NCLIP

PTSD and Veteran Trauma

3 min read

PTSD and Veteran Trauma

Key Points

  • PTSD develops after trauma exposure and can cause intrusive symptoms, avoidance, hyperarousal, and functional decline.
  • Veteran populations face elevated risk due to combat and repeated threat exposure.
  • Effective treatment combines trauma-focused psychotherapy, selected medications, and coordinated support resources.
  • Nursing care centers on safety assessment, trauma-informed alliance, and self-management coaching.

Pathophysiology

PTSD reflects persistent dysregulation of stress-response systems after trauma, with heightened threat reactivity and impaired recovery from trauma reminders. Symptom clusters include intrusion, avoidance, negative mood/cognition changes, and arousal disturbances.

Military trauma may add moral injury, repeated exposure, and social reintegration stress, increasing complexity of recovery.

Classification

  • Trauma-related symptom domains: Intrusion, avoidance, negative cognitions/mood, arousal/reactivity.
  • Context subtype consideration: Veteran and combat-related trauma contexts with occupational and identity implications.
  • Comorbidity patterns: Depression, anxiety, substance use, sleep disturbance, suicidality risk.

Nursing Assessment

NCLEX Focus

Always include safety and suicidality assessment when PTSD symptoms escalate or function deteriorates.

  • Assess trauma history and current trigger profile with client consent and pacing.
  • Assess DSM-aligned symptom clusters and duration/functional impact.
  • Assess co-occurring depression, anxiety, substance use, and sleep disturbance.
  • Assess suicide risk, self-harm risk, and environmental safety needs.
  • Assess client goals, treatment preferences, and veteran-specific support access.

Nursing Interventions

  • Build therapeutic alliance through trust, predictability, and trauma-informed communication.
  • Reinforce adherence to trauma-focused therapy and structured coping plans.
  • Provide psychoeducation on trigger management, grounding, and stress reduction.
  • Coordinate referrals to veteran-focused services, crisis resources, and peer supports.
  • Collaborate with family/support systems when aligned with client preference.

Retraumatization Hazard

Abrupt exposure to traumatic content without stabilization can worsen symptoms and disengagement.

Pharmacology

SSRIs (sertraline, paroxetine) and SNRI options such as venlafaxine are commonly used for PTSD symptom burden, with off-label agents sometimes used for specific symptoms (for example, trauma-related nightmares). Nursing monitoring includes efficacy, side effects, adherence, and safety during medication changes.

Clinical Judgment Application

Clinical Scenario

A veteran reports nightmares, hypervigilance, irritability, and avoidance of public places with worsening work function.

Recognize Cues: PTSD symptom clusters with meaningful functional impairment. Analyze Cues: Trigger burden and sleep disruption are reinforcing symptom severity. Prioritize Hypotheses: Safety, sleep restoration, and treatment engagement are immediate priorities. Generate Solutions: Combine trauma-focused therapy referral, coping coaching, and medication review. Take Action: Implement individualized plan with veteran resource linkage. Evaluate Outcomes: Reduced arousal, improved sleep, and improved functioning.

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