Question

Scenario

You are the nurse working triage in the emergency department (ED). This afternoon a woman brings in her father, ALI, a 72-year-old who is a retired doctor. The daughter reports that over the past several months she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. He had difficulty finding objects in the kitchen and at times forgets where his room is.

This morning he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his coffee, and he seems to be getting more agitated. ALI reports that he has been having memory problems for the past year and at times has difficulty remembering the names of family members and friends.

A review of his past medical history (PMH) is significant for hypercholesterolemia and coronary artery disease (CAD). He had a myocardial infarction (MI) 5 years ago. ALI’s vital signs (VS) today are all within normal limits (WNL).

Q: How do you manage a patient who is showing some signs of agitation and aggression? Discuss two skills.     

Answer 1

Agitation is a general term to describe excessive physical movement and verbal activity. Agitation include restlessness, pacing, verbal aggression, combativeness, calling out and crying, and wandering.

aggression is shouting or screaming, verbal abuse, and sometimes physical abuse.

1. Investigate the Cause of agitation :The cause is the most important factor to consider for agitation. Caregiver is charged with figuring that cause out.The cause can range from boredom to pain to a need for exercise.

2. Solve the issue: For a person with forgetfulness It's important to maintain a daily fixed routine to reduce his confusions. After identifying the cause of discomfort It's important to solve the problem or to make the person understand the condition. Never force the person to do something which he do not want to perform.

3.Addressing Unmet Needs:Caregiver should met the needs of someone who is hungry, tired, bored, lonely or in pain is paramount. May agitation is likely there for a reason, and be certain to meet the need it may be expressing.

4. Other methods :

Music: Both singing and listening to music have been shown to decrease agitation and even improve cognition in persons with forgetfulness .

Physical Touch: Pysical touch is very important. A little tender loving care goes a long way- research has demonstrated that appropriate physical touch can diminish agitation.

Physical Exercise: Physical exercise can help decrease challenging behaviors and improve cognitive ability, among other benefits.

Pet Therapy: Research has shown that animal-assisted therapy can improve mood and nutrition, as well as decrease agitated behaviors in people with forgetfulness .

These are the skills that can be used to manage patients who are showing aggression and agitation.