A nurse is caring for a client with post-traumatic stress disorder (PTSD) who experiences frequent nightmares …

Question

A nurse is caring for a client with post-traumatic stress disorder (PTSD) who experiences frequent nightmares and flashbacks. Which nursing intervention would be most therapeutic for this client?

Accepted Answer

보기 4: Teach grounding techniques to help manage flashbacks and dissociation

Teaching grounding techniques is the most therapeutic intervention as it provides practical coping skills for managing PTSD symptoms like flashbacks and dissociation. Other options may retraumatize (discussing details), mask symptoms (sedating medications), or avoid necessary triggers.

Answer

보기 1: Encourage the client to discuss the traumatic event in detail during each interaction

Answer

보기 2: Provide sedating medications before bedtime to prevent nightmares

Answer

보기 3: Avoid discussing triggers to prevent re-traumatization

Concept	Description	Nursing Implication
Grounding Techniques	Sensory-based strategies to reconnect with the present moment during dissociation or flashbacks.	First-line nursing intervention for acute distress in PTSD. Teaches 5-4-3-2-1 technique, deep breathing, holding ice.
Trauma-Informed Care	Care approach recognizing the impact of trauma, emphasizing safety, trust, choice, and empowerment.	Avoid re-traumatization. Use collaborative language. Ensure physical and emotional safety.
PTSD Core Symptoms (DSM-5)	1. Intrusion (flashbacks, nightmares) 2. Avoidance 3. Negative alterations in cognition/mood 4. Hyperarousal (hypervigilance, startle)	Tailor interventions to the specific symptom cluster. For intrusion/arousal: grounding and relaxation. For avoidance: gradual exposure (by therapist).
Dissociation	A mental process of disconnecting from thoughts, feelings, memories, or sense of identity.	Assess for depersonalization or derealization. Use grounding to "reconnect." Remain calm and present with the client.

Intervention	Therapeutic Rationale	When to Use / When to Avoid
Teaching Grounding Techniques (Correct Answer)	Empowers client, provides immediate coping, addresses dissociation, is non-invasive and client-controlled.	USE during flashbacks, panic, or dissociation. USE proactively as a preventive skill. AVOID using complex techniques when client is severely agitated.
Watch out for confusion! Forcing Detailed Trauma Narration (Option 1)	Part of formal therapy to process and integrate memories. Done in a controlled, phased manner.	AVOID by nurses in general interactions. USE only by trained therapists within a specific therapeutic framework.
PRN Sedation (Option 2)	May reduce physiological arousal temporarily but does not address psychological root.	USE cautiously per medication order for severe anxiety/sleep. AVOID as a first-line or sole intervention. It is a suppressive not a therapeutic nursing action.

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A nurse is caring for a client with post-traumatic stress disorder (PTSD) who experiences frequent nightmares and flashbacks. Which nursing intervention would be most therapeutic for this client?

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