Violent behavior
Violent behavior: Excerpt from Nursing: Interpreting Signs and Symptoms
Marked by sudden loss of self-control, violent behavior refers to the use of physical force to violate, injure, or abuse an object or person. This behavior may also be self-directed. It may result from an organic or psychiatric disorder or from the use of certain drugs or alcohol
Someone displaying violent behavior may be wildly irrational, resulting in a situation that's difficult to diffuse. Therefore, the initial intervention should be to secure the safety of the patient and anyone in the immediate vicinity, including healthcare personnel, until the patient's violent behavior can be controlled.
History and physical examination
During your evaluation, determine whether the patient has a history of violent behavior. Is he intoxicated or suffering symptoms of alcohol or drug intoxication or withdrawal? Does he have a history of family violence, including corporal punishment and child or spouse abuse? (See Understanding family violence.)
Watch for clues indicating that the patient is losing control and may become violent. Has he exhibited abrupt behavioral changes? Is he unable to sit still? Increased activity may indicate an attempt to discharge aggression. Does he suddenly cease activity (suggesting the calm before the storm)? Does he make verbal threats or angry gestures? Is he jumpy, extremely tense, or laughing? Such intensifying of emotion may herald loss of control.
If your patient's violent behavior is a new development, he may have an organic disorder. Obtain a medical history and perform a physical examination. Watch for a sudden change in his level of consciousness. Disorientation, failure to recall recent events, and display of tics, jerks, tremors, and asterixis all suggest an organic disorder.
Medical causes
Organic disorders.Disorders resulting from metabolic or neurologic dysfunction can cause violent behavior. Common causes include epilepsy, brain tumor, encephalitis, head injury, endocrine disorders, metabolic disorders (such as uremia and calcium imbalance), and severe physical trauma.
Psychiatric disorders.Violent behavior occurs as a protective mechanism in response to a perceived threat in psychotic disorders such as schizophrenia. A similar response may occur in personality disorders, such as antisocial or borderline personality.
Other causes
Drugs and alcohol.Violent behavior is an adverse effect of some drugs, such as lidocaine and penicillin G. Alcohol abuse or withdrawal, hallucinogens, amphetamines, and barbiturate withdrawal may also cause violent behavior.
Nursing considerations
▪ Take measures to protect yourself, such as remaining at a distance from the patient and calling for assistance.
▪ Remain calm, and make sure you have enough personnel for a show of force to subdue or restrain the patient if necessary.
▪ Encourage the patient to move to a quiet location—free from noise, activity, and people—to avoid frightening or stimulating him further.
▪ If the patient makes violent threats, take them seriously, and inform those at whom the threats are directed.
▪ If ordered, administer a psychotropic medication.
Patient teaching
▪ Reassure the patient, explain what's happening, and tell him that he's safe.
▪ After the patient is calm, explain the reason for his violent behavior, if known.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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