Mental Health- Test 2 Chapter 25

Front 1

-a lot of times anger is about ______(the underline ______can cause irritability, demanding ability, aggressive behavior, and violence) –they can look the same

Back 1

anxiety

Front 2

Anger

-nurses goal:

Back 2

preserve pts self-esteem and treat them with dignity (when you do that the chance of having to de-escalate someone goes down)

Front 3

-one of the most frequent triggers when violence occurs is

Back 3

during limit setting

Front 4

Nursing interventions for anger and aggression should begin when ????

Back 4

the pts experience increased anxiety

Front 5

-violence and aggression is seen in persons with

Back 5

PTSD and substance abuse disorders

Front 6

-anger coexists with

Back 6

depression, anxiety, psychosis, personality disorders

Front 7

-certain disorders can make some people prone to violence

give example:

Back 7

(impulsivity: act w/o thinking. no thinking about cause and effect)

Front 8

-______with impulsivity: quick angry responses

Back 8

ADHD

Front 9

-_______are effective in people who have anger issues (serotonin)

Back 9

SSRIs

Front 10

- impulsive aggression is linked with what neurotransmitter?

Back 10

low serotonin =

Front 11

Etiology / aggression

Back 11

-traumatic brain injury can be an issue
-low serotonin = impulsive aggression
-genetic factors
-envt factors (parents think its fine to fight)
-physical aggression in the home
-media

Front 12

-aggressive outbursts is linked with what neurotransmitter

Back 12

= dopamine

Front 13

-depressed pts with impulsivity and anger = what nuerotransmitter?

Back 13

decrease dopamine receptors

Front 14

Predictors of violence

-what is the most important predictor of immitent violence?

Back 14

hyperactivity
(pacing, restlessness)

Front 15

Predictors of violence

-increasing anxiety and tension

Back 15

(clenched jaw or fist, rigid posture, tense facial expression, mumbling to self, sweating, rapid pulse, SOB)

Front 16

Predictors of violence

-verbal abuse:

-changing of pitch:

-eye contact?

Back 16

profanity, argumentativeness

loud voice

-intensive eye contact or avoidance of eye contact

Front 17

Predictors of violence


2.recent acts of violence
3. stone silence
4. alcohol or drug intoxication
5. possession of a weapon or object that may be used as a weapon (fork, knife, rock)
6.isolation that is new

Back 17

Predictors of violence

Front 18

Predictors of violence

milieu characteristics

Back 18

(overcrowding, staff inexperience, provocative or controlling staff, poor limit setting, arbitrary revocation of privileges)

Front 19

-Best predictor of violence:

Back 19

Pts history of violence

Front 20

-Risk factors:

Back 20

male, age 14-24, low socioeconomic status, inadequate support system, prison time, people with limited coping skills (lack of assertiveness, use of intimidation)

Front 21

p. 569 –assessment guidelines

Back 21

(anger and aggression) ---- chart

Front 22

aggresion by patients occurs msot often in the context of:

Back 22

limit setting by the nurse

Front 23

patients with a history of limited coping skills, lack of assertivness, or use of intimidation are at higher risk of

Back 23

violence

Front 24

assessment guidelines
-what should the nurse assess for?

Back 24

personal triggers and responses likely to escalate patient violence

Front 25

assessment guidelines

-the nures should assess personal _____________

Back 25

sense of compoetence in an siutation of potential conflict
-consider asking for assistance of other staff members

Front 26

predictors of violence

-arbitrary revocation of privileges

Back 26

(going to the gym, smoking privilege) telling the pt “john you just lost your
smoking privilege

Front 27

Envt factors to lessen the chance of aggressive responses
(4 things)

Back 27

-privacy for pt
-enough space for pts (not overcrowded)
-balance b/w structured time and quiet time
-adequate personnel available to safely and effectively deal with a violent situation

Front 28

people have 2 coping styles
-adequate
-marginal

envt: (include 2 things)

Back 28

enough space for pts, AND healthy balance b/w structured time and quiet time

Front 29

people have 2 coping styles
-adequate
-marginal

-pts with marginal coping skills use anger or violence as a way to:

Back 29

cover other feeligns and gain a sense of mastry / control

Front 30

-when anger and aggression are the priority problems, de-escalation of anger is the primary nursing intervention (how can the nurse do that - 3)

what should she use?

Back 30

(seclusion, restrain, pharmacological means)



-use open ended statements and questions

Front 31

-PRN meds when a pt is showing increase s/s of

Back 31

anxiety or agitation

Front 32

-when _______are used in conjunction with psychosocial interventions and de-escalation techniques, ____ and ________-
behavior can be prevented

Back 32

PRNs

aggressive and violent

Front 33

-(2) are used in treatments of anger and aggression (during aggressive or violent incidents, haloperidol is most widely used)

Back 33

-Antianxiety and antipsychotics are used in treatments of anger and aggression (during aggressive or violent incidents, haloperidol (antipsychotic) is most widely used)

Front 34

-acute: what 2 drugs would you use?

Back 34

Antianxiety and antipsychotic agents (IM form) -haldol (Conventional) is commonly used

Front 35

-drugs for long term/chronic aggression: what 3 drugs would you use

Back 35

-drugs for long term/chronic aggression: Antianxiety and antipsychotics, SSRIs

Front 36

Pts with marginal coping skills
-pts with chemical dependence may be ______about being cut off from their substance of choice

what do they have concerns of?

Back 36

anxious


-have concerns that any physical pain will be inadequately addressed

Front 37

Pts with marginal coping skills

-have personality styles that:

Back 37

externalize blame (they see the source of their discomfort and anxiety as being outside themselves) so relief must come from an outside source (nurse or medication)

Front 38

-if someone is overwhelmed, the emotion they feel is _________
(what is the nureses job?

-what else do we try to get them to do?

Back 38

anxiety
- ( to reduce anxiety in working with the pt collaboratively and validating what their experience is like)


-get them to be able to name the feeling (anxiety, or anger) --sometimes just naming it gives a sense of relief

Front 39

-marginal deficits:
someone who is chemically dependent or someone who has a personality where they blame others (can’t be accountable, or everything they did is someone else’s fault) ---most diff. pts to work with


WHAT do they use to feel a sense of control??

what can the nurse do??

Back 39

-they use anger intimidation to feel a sense of control


-the nurse can anticipate their needs (provide comfort items b4 pt asks for it, build rapport, regular meeting times with pt, be very clear about what you can and can’t do)
--want interactions with the staff to be predictable “we expect doc to be in between/ 10-11”
-these pts tend to be verbally abusive

Front 40

Interactions for anxiety

Back 40

-distraction (magazines, comics, video games)

Front 41

specific steps to follow with verbal abuse

1.1. leave the room as soon as abuse begins
-pt can be informed that the nurse will return in a specific time when the situation is clam
-matter of fact, neutral manner is important
-if the nurse is in the midst of a procedure, ........

Back 41

the nurse can break off conversation and eye contract, complete the procedure quickly

Front 42

specific steps to follow with verbal abuse

2.withdrawal of attention
-

Back 42

attending positively to, reinforcing, nonabusive communication by the pt
-discussion of non-illness topics, responding to request, providing emotional support

Front 43

specific steps to follow with verbal abuse

3.routines

Back 43

(scheduled and carried out in a calm, brief, matter of fact manner)

Front 44

Caring for patients in inpatient settings

2 more significant predictors of violence are

Back 44

history of violence


history of impulsivity