Violence
Definition of Violence:
Violence is physical
aggression inflicted by one person on another and may be due to a wide range of
psychiatric disorders.
Excitement:
Patients with excitement are prone for
violence and they may harm others or harm themselves.
Common Mental Disorders Associated with Excitement and Violence Behavior:
1.
Psychotic disorder:
a)
Schizophrenia (especially paranoid and
catatonic).
b) Mania.
c)
Paranoid disorders (delusional disorders).
d) Postpartum
psychosis.
2.
Organic mental disorders:
a)
Delirium
b) Drug
intoxication and withdrawal (alcohol and heroin).
3.
Personality disorders:
a)
Antisocial personality disorders
b) Paranoid
personality disorders.
4. Brain disorders:
a)
Seizure disorders (post-epileptic confusional
state).
b) Brain
injury, encephalitis.
c)
Mental retardation with behavior problem.
Medical Conditions Associated with Excitement and Violence Behavior:
1.
Neurological illness:
a)
Seizure disorders
b) Hepatic
encephalopathy
c)
Cerebral infarcts
d) Encephalitis
e)
Wilson's diseaser
f)
Parkinson's disease etc.
2.
Endocrinopathies:
a)
Hypothyroidism
b) Cushing's
syndrome Thyrotoxicosis
c)
Diabetic crisis.
3.
Metabolic disorders:
a)
Hypoglycemia
b) Hypoxia
c)
Electrolyte imbalance.
4.
Infections:
a)
AIDS
b) Syphilis
c)
Tuberculosis.
5.
Vitamin deficiencies e.g. Folic acid,
pyridoxine, vitamin B 12.
6.
Temperature disturbances:
a)
Hypothermia
b) Hyperthermia
c)
Vitamin D.
7.
Poisoning.
Management and Nursing Care of Excited and Violent Patient:
1.
Self-protection first:
a)
Do not approach alone
b) Call
for assistance to manage any situation
c)
Do not close the door of the consulting room.
2.
Leave physical restrain to the staff members
who are trained for that:
a)
Do not challenge or confront a violent
patient
b) Always
keep an eye of a way to escape
c)
Never turn our back on the patient
d) Be
sure that sufficient staff members are there to restrain the patient.
3.
After physical restrain:
a)
Approach the patient cautiously
b) Do
not be too brave or confident.
4.
If there is no history of head injury or
brain infection, the following drugs are effective:
a)
Injection chlorpromazine 100 mg IM
b) Injection
Haloperidol 10-20 mg IM/IV
c)
Injection Diazepam 10 mg IV slowly.
5.
Assess the nutritional state: If there is
dehydration - IV fluid are essential.
6.
Attend if any external injury.
7.
If psychiatric treatment is not needed we
should call the police for help.
Advices to the Psychiatric Patient at the Time of Discharge:
Teach to the client and
family members –
1.
Encouraging the family members for home care.
2.
Nutrition education, demonstration and
counseling according to patient's need.
3.
Taking care of personal hygiene - regular
bath and cleanliness.
4.
Ensure the client to understand the
medication regime.
5.
Give the medication regularly as prescribed
by the doctor.
6.
Do not stop treatment without the doctor's
advice.
7.
Follow-up at regular interval.
8.
Improve interaction with the client.
9.
Provide safe and comfortable environment.
10.Need support for his
activities of daily living.
11.
Encourage the client to participate in social
activities.
12. Allow
the client to move freely and talk to others.
13. Encourage
client to discuss conflicts evident in the family system.
14. Teach
the client to use alternative coping methods to decrease anxiety.
15. Avoid
taking alcohol.
16.Avoid driving or performing
any activity which might need a lot of concentration after taking psychiatric
drugs.
17. Accept
him as he is and give him care and hope.
18.Encourage to the client to
maintain spiritual need.
19.Give information resources,
such as pamphlets of community-based services, health related information
(disease prevention, nutrition or diet, coping skills for caregivers, etc.) to
client and caregiver.
Violence
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