Dealing with aggressive pts

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elmarsha
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33615
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Dealing with aggressive pts
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2010-09-09 02:54:48
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aggressive patients
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Dealing with aggressive patients
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  1. Passive behavior
    Subordinates own rights to his or her perception of the rights of others
  2. Assertive behavior
    Conveys a sense of self-assurance and communicates respect for others
  3. Aggressive behavior
    Ignores the rights of others
  4. The best way to de-escalate someone is:
    To be assertive
  5. Violence results from:
    Anger occurs as a response to:
    Non-fatal assaults are more common in:
    anger or fear

    A preceived threat

    Service industries
  6. BIOPSYCHOSOCIAL THEORIES
    Biologic theories:
    -
    -
    Genetic Abnormalities
    Neuropsychologic injuries
    -
    -
    -
    -
    -
    • ◦Imbalances
    • of hormones
    • ◦Neurotransmitters



    ◦Trauma

    ◦Anoxia

    • ◦Metabolic
    • imbalance

    ◦Encephalitis

    • ◦Organic
    • brain injury
  7. Increases in what two neurochemicals can cause aggression?
    Decreases in what can cause aggression?
    • Dopamine and norepinephering
    • GABA (the calming chemical)
  8. BIOPSYCHOSOCIAL THEORIES
    Psychosocial theories
    -
    -
    -

    Behavioral theory
    • Psychoanalytic- freud
    • Psychological
    • Sociocultural

    • Pavlov-conditioning
    • humanistic and learned behavior
  9. AGGRESSION AND THE BRAIN
    Hypothalamus:
    What does it do?
    What does dysfunction lead to?
    ◦Alarm system, controls pituitary function

    ◦Dysfunction leads to overreaction to stress and over activation of pituitary
  10. AGGRESSION AND THE BRAIN
    Hippocampus
    What does it do?
    What happens if it is dysfunctional?
    ◦Regulates the recall of recent experiences and new information

    ◦Dysfunction associated with impulsivity
  11. AGGRESSION AND THE BRAIN
    Amygdala
    What does it do?
    What if its dysfunctional?
    ◦Regulates emotion, memory storage, information processing

    ◦Dysfunction affects emotion and behavior, outbursts of fear, anger, rage, hypersexuality
  12. AGGRESSION AND THE BRAIN
    frontal cortex
    What does it do?
    What if its dysfunctional?
    ◦Generates thought and purposeful behavior

    ◦Dysfunction leads to impaired judgement, poor decision-making, personality changes, aggressive outbursts
  13. Mental Disorders in which aggression often occur
    • —Antisocial
    • Personality Disorder

    —Borderline Personality Disorder

    —Conduct Disorder-usually occurs before age 15, precursor to APD

    —Delusional Disorder

    —Dementia of the Alzheimer’s Type

    —Substance Abuse

    —Intermittent Explosive Disorder

    —Schizophrenia
  14. What factors can determine self awareness?
    (Which is important when intervening with an aggressive patient)
    ◦Family of origin- walk away, share feelings

    ◦Personal responses to anger & aggression

    ◦Self-assessment can lead to self-intervention- be prepared to know how you will respond
  15. Risk factors for violence
    • •History of violence-
    • probably most important

    • •Severity of
    • psychopathology

    • •Higher levels of
    • hostility

    • •Length of time in the
    • hospital

    • •Early age of onset of
    • psychiatric symptoms

    • •Frequency of
    • admission to psychiatric hospitals
  16. NURSING PROCESS
    Assess for clients balancing factors
    -
    -
    -
    If any of these are not intact, the person is at a higher risk for violence.
    –Perception of precipitating event/current situation

    –Support system

    –Usual coping patterns
  17. NURSING PROCESS
    Environmental factors
    • –Availability of
    • dangerous objects

    –Overcrowding

    –Staffing

    –Supervision
  18. NURSING PROCESS
    Other considerations:
    —Impulse control

    • —Sensory-perceptual
    • functioning

    —Cognitive functioning

    —Social skills

    • —Impaired
    • communication

    —Helplessness

    —Powerlessness
  19. Behavioral cues indicating violence
    • ◦Clenched
    • jaws and fists

    • ◦Dilated
    • pupils

    • ◦Intense
    • staring

    • ◦Flushing
    • of face and neck

    • ◦Frowning,
    • glaring, smirking

    • ◦Pacing
    • Increased vigilance
  20. Verbal ques indicating violence
    • ◦Threats
    • of harm

    • ◦Loud
    • demanding tone

    • ◦Abrupt
    • silence

    • ◦Sarcastic
    • remarks

    • ◦Pressured
    • speech

    • ◦Illogical
    • responses

    • ◦Yelling,
    • screaming

    • ◦Statements
    • of fear or suspicion
  21. Possible nursing diagnosises
    • ◦Potential
    • for violence, other directed

    • ◦Ineffective
    • individual coping

    ◦Anxiety

    • ◦Chronic
    • low self-esteem; Situational low self esteem
  22. Preventative interventions
    • education
    • (about anger management, problem solving skills, communication skills),
    • assertiveness
  23. Anticipatory interventions
    • communication (to be able to de-escalate client and calm them down),
    • environment (therapeutic milieu),
    • behavioral (behavioral contracts, setting limits),
    • psychopharmacology
  24. Containment
    crisis management, seclusion and restraint- never a punnishment, always a last resort for safety.
  25. Ensuring safety
    —Minimizing personal

    risk



    —Nonthreatening

    communication



    —Awareness of

    environment



    —Availability of other

    staff members



    —Awareness of clothing

    and objects
  26. Interventions
    §Help patient

    verbalize feelings



    §Early recognition



    §Appropriate release

    (on an inanimate object)



    §Do not take

    personally



    §Do not ignore

    behaviors



    §Clear, consistent

    limits*(see next slide)



    §Decrease stimuli



    §Know your

    surroundings



    §Evaluate

    hallucinations (know if there are command hallucinations going on



    §Support
  27. Mood stabilizers
  28. clients who are irritable or have poor impulse control (depakote, lithium
  29. Benzodiazepines-
    use
  30. short term rather than long acting. Ativan is most common
  31. —SSRI-
    used in
  32. personality disorders to manage aggressive behavior
  33. —Chronic aggression:
    beta blockers,
  34. anticonvulsants, Lithium, Trazadone (antidepressant, used for sleep, doesn’t alter the
  35. sleep cycle)
  36. Rationale for use of seclusion
    ◦Containment—Patients are

    restricted to a place where they are safe from harming themselves and other

    patients



    ◦Isolation—Patients can

    distance themselves from relationships with others



    ◦Decrease

    in sensory input—A

    quiet atmosphere can provide relief from sensory overload
  37. Self awareness
    Remember, its a continuum. Calm and unthreatening is where we start
    —How do I feel about

    this patient/setting?



    —How are my feelings

    affecting my behavior?



    —Fear is a normal

    response.



    —Avoid personalizing.



    —Use intuition.

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