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Psych Test 1 > Anger & Agression > Flashcards

Anger & Agression Flashcards

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1
Q

Primary accelerator of aggression

A

anger

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2
Q

verbalizes anger
swearing; verbal abuse
screaming, yelling
defiance, temper tantrum

A

sources of anger/aggression

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3
Q

Sarcasm, impatience, pouting, sulking

A

passive aggression

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4
Q

Verbal Aggression or Abuse

A
  • repetitive pattern
  • warning sign of assault and battery
  • social norms influence degree of verbal abuse that is tolerated
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5
Q

Passive Aggressive

A
  • express anger indirectly and undermine others
  • deny anger and its source even when confronted
  • frustrate others around them
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6
Q

Passivity

A
  • turn anger inward
  • might be unaware of underlying anger
  • unable to say “no”
  • believe others take advantage of them
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7
Q

Assertiveness

A
  • positive way of expressing feelings
  • respect rights of others and self
  • use energy constructively
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8
Q

Common problems r/t aggression

A
  • traumatic head injury
  • damage to limbic, amygdala, or hippocampus
  • Alzheimer’s
  • alcohol and substance abuse/withdrawal
  • nutritional deficiencies (thiamine and niacin)
  • medication non-adherence
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9
Q

Model that looks at how person interacts with their environment

A

Social-psychological anger aggression model

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10
Q

Model that looks more at society (poverty, gangs, drugs)

A

Sociocultural anger aggression model

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11
Q

Triggering Phase of Assault Cycle

A
  • stress producing event occurs initiating the stress response
  • nonviolent anger
  • present no danger to others
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12
Q

Escalation Phase of Assault Cycle

A
  • responses represent escalating behaviors that indicate a movement towards the loss of control
  • irrational; threatening anger
  • loss of control impending
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13
Q

Crisis Phase of Assault Cycle

A
  • period of emotion and physical crisis; loss of control occurs
  • loss of control
  • pt approaching an attack on the environment, self, other patients, staff
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14
Q

Recovery Phase of Assault Cycle

A

-period of cooling down; person slows down and returns to normal responses

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15
Q

Post-crisis Depression Phase of Assault Cycle

A

person attempts reconciliation with others; debriefing needs to occur with the pt

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16
Q

Primary symptom of this disorder is aggression

A

Intermittent Explosive Disorder

17
Q

DSM-IV criteria for Intermittent Explosive Disorder

A
  • several episodes of failure to resist aggressive impulse (leads to assaultive acts)
  • degree of aggression expressed is grossly out of proportion to precipitating stressor
  • aggressive episodes aren’t better accounted for by another disorder or effects of substance or medical condition
18
Q

Prodromal sensations of Intermittent Explosive Disorders

A
  • head pressure
  • chest tightness
  • echo sounds
19
Q

Onset of Intermittent Explosive Disorder

A

childhood

20
Q

How does nurse assess variables of aggression

A
  • self assessment is critical
  • consider angry behaviors as sign of communication (possible loss of control)
  • nurses are ineffective if they withdrawal from hostile or demanding pt
21
Q

What are some milieu elements that contribute to escalation of aggression

A
  • excessive stimuli/noise with low ratio of nurses
  • overcrowding/lack of sufficient space
  • lack of resources for energy expenditure
  • perceived lack of control/freedom
  • lack of structured and unstructured diversional activities (exercise, movies, games, crafts)
  • lack of quiet rooms and space
22
Q

Likely times a patient will exhibit aggression

A
  • change of shift
  • mealtimes
  • visiting hours, off unit, during change
  • invasive procedures
  • hospital admission (TDO)
23
Q

Predisposing conditions to aggression

A
  • severe pain
  • confusion, malnutrition, infection
  • med toxicity, liver/kidney insufficiency
  • brain dysfunction, psychosis
  • antisocial PD, borderline PD
24
Q

Nursing Intervention of Triggering Phase

A
  • calm, clear, simple communication
    • walk toward pt while talking while lowering voice
  • encourage ventilation of feelings, problem solving
  • avoid challenging pt
  • remind pt to stay in control (make good decisions)
  • suggest time out in room
  • PO anti-anxiety or anti-psychotic meds can be given
25
Q

Nursing Intervention for Escalation Phase

A
  • take charge
  • maintain safe distance (not within swinging)
  • state observation that pt is losing control
  • administer prn med (IM if necessary)
  • offer time out or voluntary seclusion
  • staff on standby (show of support: more staff)
26
Q

Nursing Intervention for Crisis Phase

A
  • external control essential
  • seclusion or restraint (follow protocols)
  • state IM medication
27
Q

Time Out

A
  • decrease stimuli
  • RBHC: cannot last longer than 30 min
  • able to come and go as please
28
Q

Seclusion

A
  • CONTAINMENT in seclusion room (locked door)
  • goals: prevent pt harming self or others, decrease stimuli, and increase intensive nursing care
  • degrees vary and dependent on pt current status
  • adults up to 4 hours and children up to 1 hour
29
Q

Restraint

A
  • order required
  • 6-8 staff needed to safely control pt
  • impose physical control, restraint
    • pt placed in prone position with wrist and ankle restraints applied and secured to frame of bed
  • administer IM med
30
Q

Physician must evaluate pt within _______ for care and documentation

A

one hour

31
Q

What do you assess on pt in restraint and how often

A
  • q10min
  • hydration
  • elimination
  • circulation (place one finger under restraint)
  • passive ROM every 1-2 hours
32
Q

Nursing Intervention for Recovery and Depression Phase

A
  • provide support/reassurance that pt is not being punished while in seclusion
    • allowed back in milieu ASAP
  • document incident
  • staff debriefing
33
Q

Pt ready to be released from restraints when:

A
  • show signs of self control
  • up to 20min of calm behavior in adults and 5 min in children
  • decreased anxiety and agitation
  • stabilized mood
34
Q

Trauma-Informed Care

A
  • requires staff to ask ALL pt about any past traumatic events to determine how they may be affected if need to use behavioral interventions
  • ask pt what helps calm them down
35
Q

Staff Assault Victims

A
  • debriefing and recovery may be complicated
  • similar to being victim of crime
  • loss of trust, sense of control, self-esteem
  • PTSD may result
  • supportive interventions needed
  • nurse can press charges

Psych Test 1 (6 decks)

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