Brief Discussion of the Disease

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people
who have experienced or witnessed a traumatic event such as a natural disaster, a serious
accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual
violence or serious injury (American Psychiatric Association, 2020).
People suffering from PTSD have serious, unsettling thoughts and feelings about their
traumatic experience that linger long after the incident has ended. They can relive the event
through flashbacks or nightmares, experience depression, anxiety, or rage, and feel disconnected
or alienated from others. People suffering from PTSD may avoid circumstances or people that
remind them of the traumatic incident, and they may have strong negative reactions to seemingly
innocuous things such as a loud noise or an unintentional contact.
A distraught wife brings Mr. Balake, 56-year-old, to the emergency department after she
finds him writing a suicide note and planning to shoot himself in the woods with a handgun. Mr.
Balake is subdued, shows minimal effect, and his breath has the distinct odor of alcohol. When
asked about suicidal thoughts, he states that he is worthless and that his wife and family would
be better off if he were dead. He refuses to contract for safety. The decision is made to
hospitalize him to protect him from danger to himself.
Mr. Balake’s wife provides further history. Her husband is a construction contractor who
served in the Philippine Government Forces during the Battle of Marawi. He lost half his squad
from a roadside bombing, narrowly escaping with his life. He walks with a permanent limp due
to the attack. Upon returning home, he showed no signs of anxiety and refused offers of crisis
treatment, stating, “I was in a war; I can handle stress.” But six months later, Mrs. Balake noticed
that her husband had trouble sleeping, his mood was irritable or withdrawn, he avoided news
reports on television, and he started to drink daily. He complained of nightmares but would not
talk to her about his fears. He only agreed to go to his primary care nurse practitioner to request
sleeping medication.

Preoperative Management
1. Assess patients’ level of anxiety
1. Psychological Preparation
Surgery is a potential or actual threat to person’s bodily integrity and can interfere with the
attainment of goals in any phase of surgery
Implementation of Psychological Preparation
1. We need to provide expression of concern
2. The client need support from his family and friends
3. We also need to provide means of control – allow the client to participate in decision making
4. Help client meet his physical need during preoperative phase to provide feeling of security
5. Preoperative Teaching – to ensure positive surgical experience and to lessen the anxiety of the
client
Preoperative Teaching
 Involves emotional energy on the part of the nurse
 Produces behavioral changes in patients to become better prepared physically and emotionally
Three Levels
1. Information: explanation of procedures, patient care activities (V/S), physical feelings that the
patient may encounter (A/C in room, temp of solution and instruments).
2. Psychosocial support: enhance coping mechanisms to deal with anxiety, fears and provide
emotional support.
3. Skill training: guided practice of specific task to be performed by the patient in the post-
operative period can decrease anxiety, hasten recovery and help prevent complications
For example:
 coughing and deep breathing exercises
 ROM exercises
 Wound dressing
2. Legal Preparation:
Ensure that consent form has been signed
a. Informed Consent
- Since the client is incapable of signing the consent form, the nurse must obtain consent from
the wife. The client and his wife must understand the nature of surgery and must be informed of
the risk and benefits of surgery. The nurse may act as a witness and reinforce what was said
when surgeon explained the procedure to the client and family.
3. Physiological Preparation
Made by both the physician and the nurse, directed to toward safe and comfortable surgical
experience
a. Food and fluids are usually withheld 6-8 hours before the surgery to decrease gastric contents
and risk, of Gastroesophageal reflux aspiration pneumonia, respiratory arrest, or death
Noncompliance of NPO order may necessitate cancellation of surgery (elective)
b. Skin preparation: ideally a depilatory agent is the best method of removing hair (check for
allergies)
 According to Hamilton 1977, depilatory creams are not recommended because they can cause
serious irritation and rashes in a significant number of patients, which may lead to wound
infection
 Shaving will do as long as the shaving of the incision site is done immediately before the
surgical procedure and preferably in the operating room
According to Alexander and Materson, Clipping should be used as the standard process of hair
removal in the operating room immediately before the surgery without significantly increasing
the wound infection rate provided the clipper head is sterile.
3. Have the client to empty his bladder before giving preoperative medication.
e. Common Preoperative Laboratory Tests
U/A – to assess renal status, hydration,
CXR – to assess pulmonary disorders, cardiac enlargement
Blood studies: CBC, Hgb, Hct, Clotting and Bleeding time; to assess immune system status and
anemia
ECG – assess Cardiac status, electrolyte imbalances
Blood typing and cross matching – blood compatibility and replacement
f. IV line is inserted for fluid replacement and for drug administration
1. Assess patients’ level of anxiety
2. Ensure that consent form has been signed
3. Have patient empty his bladder before giving preoperative medication.
4. ask the client Not to get out of bed after medicated.
5. Put the bed as its lowest position, side rails up, call light with reach, to promote safety and
reduce incidence of falls.
6. Obtain baseline vital signs, determine LOC, monitor and document medication effects (before
and after medication is given in order to compare and gauge the effect of the drug).
7. Assist with the transfer of the patient from the hospital bed to the stretcher.
8. Check ID band and chart to ensure all information are documented