W7_Aggression Flashcards
5 stages of the assault cycle
1) Triggering Phase
Stress-producing event occurs, initiating the stress responses
2) Escalation Phase
Responses represent escalating behaviors that indicate a movement toward the lost of control.
3) Crisis Phase
Period of emotional & physical crisis during which loss of control occurs.
4) Recovery Phase
Period of “cooling down” during which the person slows down & returns to normal responses.
5) Post-Crisis Depression Phase
Period during which the person attempts reconciliation with others.
What happens during Triggering Phase
During Triggering Phase
- Muscle tension
- Voice quality (High)
- Tapping of fingers
- Pacing about
- Repeated verbalizations
- Non-compliant
- Restlessness
- Irritability
- Anxious looking
- Suspiciousness
- Perspiration
- Tremors
- Glaring
- Changes in breathing
What happens during Escalation Phase
**During Escalation Phase
**
* Pale or flushed face
- Screaming, Anger, Swearing
- Agitation, Hypersensitivity
- Threats & Demands
- Readiness to retaliate
- Tautness
- Loss of reasoning ability
- Provocative behaviors
- Clenched fists
What happens during Crisis Phase?
During Escalation Phase
- Loss of self-control
- Fighting
- Hitting
- Rage
- Kicking
- Scratching
- Throwing things
What happens during the Recovery Phase?
During Recovery Phase
- Accusations
- Lowering of voice
- Decreased body tension
- Change in conversational content
- Relaxed posture
What happens during the Post-Crisis Depression phase?
During Post-crisis dep. phase
- Crying
- Apologies
- Reconciliatory interactions
- Repression of assaultive feelings (which may later appear as hostility passive aggression)
3 Possible causes for aggression
1) Heathcare worker
2) Environment
3) Patients
Risk factors for violent behavior
1) Demographic (Young male, unemployed, limited education)
2) Behavioural
3) History
Nursing management of aggressive patients
- Self-awareness
- Control over own behavior.
- Not to escalate patient’s aggression & invite a challenging response.
- Be safe yourself (Don’t be a hero)
- Develop a therapeutic alliance with your patient.
- Encourage verbalization of feelings
- Provide direction for patients if they cannot make constructive choices.
- Use verbal de-escalation method (DEFUSE)
Nursing Management for Aggressive Patients
Rapid Tranquilization
1) Having a Safe Milieu
2) Time-out
3) Pre-discharge planning
Considerations & Management after Rapid Tranquilization
Be aware of:
1) RD
2) E.P. Reactions
3) NMS
4) Paradoxical Reactions
1) Respiratory depression: When a/w benzodiazepines treat with Flumazenil 10 micrograms/kg (max 200 micrograms/dose, repeated at 1-minute intervals PRN for up to 5 doses for reverse of respiratory depression)
2) Extrapyramidal reactions when antipsychotics are used (dystonia, dyskinesia, oculogyric crisis and akathisia; reversible with benztropine 0.02mg/kg (max 2 mg/dose) given IM
3) Neuroleptic Malignant Syndrome (NMS):when antipsychotics are used (hyperthermia muscle rigidity, autonomic dysfunction, altered mental status; muscle rigidity, autonomic dysfunction, altered mental status; check serum CK and inform Psych Team directly).
4) Paradoxical reactions (agitation and anxiety, especially when administration of benzodiazepines; stop and use antipsychotic if possible, instead)
Verbal de-escalation Technique
DEFUSE
DEFUSE
D - Detach yourself from your own emotions
E - Empathize and apologize for their experience
F - Find the facts and causes by actively listening
U - Understand their perspective and expectations
S - Seek solutions to meet or manage their expectation
E - Explain follow up action and End with reassurance
