Professional Documents
Culture Documents
Is any type of violent behaviours directed toward harming or injuring another INTENT Verbal cursing, threats (24%) Physical grabbing, pinching, kicking, hitting, biting Tasks that require close contact like bathing may lead to aggression Note: prior history of aggression is a great predictor
Demands
Capability
Physical
Hitting
Verbal
Threatening
Verbal
Yelling
Kicking
Biting
Swearing
Tapping
SSRIs
Calling out
Trazodone Carbamazepine
ANTIPSYCHOTICS
The Environment
Sensory Overload Too many people Noise level Sudden Movements Startling noises Unable to recognize noises or people Feel vulnerable and insecure
Our Approach
Pressure to get task done Talking too fast Asking too many questions Not giving the person time to respond Can startle when approached from behind Unexpected touch Nonverbal communication
Our Approach
Know the life story of the person Look for clues why person is distressed Provide soothing music Talk in calm voice Is the person in pain? Upset by something or someone around them Need for one-on-one attention Use distraction Try music, massage, quiet reading
ABC Intervention
A = antecedent What happened before the behaviours, clues, triggers B = define the behaviour What is happening, what did the resident do, describe the action, when, where and around who C = consequences What happened in the environment or the behaviour of other people because of the behaviour
Strategies
Remain calm Be flexible Explain everything you are doing to the resident Give the resident a sense of control over body and personal space Avoid situations that lead to aggressive behaviours Keep objects that could be used to hurt someone out of reach
Strategies Contd
Glasses and hearing aides Medications, especially if new Check for tight clothing, pain, need for bathroom Stick to familiar routine Plan activities when person is rested Break tasks into small manageable steps
Prevention Strategies
Limit choices Approach from front, use name Set the mood and the tone Give the person time to respond Use life story Know stressful time of day Acknowledge feelings, comforting touch
More Strategies
Regular toileting schedule Clothing is dry and comfortable One caregiver able to connect Consistent reliable routine Explore what need is being expressed Consistent staffing Communication Strategies Keep environment simple Meals one food item at a time, one utensil Clothing one outfit Activity offer one activity
Plan of Action
Remove other residents witnessing the aggression May leave the resident alone if they become aggressive when you are trying to help them and then re-approach Use another staff members Watch tone of voice or body language Eye contact, reassuring, gentle touch
Want to Go Home
Expressing a need A place of comfort, security, control Not necessarily a place Acknowledge feelings being expressed Use life story to develop meaningful distraction that will provide comfort Redirect the person with music, activity, exercise
Pharmacology
Atypical antipsychotics - (ie, clozapine [Clozaril], risperidone [Risperdal], olanzapine [Zyprexa], and quetiapine fumarate [Seroquel]) dec. extrapyramidal side effects (eg, parkinsonism, tardive dyskinesia). Neuroleptic treatment - start with a low dose (eg, 0.5 mg of haloperidol or 1 mg of risperidone) and administer it on a regular basis rather than attempting to treat specific episodes of agitation. Anticonvulsants carbamazepine, divalproex sodium (Depakote) are effective in treating behavioral disturbances in dementia and have a different side-effect profile than that of neuroleptics.
Yes
Psychotic Features
Anti Psychotics
No
Mood Features
Yes
No
Anxious Features
Yes
No
Non Specific
Yes Episodic ? No
Trials using non Anti Psychotics First
Restraints
Chemical and Physical Physical can increase aggression Chemical low maintenance dose Watch high potency anti psychotic agents like Haloperidol
Anorexia
Means lack of appetite (incorrectly named) Life-threatening restriction of caloric intake 85% women, 25% relapse, 5% die 3/1000 young women in grade 9 12 Stems from a distorted body image
Theories
FREUDIAN eating substitutes for sex FAMILY struggle for independence LEARNING societys ideal body image BIOLOGICAL genetic, damage by hypothalemus
Symptoms
Amenorrhea (no period) Dry cracking skin Constipation Increased heart rate Lanugo (fine hair on your body) Immature features
Bulimia
BU = ox + LIMOS = hunger Hungry like an ox Gross overeating (binge) and induced vomiting (purge) Affects women in their middle 20s 90% women choose easy to eat foods Family history of obesity and alcoholism Foods eaten quickly and without tasting This kind of eating will be accompanied by feelings of anxiety, guilt and remorse
Well disguised and hidden problem from family Disappearing to the bathroom after a meal, running bathwater or playing the radio at high volume. Strange night bird behaviour, staying up and going to the kitchen after everyone else has gone to bed. Going for unexpected walks or drives at night. A bulimic tries to get rid of people, or have them go to bed, so that they can binge. Disappearance of large quantities of food, or overeating, without apparent sign of weight gain. Finding food wrappers hidden behind chair cushions or under beds. Unexplained irritability and mood swings.
Recognizing Bulimia
Physical Symptoms
Swelling of the cheeks or jaw area Sore throat Calluses on the back of the hands and knuckles (from self-induced vomiting) Discoloration, staining, or deterioration of tooth enamel (caused by stomach acid) Broken blood vessels in the eyes Brittle hair or nails; dry or sallow skin Stomach pain Vitamin and mineral deficiencies, electrolyte imbalance Weakness or fatigue Chronic irregular bowel movement and constipation from laxative abuse Dehydration Loss of menstrual cycle Swelling of the lower legs and feet or loss of sensation in the hands or feet (from malnutrition or dehydration) Heart attack
Treatment Goals
Stabilize body chemical Restore normal eating patterns Determine emotions behind eating Assertive and confidence building
Treatment of Bulimia
Involves and Multidisciplinary Team Psychiatrist, Physician, Nurse, Dietitian Goals of Treatment Psychoeducation about the medical implications of bulimia Identification of triggers for binging and purging behavior Interrupting the "rituals" of bulimic episodes Challenging weight and body image beliefs Improving self-esteem and ability to communicate needs and feelings
Nursing Care
Monitor weight daily in same clothes Limit physical activity Allow pt to see food as medicine Non-judgmental Cease purging, Limit food choices in beginning 1200 cal diet, increase fluid intake Monitor and record food eaten Monitor vital signs and electrolytes Help teach relaxation and coping strategies Patient must feel that she is in control of the treatment Make contract and patient can have privileges based on weight gain Allow pt to verbalize feeling around weight gain Health teaching: dehydration, hypoglycemia Administer SSRI PROZAC. Other SSRIs (wt gain) Discuss feelings. Do not comment on wt. or appearance