Term
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Definition
| an emotional response to frustration of desires, a threat to one's needs (emotional or physical), or a challenge. It is a normal emotion that can even be viewed as positive when it is expressed in a healthy way. |
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Term
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Definition
| an action or behavior that results in a verbal or physical attack. Aggression tends to be used synonymously with violence; however, aggression is not always inappropriate and is sometimes necessary for self-protection. |
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Term
| what are the 3 most violent places in the hospital? |
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Definition
• Psychiatric units
• Emergency departments
• Geriatric units |
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Term
| What are anger's effects on your body? |
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Definition
| risk factors for hypertension and cardiovascular disease, including ischemic heart disease and cerebral vascular attacks (Kassinove & Tafrate, 2006). Suppression of anger has been shown to increase diastolic blood pressure and heart rate (Jorgensen & Kolodziej, 2007). Suppressed anger has also been shown to increase a person's perception of pain |
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Term
| Which part of the brain mediates anger experiences, which judges them as good or bad? |
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Definition
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Term
| Which neurotransmitters have a vital role in anger and agression? |
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Definition
| Serotonin, dopamine, norepinephrine, gamma-aminobutyric acid (GABA), glutamate, and acetylcholine |
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Term
| if a patient is angry, how may they show it? |
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Definition
| it may manifest as increased demands, irritability, frowning, redness of the face, pacing, twisting of the hands, or clenching and unclenching of the fists. Speech may either be increased in rate and volume or may be slowed, pointed, and quiet. |
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Term
| describe Trauma-informed care |
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Definition
| It is based on the notion that disruptive psychiatric patients often have histories that include violence and victimization . Trauma-informed care focuses on the patient's past experiences of violence or trauma and the role it currently plays in their lives. |
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Term
| what are some of the signs and symptoms that may usually precede a violent outburst? |
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Definition
• Hyperactivity: most important predictor of imminent violence (e.g., pacing, restlessness)
• Increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have shortness of breath, sweating, and rapid pulse)
• Verbal abuse: profanity, argumentativeness
• Loud voice, change of pitch; or very soft voice, forcing others to strain to hear
• Intense eye contact or avoidance of eye contact |
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Term
| what is the best predictor of a future violent outburst by a patient? |
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Definition
| a past history of violence |
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Term
| what are some of the main nursing (NOC) diagnosis that might be given to a violent patient? |
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Definition
| Ineffective coping (overwhelmed or maladaptive), Stress overload, Risk for self-directed violence, and Risk for other-directed violence |
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Term
| Name 5 de-escalation techniques for a patient |
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Definition
• Maintain the patient's self-esteem and dignity.
• Maintain calmness (your own and the patient's).
• Assess the patient and the situation.
• Identify stressors and stress indicators.
• Respond as early as possible.
• Use a calm, clear tone of voice.
• Invest time.
• Remain honest.
• Establish what the patient considers to be his or her need.
• Be goal oriented.
• Maintain a large personal space.
• Avoid verbal struggles.
• Give several options.
• Make clear the options.
• Utilize a nonaggressive posture.
• Use genuineness and empathy.
• Attempt to be confidently aware.
• Use verbal, nonverbal, and communication skills.
• Be assertive (not aggressive).
• Assess for personal safety. |
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Term
| what are the main 2 classes of drugs used in anger/agression? |
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Definition
| Antianxiety agents and antipsychotics |
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Term
| what has historically been the most widely used antipsychotic? |
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Definition
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Term
| what is taking haloperidol's place as the most common antipsychotic drug? |
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Definition
| olanzapine and ziprasidone |
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Term
| an antipscyhotic is often mixed with what drug before giving IM? |
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Definition
| A combination of antipsychotic (haloperidol or perphenazine) and a benzodiazepine (lorazepam) can be given IM |
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Term
| List 5 of the different classes of medications given to angry/violent patients |
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Definition
Selective serotonin reuptake inhibitors (SSRIs)
Lithium
anticonvulsants
gabapentin
benzo's
atypical antipsychotics
beta-blockers
psychostimulants |
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Term
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Definition
| “the involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving” (p. 96). The goal of seclusion is never punitive. Rather, the goal is safety of the patient and others. |
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Term
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Definition
| “any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely” |
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Term
| what contrandications do you assess a patient for, before secluding them? |
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Definition
| pregnancy, COPD, head or spinal injury, seizure disorder, abuse, history of surgery or fracture, morbid obesity, and sleep apnea. |
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Term
| what are the legal requirements for using a mechanical restraint? |
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Definition
• Multidisciplinary involvement
• Appropriate health care provider's signature according to state law
• Patient advocate or relative notification
• Restraint/seclusion discontinuation as soon as possible
• No use of weapons |
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Term
1. Which statement about violence and nursing is accurate?
1. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence.
2. About 1 in 10 nurses will face an injury due to patient violence during their careers.
3. Emergency, psychiatric, and step-down units have the highest rates of violence towards staff.
4. Violence primarily affects inexperienced or unskilled staff who cannot calm their patients. |
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Definition
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Term
2. A nurse working with a patient who describes himself as “always angry” should assess the patient for which problem(s)? Select all that apply.
1. Pain
2. Dementia
3. Tachycardia
4. Hypertension
5. Traumatic brain injury |
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Definition
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Term
3. Which statement(s) by a patient indicate an increased likelihood of violent behavior? Select all that apply.
1. “People push me, but they can only push me so far.”
2. “I have a right to feel angry, and right now I am angry.”
3. “You are really stupid. I'd get better nursing care from a monkey.”
4. “A man has to do what a man has to do when somebody crosses him.”
5. “This is frustrating; I wish people would leave me alone. That's what would help me.” |
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Definition
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Term
4. A nurse, Sarah, responds to loud, angry voices coming from the day room, where she finds that Mr. Christopher is pacing and shouting that he “isn't going to take this (expletive) anymore.” Which reaction by Sarah is likely to be helpful in deescalating Mr. Christopher?
1. Act calm, quiet, and in control.
2. State, “You are acting inappropriately and must calm yourself now.”
3. Match the patient's volume level so that he is able to hear over his own shouting.
4. Stand close to the patient so you can intervene physically if needed to protect others. |
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Definition
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Term
5. Andrea is a patient anxiously waiting her turn to speak with staff. The nurse is very busy, however, and asks if Andrea can wait a few minutes so she can finish her task. The nurse is distracted and forgets her promise temporarily, and 45 minutes pass before the nurse remembers and approaches Andrea. On seeing the nurse, Andrea accuses the nurse of lying and refuses to speak with her. Which response by the nurse is most likely to be therapeutic at this time?
1. “You seem angry that I didn't speak with you when I promised I would.”
2. “Look, I'm sorry for being late, but screaming at me is not the best way to handle it.”
3. “You are too angry to talk right now. I'll come back in 20 minutes and we can try again.”
4. “Why are you angry? I told you that I was busy and would get to you soon as I could.” |
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Definition
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