Title: Post-Traumatic Stress Disorder (PTSD)
Scenario: Parents bringing their 11 year old to a mental health clinic for evaluation share with the intake nurse that, “We have been really concerned since the school shooting incidence.”
The child’s history interview with the parents provides the following data:
Child was present a month ago when an active shooter incident occurred at the local elementary school. The child spent 45 minutes hiding in a supply closet with 4 other classmates until police brought them safety out of the building. The parents report that “everything seemed fine at first” but within the last 2 weeks the child has developed problems sleeping being awaken 2-3 times a night by nightmares described as involving “scary people with guns.” Parents report the child can be “happy 1 minute and crying the next; being physically aggressive towards our other children for not reason.” The child’s asthma symptoms have increased requiring an adjustment in medication management and reports of “headaches” are common since the shootings. The mother confided that she’s found the child, “hiding in the closet” several times and with the child explaining, “that’s what I did to stay safe.” The child prefers to watch television or read books than go outside and play. The father added that the child. “has always been a bit forgetful but that’s gotten worse in the last 2 weeks as well.”
Item Type: Enhanced Hot Spot (Highlighting)
Highlight the history interview findings that require follow-up since they are suggestive of a mental health concern.
Child was present in class a month ago when an active shooter incident occurred at the local elementary school. The child spent 45 minutes hiding in a supply closet with 4 other classmates until police brought them safety out of the building. The parents report that “everything seemed fine at first” but within the last 2 weeks the child has developed problems sleeping being awaken 2-3 times a night by nightmares described as involving “scary people with guns.” Parents report the child can be “happy 1 minute and crying the next; being physically aggressive towards our other children for not reason.” The child’s asthma symptoms have increased requiring an adjustment in medication management and reports of “headaches” are common since the shootings. The mother confided that she’s found the child, “hiding in the closet” several times and with the child explaining, “that’s what I did to stay safe.” The child prefers to watch television or read books than going outside to play and repeatedly states, “I want to be a teacher or policeman when I grow up.” The father added that the child. “has always been a bit forgetful but that’s gotten worse in the last 2 weeks as well”.
Cognitive Skill: Recognize Cues
Reference: Halter-Jordon, Margaret. (2018) Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders, Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, (ed. 8). St. Louis: Elsevier.
Discuss first priority with this patient.
1. What questions would you ask child? How would you build trust with an 11 year old that is anxious?
2. What concerns would you have for child and family?
3 What could be some trauma interventions for the family and child who is experiencing anxiety and flashbacks inside and outside the hospital
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