AGGRESSION

 

AGGRESSION

Aggression is a Psychiatric emergency and as such, therefore, the nursing 

management (nursing care) MUST be categorised into two domains;

1. Immediate Management

2. Subsequent management

Immediate nursing management of the client

Immediate nursing care addresses the needs of patient in acute stages when the patient is restless, aggressive and showing irrational behaviour threatening harm to self and others

The immediate management (nursing care) has four (4) main components, namely;

1. Seclusion

2. Restraining

3. Promotion of safety

4. Drug management

Seclusion

 Since the patient is aggressive and can harm others, seclusion is done to protect other patients, relatives as well as health care staff from harm.

 The patient will be nursed in a SUICIDE place near the nurses bay for closer 

monitoring as these patients may harm themselves

 The unit should have a small window where the medical personnel can peep and monitor the patient‟s behavior so as to prevent suicide6

 The seclusion room where the patient is nursed should not have any injurious objects which the patient may use to harm themselves

 The unit should not have ropes, wires, shoe lases, drugs and sharp objects which the patient can use to harm himself

 The unit should be well lit for clear AND so as to prevent falls and other injuries

Restraining

 Restraining an aggressive patient is necessary to protect him, other patients, relatives and health personnel from harm

 This activity is done as a collective effort as the client is aggressive and may cause harm to the nurse, if alone

 In achieving this, a cotton rope is used to tie the patient

 The rope should be tight enough to restrain the patient but it should not be too tight to cause severe injuries to the patient

 Tying a patient with a wire or a chain MUST be avoided to prevent injuring the 

patient

Promotion of safety

 Admit the patient in a less stimulating environment; with minimal light, noise and odor free to prevent aggression

 Remove from the environment any item that the patient may use to kill themselves in order to provide safety of the patient. 

 All sharp objects, belts, drugs, medical equipment or water should be isolated from the patient to prevent suicide

 The patient should not be left alone, so involve family members in the care of patient to provide safety. 

 Usually a floor bed is ideal to prevent falls

 When he stabilizes patient should be escorted wherever he goes to prevent him from suicide attempts

 Ideally, do not nurse the client on a height floor as the client may attempt to jump and commit suicide

 If the client is nursed on a height floor, the windows must have burglar bars to prevent jumping

 Nurse the client in a well lit room for easy observation in case the patient tries to harm themselves

Drug management

 Drug administration using Antipsychotics (Neuroleptic) drugs as well as electroconvulsive therapy are used to calm the patient by stabilising the mood

 Antipsychotic drugs with Sodium valproate and Haloperidol will reduce the 

production of neurotransmitter (Dopamine) and also relaxes the muscles in a patient

 Electroconvulsive therapy introduces high voltage electrical current in the patient's brain, inducing a vigorous seizure thereby suppressing the production of dopamine leading to muscle exhaustion 

Subsequent management

Alert: Subsequent nursing care is the care given after the patient has stablised and the risk of self injury is minimused or eliminated Some of the headings under subsequent nursing care are;

 Aims 

 Environment 

 Psychological Support 

 Observation 

 History Taking 

 Therapeutic nurse relationship 

 Nutrition and Fluids 

 Mental State Examination (MSE) 

 Rest and Activity 

 Linkages and Support 

Alert: the aims of the nursing care are usually, if not always, put on subsequent 

nursing management and not on immediate nursing care