[Exam 2] Chapter 11: Anger, Hostility, and Aggression Flashcards
When does anger result?
When a person is frustrated, hurt, or afraid.
When anger is handled appropriately, it can be a positive force that causes what?
helps a person resolve conflicts, solve problems, and make decisions
What is hostility?
Also called verbal aggression, is an emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior
What is physical aggression?
Behavior in which a person attacks or injures another person or destroys property.
Anger: This can be a normal and healthy reaction when?
Situation or circumstances are unfair or unjust
Personal rights are not respected
Realistic expectations are not met
Anger: When does anger become negative?
When the person denies, suppresses, or expresses it inappropriately
Anger: Consequences of holding in anger include hwat?
Physical problems such as migraines, ulcer, or coronary diseases
Emotional problems like depression and low self-esteem
Anger: Nurses can help client by role-playing ssertive communication techniques. What are these?
Uses “I” statements that express feelings and are specific to the siutation. “I feel angry when you interrupt me” This shows appropriate expression
Anger: What is catharsis?
When some poeple express their angry feelings by engaging in aggressive but safe activities like hitting a punching bag
Anger: Wht is the problem with catharsis?
Can increase rather than alleviate angry feelings
Anger: What can be effective in managing situations or problems that provoke angry feelings?
Distraction, problem-solving, and changing one’s perspective or reframing
Anger: What is high hostility and anger associated with?
Increased risk of coronary artery disease and hypertension
Anger: Anger suppression common in what demographic?
Women, who have been socialized to maintain and enhance relationships with others and avoid the expression or negative emotions
Anger: WOmens anger often results when?
People deny them power or resources, treat them unjustly, or behave irresponsibly toward them
Hostility and Aggression: What are teh stages in aggressive incidents?
Triggering Phase (Incident or situation that initiates an aggressive response)
Escalation Phase
Crisis Phase
Recovery Phase
Post-crisis Phase
Hostility and Aggression: As clients behavior escalates toward crisis phase, what happens?
He /she loses ability to perceive events accurately, solve, problems, express feelings appropriately, or control their behavior
Hostility and Aggression: How do violent patients tendn to act when compared with nonviolent patients?
More symptomatic, have poorer functioning, and have a marked lack of insight
RElated Disorders: SOme clients with depression have what happen?
Anger attacks. Sudden intense spells of anger typically ocur when depressed person feels emotionally trapped
RElated Disorders: Anger attack involves what?
Verbal expressions of anger or rage but no physical aggression . Is uncharacteristic and is followed by remorse
RElated Disorders: What iis intermittent explosive disorder (IED)?
Rare psychiatric diagnosis chcaracterized by discrete episdoes of aggressive impulses that result in serious assaults or destruction of property
RElated Disorders: When is IED diagnosis made?
Only if the client has no other comorbid psychiatric disorders.
RElated Disorders: When does IED develop?
BEtween late adolescnce and 30s. More often males with dependent personality feaures who respond to feelings of usefulness with violent outbursts
RElated Disorders: What is Acting out?
Immature defense mechanism by which person deals with emotional conflicts or stressors through actions rather than reflection
Neurologic Theories: What plays a role in aggressive behavior?
Serotonin plays a major inhibitory role
Neurologic Theories: Low serotonin levels may lead to what?
Aggressive behavior
Neurologic Theories: Increased activity of dopamine and norepinephrine in brain associated with
increased impulsively violent behavior
Neurologic Theories: Damage to what part of the brain can lead to aggressive behavior?
Damage to limbic system, frontal, and temporal lobes
Psychosocial Theories: AS a child matures, they develop impulse control.. what is this?
Ability to delay gratification
Psychosocial Theories: What can increase a childs risk for failing to develop socially appropriate behavior?
Children in dysfunction families with poor parenting, children who receive inconsistent responses to their behaviors, and children in poor families
Psychosocial Theories: Lack of develop in children can lead to what behaviors?
Impulsive, easily frustrated, and prone to aggressive behavior
Cultural Considerations: How do Native Americans and Asian culture view expressing anger?
As rude or disrespectful and to avoid it at all costs
Cultural Considerations: What is Hwa-Byung or Hwabyeong?
Culture-bound syndrome that literally translates as anger syndrome or fire illness, attributed to the suppression of anger
Cultural Considerations: Where is Hwa-Byung predominately seen?
In Korea with women
Cultural Considerations: What is Hwa-Byung characteriszed by?
Sighing, abdominal pain, insomnia, irritability, anixetty, and depression
Cultural Considerations: What is Bouffee Delirante?
Condition observed in West Africa and Haiti characterized by sudden outbursts of agitated and aggressive behavior, marked confusion, and psychomotor excitment
Cultural Considerations: Episodes of Bouffee Delirante may include what?
Visual and Auditory hallucinations and paranoid idealization that resemble brief psychotic episodes
Cultural Considerations: What is Amok?
Dissociative episode characterized by a period of brooding, following by an outburst of biolent, aggressive, or homicidal behavior directed at other people
Cultural Considerations: What is Amok precipitated by?
Slight or insult and is seen only in men .
