Violence & Agitation Flashcards Preview

ACNP III - Exam 2 > Violence & Agitation > Flashcards

Flashcards in Violence & Agitation Deck (9):

What are some predisposing factors that contribute to a violent patient?

  • Single Best Predictor: History of aggression or violent behavior
  • Family history of violence
  • Childhood abuse
  • Use of alcohol or illicit substances
  • Criminal history
  • Non-adherence to therapy (both psychological and medication)
  • Impulsivity
  • Psychosis
  • Hostility
  • Personality disorder
  • History of acute or chronic brain disorders/trauma
  • Poorly managed chronic medical problems, including pain management


What are some subjective findings found in a violent patient?

Acute violence:

  • Agitation
  • Rage
  • Anxiety or fear

Abusive patient:

  • Remorse/guilt, post violence
  • Controlling nature towards abused person
  • Verbal threats, agitation


What are some subjective findings found in a patient who has been abused?

  • Low self-esteem, guilt, inferiority complex
  • Fear, anxiety, depression
  • Evasiveness when questioned


What are some physical exam findings seen in patients who are abusive?

  • Hyperactivity
  • Increasing physical tension signs such as, clenched jaw/fists, rigid posture
  • Verbal profanity, loud voice
  • Alcohol on breath


What are some physical exam findings seen in patients who are abused?

  • Old scars, fractures poorly healed, bite marks, bruises
  • Vaginal/anal lacerations, STD’s
  • Anxiety


What labs/diagnostic tests should be done for an abusive patient?

  • CT head (r/o subdural hematoma, malignancy)
  • Urine/serum drug screen
  • Electrolytes and metabolic panel
  • EEG (r/o seizures)


What labs/diagnostic tests should be done for an abused patient?

  • Assess for trauma/injury
  • X-rays of injuries
  • Test for STDs


How do you manage an abusive patient?

  • Summon police if violent or armed with weapon
  • Address  calmly, non-violently
  • Maintain adequate distance; stand between abuser and door (do not block your exit from room)
  • Speak in soft voice, listen carefully, do not force eye contact
  • Medication if warranted:
    • Lorazepam (Ativan) 1-2 mg (dependent upon age and size) po, IM or IV
    • Haloperidol (Haldol), 2-5mg (dependent upon age and size)
    • Ziprasidone (Geodon)  10-20mg IM dependent upon age and size
  • Physical restraints (last option)
  • Must have established protocol for use of restrained by trained personnel only
  • Use least restrictive mechanism of restraint at all times.
  • Consult psychiatry if danger to self or others
  • Hospitalize if warranted
  • Correct underlying medical problems
  • Legal duty requires threatened individuals be warned if a person voices harmful intent against another person with notification of authorities


How do you manage an abused person?

  • All patients should be screened for domestic violence or abuse
  • If current abuse exists:
    • Discuss options with patient, including all resources, i.e. shelters, family, friends, social service
    • Problem solve to avoid further episodes.