Page 12 Complete Your CE Test Online - Click Here ● ● Other studies found a 14% prevalence of PTSD, with findings that range from 4 percent to 17% in those who served in Iraq. ● ● A 2014 comprehensive analysis found that among male and female soldiers aged 18 years or older returning from Iraq and Afghanistan, PTSD rates range from nine percent soon after returning from deployment to 31% a year after deployment. ● ● Fifty percent of veterans with PTSD do not seek treatment. Half of those who do seek treatment report receiving only “minimally adequate” treatment. EBP alert! Research shows that PTSD affects a significant portion of the general population as well as veterans. This means it is probable that nurses will encounter a client suffering from PTSD. Therefore, they must be able to recognize the disorder, facilitate treatment, and provide appropriate nursing care. PTSD and traumatic brain injury An estimated 22% of all combat casualties from the conflicts in Iraq and Afghanistan are traumatic brain injuries (TBIs). Vietnam related combat casualties from brain injuries are 12% (U.S. Department of Veterans Affairs, 2017). The primary cause of TBI in Veterans of Iraq and Afghanistan are blasts, blast plus motor vehicle accidents (MVAs), MVA’s alone, and gunshot wounds. Research shows that exposure to blasts is unlike other causes of military TBI, and it may cause different symptoms. For example, veterans seem to experience post-concussive symptoms for longer than the civilian population experiencing TBI. In fact, some studies show that most veterans continue to have residual symptoms 18-24 months after the injury. Compounding the effects of military TBI is the problem that many veterans have multiple medical problems including PTSD, chronic pain, and substance use/abuse. Clients with TBI frequently meet the criteria for PTSD on screening instruments for TBI and vice versa (U.S. Department of Veterans Affairs, 2017). Therefore, it is imperative that nurses as well as other healthcare professionals screen for both problems when working with veterans. PTSD and substance abuse It is not uncommon for persons with PTSD to develop unhealthy coping mechanisms in order to deal with the symptoms of the disorder, such as: drinking excessively, using drugs, or smoking heavily. Having PTSD increases the risk that the affected person will develop a drinking or drug problem. Abuse of these substances can lead to Substance Use Disorder (SUD), which must be treated in conjunction with PTSD (U.S. Department of Veterans Affairs, 2015b). There is a strong link between PTSD and SUD in the entire population. Statistics specific to veterans include (U.S. Department of Veterans Affairs, 2015b): ● ● Veterans with both PTSD and alcohol abuse problems tend to be binge drinkers, which may be a response to bad memories of combat trauma. ● ● Nearly one in three veterans who seek treatment for SUD also has PTSD. ● ● The number of veterans who use nicotine products is almost double for those who have PTSD compared to those who do not. ● ● About one in 10 soldiers returning from the wars in Iraq and Afghanistan who are seen in a VA setting have a problem with alcohol or other drugs. Risk factors Risk factors for the development of PTSD in veterans include (U.S. Department of Veterans Affairs, 2015a): ● ● Being female. ● ● Being Hispanic. ● ● Family problems. ● ● Longer time of deployment. ● ● Low morale and poor social support within his/her unit. ● ● Lower level of education. ● ● Lower rank. ● ● Member of the National Guard or Reserves. ● ● More severe combat exposure such as deployment to forward areas close to the enemy and/or seeing others wounded or killed. ● ● More severe physical injury. ● ● Not being married. ● ● Prior exposure to trauma. ● ● TBI. Signs and symptoms of PTSD Veterans with PTSD generally report that symptoms began immediately or soon after the traumatic triggering event(s), although they may not become evident for months or years later (Durkin, 2013). PTSD symptoms can be grouped into 4 main categories (Durkin, 2013; National Center for PTSD, 2016). 1. Reliving the event: Also referred to as re-experiencing. This involves having memories of the traumatic event(s) that triggered the disorder return at any time. Veterans may have nightmares or feel as though they are living through the trauma again. These feelings are referred to as flashbacks. 2. Avoiding situations that remind veterans of the event: Veterans may go to considerable effort to avoid situations or people that bring back memories of the event. For example, hot weather and tall grass may trigger flashbacks of traumatic events for Vietnam veterans, making them avoid living or visiting areas with hot climates. Avoidance of situations that trigger memories may reach phobic proportions, with veterans taking extreme measures to avoid them. 3. Having more negative thoughts and feelings than before: The way veterans think about themselves and others may change because of the traumatic events they have experienced. They may have feelings of detachment or estrangement that damage or even destroy interpersonal relationships. Veterans may feel guilty that they have survived while friends or comrades were killed or injured. Those who were injured may relive the experience of sustaining those injuries as part of reliving the traumatic events, and they may also view themselves differently—as in cases where injuries result in permanent disabilities, such as the loss of a limb. 4. Hyperarousal: This involves feeling anxious and jittery and always being on the lookout for danger in environments. Veterans may abruptly become angry or irritable for reasons unknown to others. Additional symptoms include (Borchers, 2015; Durkin, 2013): ● ● Intrusive memories of the traumatic event. ● ● Trouble falling or staying asleep. ● ● Aggressive outbursts upon awakening. ● ● Survivor’s guilt. (Feeling guilty or having done something wrong by surviving a traumatic event such as combat when others did not.) ● ● Chronic anxiety. ● ● Panic attacks. (Sudden feelings of extreme fear and anxiety. The heart pounds and there may be difficulty in breathing. They may feel as if they are dying or losing their minds.) ● ● Depression. ● ● Suicidal thoughts. Diagnosis Diagnosis depends on a thorough physical and mental health assessment. However, as noted, veterans are sometimes reluctant to seek help for mental health issues. This makes veteran/family education particularly important. Veterans, families, and colleagues may believe that certain behaviors are a normal part of readjusting to life at home. Some, including veterans themselves, may believe that seeking help is a sign of weakness or that nothing, including medical treatment, can help them. Therefore, veterans and families should be taught about the signs and symptoms of PTSD and that there is effective treatment available. Nursing consideration: Whenever veterans seek medical attention they should also be evaluated for signs and symptoms of PTSD and other mental health problems. Such problems may be identified when veterans are seeking help for other reasons or even when they are accompanying family members to medical office visits. As PTSD can manifest days to years after the event, the screening should be ongoing throughout the veteran’s life.