crisis and aggression (halter ch 26, 27)

Question 1

a disturbance caused by a

stressful event or perceived threat

Answer 1

crisis

Question 2

stages of crisis

Answer 2

1) anxiety activates usual methods of coping
2) more anxiety because coping failed
3) new coping is tried or threat is redefined so old coping works
4) if unresolved, panic and severe anxiety

Question 3

2 types crisis

Answer 3

maturational

situational

Question 4

type of crisis:

• developmental events require role changes
• need good role models
• may fluctuate between stages for a time

Answer 4

maturational crisis

Question 5

type of crisis:

• life event upsets person’s psychological equilibrium
• usually multifaceted

Answer 5

situational crisis

Question 6

what to assess for pt in crisis (5)

Answer 6

• perception of event
• coping mechanisms
• support systems
• mental status, previous history/functioning
• identify pt strengths

Question 7

7 possible nursing diagnoses for crisis intervention

Answer 7

• risk self-directed violence
• chronic low self esteem
• hopelessness
• powerlessness
• severe/panic levels of anxiety
• disturbed thought process
• sleep deprivation

Question 8

steps to provide help for someone in crisis (ALGEE)

Answer 8

• Assess for r/f suicide, harm, homicide
• Listen non-judgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other options

Question 9

5 possible physiological effects of crisis

Answer 9

• shock
• confusion
• denial
• anxiety
• lethargy/heroics

Question 10

tips for breaking bad news (ABCDE)

Answer 10

• Advance preparation
• Build a therapeutic environment/alliance
• Communicate well
• Deal with pt and family reaction
• Encourage and validate emotions

Question 11

4 ways people deal with conflict

Answer 11

• passive
• aggressive
• passive aggressive
• assertive

Question 12

way of dealing with conflict: subordinate their own rights

Answer 12

passive

Question 13

way of dealing with conflict: ignoring the rights of others

Answer 13

aggressive

Question 14

way of dealing with conflict: vents in an indirect, yet harmful manner

Answer 14

passive aggressive

Question 15

way of dealing with conflict: respects others and gets needs met

Answer 15

assertive

Question 16

what is the best predictor for violence

Answer 16

history of violence

Question 17

4 factors that increase aggression and can lead to violence

Answer 17

• history of violence
• active psychotic syndrome
• substance abuse
• conduct disorder

Question 18

signs of aggression

Answer 18

• sarcasm
• verbal/physical threats
• change in voice tone
• degrading comments
• pacing
• throwing or striking objects/people
• suspiciousness
• invasion of personal space
• agitation/irritability
• self mutilation

Question 19

how many hrs can an adult have an order for restraints? how many hrs for 9-17 yo?
how many hrs for <9 yo?

Answer 19

adult: 4 hrs
9-17 yo: 2 hrs
<9 yo: 1 hr

Question 20

regulations to remember with restraints (3)

Answer 20

• must release if asleep
• must have face to face assessment with psychiatrist within one hour
• need dr order

Question 21

2 psychiatric emergency meds

how to admin for fastest effect

Answer 21

(antipsychotics)

• haldol
• zyprexa (olanzapine)

administer IM injection

Question 22

de-escalation techniques

Answer 22

• maintain calmness
• respond as early as possible
• avoid invading personal space
• avoid arguing
• be assertive, not aggressive
• give several clear options

Question 23

nursing considerations for ensuring safety when pt is becoming aggressive (6)

Answer 23

• avoid wearing dangling earrings, necklaces, scarves
• ensure there is enough staff for backup
• always know layout of area
• don’t stand directly in front of pt or doorway
• if pt begins to escalate, provide feedback
• avoid confrontation/force