Module 2- Anger, Hostility And Agression

Question 1

Acting out

Answer 1

An immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than through reflection of feelings

Question 2

Anger

Answer 2

A normal human emotion involving a strong, uncomfortable, emotional response to a real or perceived provocation

Question 3

Catharsis

Answer 3

Activities that are supposed to provide a release for strong feelings such as anger, or rage

Question 4

Hostility

Answer 4

An emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior; also called verbal agression

Question 5

Impulse Control

Answer 5

The ability to delay gratification and to think about ones behavior before acting

Question 6

Physical Agression

Answer 6

Behavior in which a person attacks or injures another person or that involves destruction of property

Question 7

Aggressive Incident Phases

Answer 7

Triggering Phase
Escalation Phase
Crisis Phase
Recovery Phase
Post Crisis Phase

Question 8

Triggering Phase

Answer 8

An event or circumstance in the environment that initiates the clients response, which is often anger or hostility.
S/S: Restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, anger

Question 9

Escalation

Answer 9

The clients responses represent escalating behaviors that indicate movement toward loss of control
S/S: Pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly.

Question 10

Crisis

Answer 10

During an emotional and physical crisis, the client loses control
S/S: Loss of emotional or physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, inability to communicate clearly

Question 11

Recovery

Answer 11

The client regains physical and emotional control

S/S: Lowering of voice, decreased muscle tension, clearer more rational communication, physical relaxation

Question 12

Post Crisis

Answer 12

The client attempts to reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents
S/S: Remorse, apologies, crying, quiet, withdrawn behavior

Question 13

Nursing Process: Assessment

Answer 13

Factor influencing aggression
Past history (how did patient handle)
Determine what phase of aggression cycle patient is in
What is patient saying
Changes in voice, volume, pitch, speed
Changes in facial expression

Question 14

Nursing Process: Interventions

Answer 14

Most effective, least restrictive when implemented early in cycle of aggression
Environmental Management:
    Planning activities
    Environmental Discussions
    Scheduled one to one interactions
    Assistance with problem solving and conflict 
    resolution
    Safety of other patients

Question 15

Nursing Process: Triggering Phase

Answer 15

Approach in nonthreatening, calm manner
Convey empathy, listen
Encourage verbal expression of feelings
Suggest patient go to a quieter area
Use PRN medications
Suggest physical activity such as walking

Question 16

Nursing Process: Escalation Phase

Answer 16

Take control; provide direction in firm, calm voice
Direct patient to room or quiet area for time out
Offer medication again
Let patient know aggression is unacceptable, nurse or staff will help maintain/regain control
If ineffective, obtain help from other staff (show of force)

Question 17

Nursing Process: Crisis Phase

Answer 17

Inform patient that behavior is out of control and staff is taking control to provide safety and prevent injury
Use of restraint or seclusion only if necessary

Question 18

What must the physician order contain for restraint or seclusion

Answer 18

1. Date and Time
2. Type of restraint to be used
3. Behavior criteria for release

Question 19

When should the RN assess the patient after restraints are used?

Answer 19

1. Immediately after restraints are initiated

2. Every 2 hours

Question 20

What should the RN assess on the 2 hour checks for a patient in restraints?

Answer 20

Respiratory and cardiac status
Mental status
Range of motion, exercise of limbs
Hydration, nutritional needs are met and documented
Hygiene, toileting, and elimination needs are met and documented

Question 21

How long after restraints are applied does the physician have to perform a face to face assessment?

Answer 21

1 hour

Question 22

Nursing Process: Recovery Phase

Answer 22

Talk about situation
Help patient relax or sleep
Explore alternatives to aggressive behavior
Provide documentation of any injuries
Debrief Staff

Question 23

Nursing Process: Post Crisis Phase

Answer 23

Remove patient from any restraint or seclusion to rejoin group
Calmly discuss behavior (no lecturing or chastising); allow patient to return to activities, groups, and so forth
Focus on appropriate expression of feelings, resolution of problems or conflicts in non aggressive manner

Question 24

Nursing Process: Evaluation

Answer 24

GOAL: To teach angry, hostile and potentially aggressive patients to express feelings verbally and safely without threats or harm to others or destruction of property.

Question 25

possible consequences of suppressing anger

Answer 25

migraines, headaches, ulcers, or coronary artery disease and emotional problems such as depression and low self esteem, increase risk of HTN

Question 26

Lithium treatment

Answer 26

effective I treating aggressive clients with bipolar disorder, conduct disorder and intellectual disability

Question 27

carbamazepine (Tegretol) or valproate (Depakote) are used to treat aggression associate with

Answer 27

dementia, psychosis and personality disorder

Question 28

Atypical antipsychotic such as clozapine (Clorazil), risperidone (Risperdal) and olanzapine (Zyprexa) have been effective in treating patient with

Answer 28

dementia, brain injury, intellectual disability and personality disorder

Question 29

Benzodiazepines can reduce

Answer 29

irritability and agitation in older adults with dementia.
For other aggressive clients it can cause them to lose their inhibitions thus causing an increase of aggression
“requires cautious use”

Question 30

Haloperidol (Haldol) and lorazepam (Ativan) are commonly used in combination to

Answer 30

decrease agitation or aggression and psychotic symptoms