Stress & Crisis Management and Aggression/Abuse Flashcards
Acute vs. Chronic Stress
Acute:
- Sympathetic nervous system activated (increased HR, BP, RR, CO, and metabolism)
- Decreased appetite
- Unhappy/sorrowful
- Return to homeostasis once threat is gone
Chronic:
- Depression, chronic pain, disturbed sleep
- Weight gain/loss
- Increased risk for MI/stroke or infection
- Poor diabetes/HTN control
- Fatigue, irritable, impaired concentration
Crises
Emotional responses to a stressor that cannot be managed with normal coping mechanisms
Ex. sudden events with no warning, overwhelming/life-threatening event, actual/perceived loss, shift from familiarity
Protective Factors of Stress
Helps people be more resilient towards stress
- Physical health
- Strong sense of self
- Spiritual beliefs
- Optimism
- Humor
- Strong support system
Aggression risk factors
- Past history of violence or criminal activities
- Unwillingness to follow rules
Signs of agitation
- Clenched fist
- Fidgeting
- Loud speaking
- Increased RR
- Hyperactivity/pacing
Common characteristics of perpertrators of abuse
- Abused as a child
- Violent outbursts
- Hostile/blames others
- Only dangerous towards family
- High expectations of others
- Perceives victim as “bad”
- Hx. substance abuse
- Impulsive, immature, low self-esteem
Common characteristics of victims
- Low self-esteem
- Feelings of helplessness, hopelessness, powerlessness, guilt, shame
- May protect perpertrator and/or take blame for abuse
- May deny/undermine severity of situation
- Feelings of self-loathing, anger, and terror
Goals/priority of abuse assessment findings
- Develop a safety plan (escape plan, extra money, pack a bag, have vital documents, bank info, clothes, etc)
- Educate on resources & signs of danger
- Perform lethality assessment
Interventions for stress & abuse assessment findings
- Have a calm demeanor
- Talk simply but direct in telling them what to do; use concrete language
Pharmacological Therapy
Typical/Conventional Antipsychotics:
- Haloperidol (lots of extrapyramidal effects & adverse effects)
Atypical/unconventional antipsychotics:
- Ziprasidone, allanzopine
- AE: high risk metabolic syndrome
Olanzapine
Atypical antipsychotic; fewer adverse effects than typical!
Indications:
- schizophrenia spectrum disorder, psychotic episodes
Adverse Effects:
- Low risk of extrapyramidal symptoms
- High risk for diabetes, weight gain, dyslipidemia, sedation, orthostatic hypotension, and anticholinergic effects
Nursing Considerations:
- Contraindicated in elderly patients with dementia
- Use cautiously in patients with CV, CVA, seizures, or diabetes mellitus
- Avoid alcohol
- Monitor blood glucose frequently on diabetic patients
Ziprasidone
Atypical Antipsychotic
Indications:
- schizophrenia spectrum disorder, psychotic episodes
Adverse Effects:
- Orthostatic hypotension, anticholinergic effects, rash, and prolonged QT intervals
- Lower risk of EPS, diabetes, dislipidemia, weight gain
Nursing Considerations:
- Contraindicated for elderly patients with dementia
- Avoid CNS depressants, levodopa and other dopamine receptor agonists, and medications that prolong QT interval
Haloperidol
Conventional Antipsychotic
Indications:
- Primarily used for schizophrenia spectrum disorders
- Treats positive symptoms
Adverse Effects:
- Very high risk for EPS (acute dystonia, tar dive dyskinesia, Parkinsonism, akathisia)
Nursing Considerations:
- Contraindicated in patients with dementia, severe depression, Parkinson’s, prolactin-dependent breast cancer, severe hypotension, or coma
- Use cautiously with seizures, heart disorders, or kidney disease
- Avoid OTC meds with anticholinergic agents (sleep aids)
- Avoid CNS depressants
