected because you will have to adjust the car's new tendency to veer off to the left or right. Going further, if nothing happens other than the increasing of a memory, that alone constitutes a permanent alteration. Hence, the spiritual essence, which is concerned to keep its vessel on procedure to carry out its mission, will make a decision either or not to employ the thought, speech and/or performance to respond.However, there is also the reflex arc which is the quality to sass to stimuli without prior thought. This is where the body has learned to react a certain way to minimize injury. The nerve impulse never reaches the brain because there is a preprogrammed response ready for performance the occasion the impulse reaches the spinal cord. The reflex arc is a tool for defense. It functions at the basic animal level because it is there purely for self-preservation. This idea pertains to the quality to swiftly withdraw the hand from a hot object without reasoning about it first. Therefore, this conference is concentrated on the sudden alteration of all of the learned responses to stimuli industrialized over a lifetime by desire, learning and forming habits. As with any other existing or inherent condition problem, the resolution for undoing the sudden convert imposed by trauma lies in how the association between the spirit and the mind-body was affected.

Inappropriate Startle Responses
Inappropriate startle responses are a serious condition threat because they cause immoderate amounts of stress. Being startled is a stark reaction to an unexpected occurrence. There is a sudden publish of adrenalin with an increase in heart rate and blood pressure. With this condition the trigger can be any environmental sound or sight that would otherwise not yield any effect, such as end a door, shutting a kitchen cabinet or dropping the toilet seat. The cause of this is not well understood.However, the nature of trauma is such that it all the time happens without warning and there is regularly a particular sound or sight related with it like street noise or the sound of the crash. In this vein, the mind-body learns at the occasion of impact to connect any sudden unexpected stimuli with immanent danger.Moreover, during normal performance we can receive a lot of input through our five senses without being overwhelmed. Thus we are able to support our own well-known way of being or make a conscious exertion to adopt separate reactive behaviors. However, during a traumatic event we are bombarded with intensified stimuli that make a persisting impression, like a meteor that slams into the earth creating a crater that is much larger in diameter than the cosmic missile.The resolution is fairly simple. The victim needs to re-learn how to sass to assorted sites and sounds. One effective recipe is to have family members repeatedly make noises in the house while development certain the injured someone is aware of when it is going to happen. One lady that I counseled, who was "jumping at every noise" realized that she only recoiled from unexpected sounds. Thus, at my suggestion, she got her husband and children to tell her before they made their usual noises. After a few weeks she became re-accustomed to the assorted household clatters and was no longer being startled.

Inappropriate Fight or Flight Responses
The process of developing "learned" autonomic responses is one of memory. The brain "remembers" the stimulus and records a "programmed" response. This causes the someone to go into performance without prior idea whenever that particular trigger shows up again. These "stress activators" can be any site, sound, touch, smell or type of "feel" that bears a similarity to the injurious event. Hence the victim perceives danger and the mind-body responds accordingly with an adrenalin rush that produces rapid heart beat and respirations, elevated blood pressure and intense emotional excitement which can ensue in a panic attack. Most often the threat is not real and if this condition perpetuates it can come to be a psychotic delusion.In assorted cases, I have treated habitancy who were terrified of driving to the extent that they idea that they were going to crash and burn while the car was still in the driveway. Additionally, there was a lady mail carrier who had been mauled by a German shepherd and was frightened of dogs and the construction inspector injured by an exploding boiler who was petrified of turning on his stove or oven. These reactions were all the ensue of instantaneous conditioned reflex. The trauma produced such an splendid impression in the memory cells of the brain, which "taught" the mind-body that the incident was going to happen again any second. The mail carrier believed that every dog was a vicious man eater; and the construction inspector was convinced that any heat producing appliance was about to explode.Therefore, the clarification is to learn not to be scared of those triggers, such as a car, a dog, or a stove. Although the resolution may be simple it is not easy. learning to discard these trauma-induced condition reflexes is a tedious task but must be fulfilled, or the victim's quality of life will be enduringly and severely impaired.First, since we are creatures of habit, the intellect gains force by repetition. If you mouth something often adequate you will start to believe it. Therefore, the victims need to repeatedly state out loud that there is nothing to fear and that it was only a particular act of the Almighty (some would prefer to call it a "freak accident").Second, the someone who is scared to drive a car needs to go into performance and get behind the wheel. However, this must be a step-by-step process. The victim should not start driving right away. There is a radio talk show personality in

South Florida by the name of JoyceKaufman who recently became severely injured in a bicycle accident. She called it "a life-altering event" and was wondering either she should ever get back on her bicycle again. When she came back on the air, many listeners called in saying that a someone scared of driving after an emergency should get into the car and start driving immediately to overcome the fear. That would be a terrible mistake because a someone who is nervous and jittery would be a danger to self and others on the road. The someone must do this slowly and rebuild some self-confidence. It has to be like learning to drive all over again.Finally, in the case of the mauling victim, learning to be comfortable nearby dogs again is more problematic, but can be accomplished. For this, one would need to have microscopic exposure to a very docile animal. I would pick a very old dog that can't do anything but lie nearby all day. Although this someone may never come to be a dog-lover, the victim needs to be able to walk down the street without being terrorized in the proximity of other people's dogs. Any unleashed strange animal should be cause for alarm, but the former bite victim can construct some comfort level in the proximity of dogs locked in behind a fence or held on a leash.

Wrap up
Coping with trauma is much more than recovering from broken bones, sprains, bruises, lacerations and concussions. Every aspect of life is adversely affected and dealing with the after effects requires a cooperative exertion between the victim and every essential someone in his or her life. The attorney needs to have evidence that there was a series of responses for which the client received pro help and that there was a concerted exertion to decree the problems. In this way the attorney would know either the client's claim of post traumatic stress causing a long term deterioration in the quality of life is real or contrived.

Post Traumatic Stress and the Nursing analysis - Part 2

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