Posttraumatic Stress Disorder Mr. Blake is brought to the emergency department by his wife after she finds him writing a suicide note and planning to take a bottle of prescription sleeping pills. Mr. Blake is subdued, shows minimal effect, and has the odor of alcohol on his breath. When asked about his 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 self. Mr. Blakes wife gives further history. Her husband is a 50-year-old retired firefighter who was part of the emergency team that responded to the World Trade Center terrorist attack on September 11, 2001. He lost half of his crew members in the fire. A few months later, he decided to take an early retirement so that he and his wife could move south to be near their daughters family. Initially, he showed no signs of anxiety and refused offers of crisis treatment, stating, I was in Vietnam, I can handle stress. But six months later, Ms. Blake noticed that her husband had trouble sleeping, his mood was irritable or withdrawn, he avoided news reports on television, and he started drinking daily. He complained of nightmares but would not talk to her about his fears. He only agreed to go to the primary care physician to request sleeping medication. Mr. Blake is admitted to the psychiatric unit and is assigned to a nurse, Ms. Dawson. He is passive as she orients him to the unit, but she observes that he looks around carefully and is easily startled by sounds on the unit. Assessment Objective Data Sleep difficulty, nightmares Increased alcohol consumption Irritability Withdrawn mood Constricted/reduced range of affect Supportive family Avoidance of news coverage on TV Refuses to contract for safety Plan for suicide Firefighter in 9/11 Witnessed deaths of coworkers Hypervigilant Subjective Data I dont deserve to live. I should have died with the others. You cant stop me. Feels worthless I can handle stress. Family would be better off without me. unrealistic guilt Self-Assessment Ms. Dawson is a registered nurse with an AA degree and three years of experience on this unit. Initially, she feels sympathy for Mr. Blake, and he reminds her of her Uncle James, who also served in Vietnam. She is concerned because his suicide plan is lethal and he is guarded in his speech, not revealing his thoughts or feelings. She realizes that as she implements suicide precautions, she must demonstrate an attitude of hope and acceptance to encourage him to develop trust. Also, she must stay neutral and not convey pity or sympathy. As a firefighter, Mr. Blake was once a care provider, and he already feels like a failure because he could not save his friends or prevent his own symptoms. Diagnosis Risk for suicide, related to anger and hopelessness due to severe trauma, as evidenced by suicidal plan and verbalization of intent. Lethal plan with saved presc.

1. Posttraumatic Stress Disorder
Mr. Blake is brought to the emergency department by his wife after she finds him writing a
suicide note and planning to take a bottle of prescription sleeping pills. Mr. Blake is subdued,
shows minimal effect, and has the odor of alcohol on his breath. When asked about his 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 self.
Mr. Blakes wife gives further history. Her husband is a 50-year-old retired firefighter who was
part of the emergency team that responded to the World Trade Center terrorist attack on
September 11, 2001. He lost half of his crew members in the fire. A few months later, he decided
to take an early retirement so that he and his wife could move south to be near their daughters
family. Initially, he showed no signs of anxiety and refused offers of crisis treatment, stating, I
was in Vietnam, I can handle stress. But six months later, Ms. Blake noticed that her husband
had trouble sleeping, his mood was irritable or withdrawn, he avoided news reports on television,
and he started drinking daily. He complained of nightmares but would not talk to her about his
fears. He only agreed to go to the primary care physician to request sleeping medication.
Mr. Blake is admitted to the psychiatric unit and is assigned to a nurse, Ms. Dawson. He is
passive as she orients him to the unit, but she observes that he looks around carefully and is
easily startled by sounds on the unit.
Assessment
Objective Data
Sleep difficulty, nightmares
Increased alcohol consumption
Irritability
Withdrawn mood
Constricted/reduced range of affect
Supportive family
Avoidance of news coverage on TV
Refuses to contract for safety
Plan for suicide
Firefighter in 9/11
Witnessed deaths of coworkers
Hypervigilant
Subjective Data
I dont deserve to live. I should have died with the others.

2. You cant stop me.
Feels worthless
I can handle stress.
Family would be better off without me.
unrealistic guilt
Self-Assessment
Ms. Dawson is a registered nurse with an AA degree and three years of experience on this unit.
Initially, she feels sympathy for Mr. Blake, and he reminds her of her Uncle James, who also
served in Vietnam. She is concerned because his suicide plan is lethal and he is guarded in his
speech, not revealing his thoughts or feelings. She realizes that as she implements suicide
precautions, she must demonstrate an attitude of hope and acceptance to encourage him to
develop trust. Also, she must stay neutral and not convey pity or sympathy. As a firefighter, Mr.
Blake was once a care provider, and he already feels like a failure because he could not save his
friends or prevent his own symptoms.
Diagnosis
Risk for suicide, related to anger and hopelessness due to severe trauma, as evidenced by suicidal
plan and verbalization of intent.
Lethal plan with saved prescription medication and alcohol
Refusal to contract for safety
Emotional withdrawal from wife
Posttrauma response, related to exposure to traumatic event and inability to assist fellow soldiers.
Feelings of guilt
Hypervigilance
Feelings of worthlessness
Insomnia
Suicide attempt
Outcomes Identification
Patient will consistently refrain from attempting suicide.
Patient will demonstrate effective anxiety reduction skills and attend support groups.
Planning
The initial plan is to maintain safety for Mr. Blake while encouraging him to express feelings
and recognize that his situation is not hopeless. The priority is Mr. Blakes risk for suicide, and as
that resolves the nurse will begin to address Mr. Blakes, posttrauma symptoms.
Assignment: Implementation
Review the case study above and consider Mr. Blake's diagnosis, outcome identification and

3. planning. Fill out the short care plan that is attached with this assignment. You will need:
1. Three short-term goals for Mr. Blake. Remember these are achievable in a set amount of time.
2. Five interventions for each goal and five rationales for why yo selected your interventions.
This is a personalized care plan for Mr. Blake so be sure to refer back to the above case study as
you work.
3. Evaluate and state why or why not you believe your goals for Mr. Blake are met. (Hint: Look
at your goals and interventions. Based on Mr. Blake's presentation do you feel he will meet his
goals for you? Refer to the case study for your whys and why nots)
4. In a brief paragraph under the Follow-up heading for this assignment write about what Mr.
Blake can do to maintain his health and safety, and also continue his therapy. In a second
paragraph, write about what you have learned regarding post traumatic stress and the veteran
population.