Treament: Treatment of aggressive clienets often focuses on treating what?
The underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar disorder
Treament: What has Lithium been useful for?
Treating aggressive clients with bipolar, conduct disorders in children, and intellectual disability
Treament: What has Carbamazepine (Tegretol) and Valproate (Depakote) been used for?
Treat aggression associated with dementia, psychosis, and personality disorders
Treament: What has Clozapine (Clozaril), Risperidone (Risperdal), and Olanzapien (Zyprea) been effective for?
Treating aggressive clients with dementia, brian injury, intellectual disability and personality disorders
Treament: What are Benzoodiazepines used for?
Reduce irritabiltiy and agitation in older adults with dementia, but can result in loss of social inhiition for other aggressive clients
Treament: Haloperidol (Haldol) and Lorazepam (Ativan) commonly used in combination to decrease
agitation or aggression and psychotic symptoms .
Treament: PAtietns who are agitated and aggressive but not psychotic benefit from what?
Lorazepam, which can be given 2mg doses every 45-60 mins
Treament: Atypical antipsychotics are more effective than conventional antipsychotics for what?
Aggressive, psychotic clients
Treament: What should you be careful of with antipsychotic meds?
They require careful assessmetn for development of extrapyramidal side effects, that can be treated with benztropine
Five Phase Aggression Cycle: TRiggering Definition
An event or circumstance in the environment initiates the client’s response , often anger or hostility
Five Phase Aggression Cycle: Triggering S&S
Restlessness, anxiety, irritability, paacing, muscle tension, rapid breathing, anger
Five Phase Aggression Cycle: Five Phase Aggression Cycle: Escalation Definition
Client’s responses present escalating behaviors that indicate movement toward a loss of control
Five Phase Aggression Cycle: Escalation S&S
Pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists
Five Phase Aggression Cycle: Crisis definition
During an emotional and physical crisis, client loses control
Five Phase Aggression Cycle: Crisis S&S?
Loss of emotional and physicl control, throwing objects, kicking, hitting
Five Phase Aggression Cycle: Recovery definition
Client regains physical and emotional control
Five Phase Aggression Cycle: Recovery S&S
Lowering of voice, decreased muscle tension, clearer, more rational communication
Five Phase Aggression Cycle: Postcrisis definition
Client attempts reconcillation with others and returns to the level of functioning before the agressive incident and its antecedents
Five Phase Aggression Cycle: Postcrisis S&S
Remorse, apologies, crying, quiet, withdrawn behavior
Nursing Process - Intervention: Intereventions are most effective and least restrictive when?
Implented early in the cycle of aggression
Managing the Environment: : What gives clients the chance to talk about events or issues when they are calm?
Group or planned activites such as playing card games, watching and discussing movies or participating in information discussions
Managing the Environment: If client has conflict or dispute with one naother, what can the nurse offer?
The opportunity for problem-solving or conflict resolution.
Managing Aggressive Behavior: In the trigger phase, nurse should approach client how?
In a nonthreatening, calm manner in order to deescalate the client’s emotion and behavior
Managing Aggressive Behavior: As the client’s anger subsides, nurse can help the client use what?
Relaxation techniques and look at ways to solve any problems or conflicts that may exist
Managing Aggressive Behavior: What should the nurse do if the client progresses toward the escalation phase?
Provide directions in a calm, firm voice. Client should be directed to take time-out for cooling off and that aggressive behavior is not acceptable.
Managing Aggressive Behavior: How many staff members should remain close initially?
4-6, also called a show of force.
Managing Aggressive Behavior: How many staff members needed to restrain an aggressive client?
4-6 staff members
Managing Aggressive Behavior: How do the 4-6 staff members take control?
Ech take a limb, one proteects clients head, and other helps control clients torso
Managing Aggressive Behavior: What is the goal for the patient?
To teach angry, hostile, and potentially aggressive clients to expres their feelings verbally and safely without threats or harm to others or destruction of property
Workplace Hostility: What did the JCAHO release in 2008?
Issued a sentinel event alert concerning “intimidating and disruptive behaviors” that undermine a culture of safety and lead to errors, decreased patient satisfactions, preventable outcomes, and loss of qualified personnel
Workplace Hostility: What di the JCAHO add in 2016?
Workplace bullying. This included abusive conduct, and verbal abuse as well which prevents things from getting done
Community-Based Care: What helps a client achieve stability?
Regular follow-up appointments, compliance with prescribed medication, and participation in community support programs
Community-Based Care: Assasults by clients in the community were caused partly by
stressful living situations, increased access to alcohol and drugs, availability of lethal weapons, adn noncompliance with medications
Community-Based Care: Clients who were assaultive were most likely to be who?
Older male clients with schizophrenia and younger clients with personality disorders
Community-Based Care: What was Assaulted Staff Action Program (ASAP) established for?
To help staff victims cope with the psychological sequelae of assaults by clients in community-based residental program s
Community-Based Care: Aggressive behavior is less common and less intense on units with what?
Strong psychiatric leadership, clear staff roles, and planned and adequae events such as staff-client interaction, group interaction, and activities
