crisis and aggression (halter ch 26, 27) Flashcards
a disturbance caused by a
stressful event or perceived threat
crisis
stages of crisis
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
2 types crisis
maturational
situational
type of crisis:
- developmental events require role changes
- need good role models
- may fluctuate between stages for a time
maturational crisis
type of crisis:
- life event upsets person’s psychological equilibrium
- usually multifaceted
situational crisis
what to assess for pt in crisis (5)
- perception of event
- coping mechanisms
- support systems
- mental status, previous history/functioning
- identify pt strengths
7 possible nursing diagnoses for crisis intervention
- risk self-directed violence
- chronic low self esteem
- hopelessness
- powerlessness
- severe/panic levels of anxiety
- disturbed thought process
- sleep deprivation
steps to provide help for someone in crisis (ALGEE)
- Assess for r/f suicide, harm, homicide
- Listen non-judgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other options
5 possible physiological effects of crisis
- shock
- confusion
- denial
- anxiety
- lethargy/heroics
tips for breaking bad news (ABCDE)
- Advance preparation
- Build a therapeutic environment/alliance
- Communicate well
- Deal with pt and family reaction
- Encourage and validate emotions
4 ways people deal with conflict
- passive
- aggressive
- passive aggressive
- assertive
way of dealing with conflict: subordinate their own rights
passive
way of dealing with conflict: ignoring the rights of others
aggressive
way of dealing with conflict: vents in an indirect, yet harmful manner
passive aggressive
way of dealing with conflict: respects others and gets needs met
assertive
what is the best predictor for violence
history of violence
4 factors that increase aggression and can lead to violence
- history of violence
- active psychotic syndrome
- substance abuse
- conduct disorder
signs of aggression
- 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
how many hrs can an adult have an order for restraints? how many hrs for 9-17 yo?
how many hrs for <9 yo?
adult: 4 hrs
9-17 yo: 2 hrs
<9 yo: 1 hr
regulations to remember with restraints (3)
- must release if asleep
- must have face to face assessment with psychiatrist within one hour
- need dr order
2 psychiatric emergency meds
how to admin for fastest effect
(antipsychotics)
- haldol
- zyprexa (olanzapine)
administer IM injection
de-escalation techniques
- maintain calmness
- respond as early as possible
- avoid invading personal space
- avoid arguing
- be assertive, not aggressive
- give several clear options
nursing considerations for ensuring safety when pt is becoming aggressive (6)
- 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
