Module 2- Anger, Hostility And Agression Flashcards
Acting out
An immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than through reflection of feelings
Anger
A normal human emotion involving a strong, uncomfortable, emotional response to a real or perceived provocation
Catharsis
Activities that are supposed to provide a release for strong feelings such as anger, or rage
Hostility
An emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior; also called verbal agression
Impulse Control
The ability to delay gratification and to think about ones behavior before acting
Physical Agression
Behavior in which a person attacks or injures another person or that involves destruction of property
Aggressive Incident Phases
Triggering Phase Escalation Phase Crisis Phase Recovery Phase Post Crisis Phase
Triggering Phase
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
Escalation
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.
Crisis
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
Recovery
The client regains physical and emotional control
S/S: Lowering of voice, decreased muscle tension, clearer more rational communication, physical relaxation
Post Crisis
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S/S: Remorse, apologies, crying, quiet, withdrawn behavior
Nursing Process: Assessment
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
Nursing Process: Interventions
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 patientsNursing Process: Triggering Phase
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
Nursing Process: Escalation Phase
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)
Nursing Process: Crisis Phase
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
What must the physician order contain for restraint or seclusion
- Date and Time
- Type of restraint to be used
- Behavior criteria for release
When should the RN assess the patient after restraints are used?
- Immediately after restraints are initiated
2. Every 2 hours
What should the RN assess on the 2 hour checks for a patient in restraints?
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
How long after restraints are applied does the physician have to perform a face to face assessment?
1 hour
Nursing Process: Recovery Phase
Talk about situation Help patient relax or sleep Explore alternatives to aggressive behavior Provide documentation of any injuries Debrief Staff
Nursing Process: Post Crisis Phase
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
Nursing Process: Evaluation
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.
possible consequences of suppressing anger
migraines, headaches, ulcers, or coronary artery disease and emotional problems such as depression and low self esteem, increase risk of HTN
Lithium treatment
effective I treating aggressive clients with bipolar disorder, conduct disorder and intellectual disability
carbamazepine (Tegretol) or valproate (Depakote) are used to treat aggression associate with
dementia, psychosis and personality disorder
Atypical antipsychotic such as clozapine (Clorazil), risperidone (Risperdal) and olanzapine (Zyprexa) have been effective in treating patient with
dementia, brain injury, intellectual disability and personality disorder
Benzodiazepines can reduce
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”
Haloperidol (Haldol) and lorazepam (Ativan) are commonly used in combination to
decrease agitation or aggression and psychotic symptoms
