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44 Cards in this Set

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

-nurses goal:
preserve pts self-esteem and treat them with dignity (when you do that the chance of having to de-escalate someone goes down)
-one of the most frequent triggers when violence occurs is
during limit setting
Nursing interventions for anger and aggression should begin when ????
the pts experience increased anxiety
-violence and aggression is seen in persons with
PTSD and substance abuse disorders
-anger coexists with
depression, anxiety, psychosis, personality disorders
-certain disorders can make some people prone to violence

give example:
(impulsivity: act w/o thinking. no thinking about cause and effect)
-______with impulsivity: quick angry responses
-_______are effective in people who have anger issues (serotonin)
- impulsive aggression is linked with what neurotransmitter?
low serotonin =
Etiology / aggression
-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
-aggressive outbursts is linked with what neurotransmitter
= dopamine
-depressed pts with impulsivity and anger = what nuerotransmitter?
decrease dopamine receptors
Predictors of violence

-what is the most important predictor of immitent violence?
(pacing, restlessness)
Predictors of violence

-increasing anxiety and tension
(clenched jaw or fist, rigid posture, tense facial expression, mumbling to self, sweating, rapid pulse, SOB)
Predictors of violence

-verbal abuse:

-changing of pitch:

-eye contact?
profanity, argumentativeness

loud voice

-intensive eye contact or avoidance of eye contact
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
Predictors of violence
Predictors of violence

milieu characteristics
(overcrowding, staff inexperience, provocative or controlling staff, poor limit setting, arbitrary revocation of privileges)
-Best predictor of violence:
Pts history of violence
-Risk factors:
male, age 14-24, low socioeconomic status, inadequate support system, prison time, people with limited coping skills (lack of assertiveness, use of intimidation)
p. 569 –assessment guidelines
(anger and aggression) ---- chart
aggresion by patients occurs msot often in the context of:
limit setting by the nurse
patients with a history of limited coping skills, lack of assertivness, or use of intimidation are at higher risk of
assessment guidelines
-what should the nurse assess for?
personal triggers and responses likely to escalate patient violence
assessment guidelines

-the nures should assess personal _____________
sense of compoetence in an siutation of potential conflict
-consider asking for assistance of other staff members
predictors of violence

-arbitrary revocation of privileges
(going to the gym, smoking privilege) telling the pt “john you just lost your
smoking privilege
Envt factors to lessen the chance of aggressive responses
(4 things)
-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
people have 2 coping styles

envt: (include 2 things)
enough space for pts, AND healthy balance b/w structured time and quiet time
people have 2 coping styles

-pts with marginal coping skills use anger or violence as a way to:
cover other feeligns and gain a sense of mastry / control
-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?
(seclusion, restrain, pharmacological means)

-use open ended statements and questions
-PRN meds when a pt is showing increase s/s of
anxiety or agitation
-when _______are used in conjunction with psychosocial interventions and de-escalation techniques, ____ and ________-
behavior can be prevented

aggressive and violent
-(2) are used in treatments of anger and aggression (during aggressive or violent incidents, haloperidol is most widely used)
-Antianxiety and antipsychotics are used in treatments of anger and aggression (during aggressive or violent incidents, haloperidol (antipsychotic) is most widely used)
-acute: what 2 drugs would you use?
Antianxiety and antipsychotic agents (IM form) -haldol (Conventional) is commonly used
-drugs for long term/chronic aggression: what 3 drugs would you use
-drugs for long term/chronic aggression: Antianxiety and antipsychotics, SSRIs
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?

-have concerns that any physical pain will be inadequately addressed
Pts with marginal coping skills

-have personality styles that:
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)
-if someone is overwhelmed, the emotion they feel is _________
(what is the nureses job?

-what else do we try to get them to do?
- ( 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
-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??
-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
Interactions for anxiety
-distraction (magazines, comics, video games)
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, ........
the nurse can break off conversation and eye contract, complete the procedure quickly
specific steps to follow with verbal abuse

2.withdrawal of attention
attending positively to, reinforcing, nonabusive communication by the pt
-discussion of non-illness topics, responding to request, providing emotional support
specific steps to follow with verbal abuse

(scheduled and carried out in a calm, brief, matter of fact manner)
Caring for patients in inpatient settings

2 more significant predictors of violence are
history of violence

history of impulsivity