Sepsis Related ARDS and PTSD

Sepsis Related ARDS and PTSD
Acute respiratory distress syndrome (ARDS) is a traumatic life-altering illness that can be caused by sepsis. It can be especially traumatic if it is acquired as a young adult and
Post-traumatic stress disorder (PTSD) develops as a person enters into later life. Re-living or even a perception, or fear of a reoccurrence of a traumatic event can manifest itself into PTSD. My PICO question asks: for sepsis related ARDS patients, does the use of counseling reduce the risk of PTSD, compared with patients without counseling? My research on this question could not be fully supported. It is suggested that biological influences and life experience play a much larger role in PTSD than counseling. Post-traumatic stress disorder is a psychological and physical response to a life-threatening trauma. The perception of the trauma is characterized as an individual perception and is different for each person. The psychological response can include re-experiencing the trauma, intrusive thoughts and memories, overwhelming fear, depression and disassociations with the trauma. The physical response can include, but are not limited to, nausea, headache, palpitations, diarrhea, vomiting and insomnia. Without treatment, psychological disabilities can manifest into substance abuse, physical abuse and mental disorders. In order for patients to recover, learning how to expand on the relationship between mental health and physical health and determining if counseling is needed in order to avoid any potential and further psychological and physical threats should be priority. PTSD usually presents in clusters within one month after a traumatic event. Cluster A-fearful response after a traumatic event. Cluster B-three disassociated symptoms. Cluster C-re-experiencing symptoms. Cluster D-marked avoidance. Cluster E-marked anxiety. Cluster F-evidence of significant stress or impairment in everyday task completion. In order for a diagnosis of PSTD, disturbances in all six areas must last a minimum of two days and a maximum of four weeks. (Snyder, 2008) The statement that presents through my research is that PSTD is unpredictable. Biologic reasons may be the culprit. History and processing by the patient and how they handle trauma, as well as their family and social upbringing all play a part in how PTSD can be triggered and appear. “As the traumatic event is processed, understanding and meaning are attributed to the event within the contexts of social and cultural environments. Studies indicate the level of psychological impact of the trauma experience or the individual depends heavily on pre-trauma functioning. Pre-existing depression and anxiety and multiple trauma exposures seem to increase an individual’s vulnerability to the stressors related to trauma. With the highest rates of PSTD associated with violent or sexual trauma.” (Nakell, 2007) For some patients, symptoms are vague. If ARDS was perceived as a traumatic event as a young adult, it can reactivate as an older adult if another traumatic event happens. Patients can seek care through their primary care or behavioral health services to learn to recognize PSTD. Life history, co-morbidities and physical assessments are imperative to treatment for patients with PTSD. Many treatment plans include pharmacological and psychotherapy. The focus on ARDS patients should be individualized to include trauma, anxiety and cognitive therapy, and stress management. Optimal physical and mental health should be the long term goal to improve the quality of life for individuals with ARDS related PSTD. Functional impairment should also be a factor in treatment. Any correlation in symptoms can be beneficial, based on this knowledge. It can guide goals, modifications, and may allow for the patient to learn new coping skills to effectively help improve their symptoms. This can also ensure patient involvement in their own care to help recognize stressors and triggers related to an onset of a reoccurrence. (Rodriquez, Holowka, Maxx, 2012) In conclusion, there is no solid proof that counseling can reduce the risk of PTSD in ARDS patients. However, a good assessment of history and co-morbidities by a primary care provider in addition to a behavioral/mental health professional can lead to better control and recognition of symptoms and triggers to avoid a reoccurrence of PSTD. References

Snyder, M. (2008) Late-onset post-traumatic stress disorder. Journal of Psychosocial Nursing & Mental Health Services, 46(11), 39-44. Doi:10.3928/02793695-20081101-10

Nakell, L. (2007) Adult post-traumatic stress disorder: Screening and testing in primary care. Primary Care, 34, 593-610.

Rodriquez, P., Holloway, D. W. & Maxx, B. P. (2012) Assessment of post-traumatic stress disorder-related functional impairment: a review. Journal of Rehabilitative Research & Development 49(5). Doi:10.1682/JRRD-2011.09.0162
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