Alcohol Intoxication Definition

A person is said to suffer from alcohol intoxication when the quantity of alcohol the person consumes produces behavioral or physical abnormalities. In other words, the person's mental and physical abilities are impaired. In addition to the signs of physical and mental impairment, alcohol levels can also be measured in the blood. Most states have specific levels at which the driving of a motor vehicle is forbidde

Alcohol Intoxication Causes

Alcohol is a generic term for ethanol, which is a particular type of alcohol produced by the fermentation of many foodstuffs - most commonly barley, hops, and grapes. Other types of alcohol commonly available such asmethanol (common in glass cleaners),isopropyl alcohol (rubbing alcohol), and ethylene glycol (automobile antifreeze solution) are highly poisonous when swallowed, even in small quantities. Ethanol produces intoxication because of its depressive effects on various areas of the brain causing the following physical and mental impairments in a progressive order as the persons alcohol level increases (the person becomes more and more intoxicated).

Disinhibition of normal social functioning Euphoria (excessive talking, showing off) Ataxia (uncoordinated gait-walking) Poor judgment Loss of memory Slurred speech Worsening ataxia Vomiting Confusion and disorientation Progressive lethargy and coma Ultimately the shutdown of the respiratory centers and death What happens to brain function: Alcohol increases the effect of the body's naturally occurring neurotransmitter GABA (gamma amino butyric acid). Neurotransmitters are substances that chemically connect the signals from one nerve to the next allowing a signal to flow along a neural pathway. An inhibitory neurotransmitter (alcohol) reduces this signal flow in the brain. This explains how alcohol depresses both a person's mental and physical activities. By way of comparison, cocaine does the opposite by producing a general excitatory effect on the nervous system. Available forms and measurement: A standard "drink" of ethanol consists of 10 grams. This amount is equal to:

Ten ounces (300 cc) of regular beer (5% alcohol content); Three quarter ounces of wine (12% alcohol content); or One ounce of hard liquor (40% alcohol content, 80 "proof"). Absorption: Approximately 20% of ethanol is absorbed into the bloodstream directly from the stomach, and 80% from the small intestine. Consequently, the longer the ethanol/alcohol remains in the stomach, the slower it will be absorbed and the lower the peak in the blood alcohol concentration (BAC).

This explains the apparent sobering effect of food, which slows the process of emptying the stomach contents, slows the absorption of alcohol, and thus reduces the peak blood alcohol concentration reached. When alcohol is consumed with food, absorption generally is complete in 1-3 hours during which time the blood alcohol concentration will peak. If no further alcohol is consumed, sobering up will follow this peak level of blood alcohol concentration. Distribution: Ethanol is highly soluble in water and is absorbed much less in fat. So alcohol tends to distribute itself mostly in tissues rich in water (muscle) instead of those rich in fat.

Two people may weigh the same, yet their bodies may have different proportions of tissue containing water and fat. Think of a tall, thin person and a short, obese person who both weigh 150 pounds. The short, obese person will have more fat and less water making up his/her body than the tall, thin person. If both people, in this example, consume the same amount of alcohol, the short, obese person will end up with a higher blood alcohol concentration. This is because the alcohol he drank was spread into a smaller water "space." Women's bodies, on average, have more fat and less water than men's bodies. Using the same logic, this means that a woman will reach a higher blood alcohol concentration than a man of the same weight when both drink the same amount of alcohol. Metabolism (elimination): Metabolism is the method by which the body processes alcohol and everything else a person eats or drinks. Some of the alcohol is converted to other substances (such as fat, as in "beer belly"). Some is burned as energy and converted to water and carbon dioxide. A small amount is excreted unchanged in the breath and urine. The liver metabolizes about 90% of the ethanol. The lungs excrete about 5% during exhalation (breathing out). Alcohol excretion by the lungs forms the basis for Breathalyzer testing. Another 5% is excreted into the urine.

The average person metabolizes about one standard drink (10 grams) per hour. Heavy drinkers have more active livers ,and may be able to metabolize up to three drinks per hour. People with liver diseases will metabolize less than one drink per hour. In many chronic alcoholics, the liver becomes ineffective and can no longer metabolize alcohol, or anything else, efficiently. This is known as alcoholiccirrhosis.

In alcoholic cirrhosis, the liver cells become badly scarred. This scarring has the effect of blocking blood flow through the liver, impeding exchange of metabolic chemicals into and out of the liver cells, and damaging the cells' ability to function.

Alcohol Intoxication, Physician Treatment and Follow-up

Treatment: No specific treatment can reverse the effects of alcohol intoxication.

Intoxicated people often receive IV fluids and B complex vitamins for dehydration(alcohol is a diuretic and increases urine output) and as a precaution or treatment for vitamin deficiency. In severe cases - those of severe stupor and coma - the person should be intubated (a breathing tube placed in the patient's airway) to support respirations (which may stop spontaneously) and to protect the lungs from filling with vomit/secretions. o Intubation involves placing a short, flexible plastic tube into the windpipe (trachea) just below the vocal cords and connecting the tube to a respirator machine. The tip of the tube has a small donut-shaped balloon around it, which is inflated to seal the end of the tube to the inside of the windpipe. This accomplishes two things: It prevents the air from the respirator from leaking out into the mouth instead of going into the lungs. It provides a protective seal so that a large amount of vomit in the mouth is prevented from entering the lungs where it could cause damage and possible suffocation. Follow-up: Barring any major complications, most intoxicated people may go home from the hospital's emergency department. For some medical and many legal reasons, most hospitals prefer to keep people suspected of alcohol intoxication under observation until their blood alcohol concentration falls to below 100 mg/dL.

In most people, the liver metabolizes about 10 grams of ethanol per hour. This corresponds to a blood alcohol concentration fall of about 20 mg/dL per hour. Thus, the length of time a person (and family) will need to wait until discharge may be expressed by the formula (blood alcohol concentration-100)/20 = the wait in hours. For example, the blood alcohol concentration from a blood sample drawn at midnight is 280 mg/dL. (280-100)/20 = 9. The blood alcohol concentration should fall to 100 mg/dL by 9 am (midnight plus 9 hours). A social worker may talk with the intoxicated person prior to discharge from the hospital. The social worker may advise the person to go to an alcohol treatment center. This is an extremely difficult situation because many people either don't recognize their problem if they are chronic drinkers, or don't have any desire to correct the situation.

lcohol Intoxication Signs and Symptoms

The effects of alcohol vary widely from person to person. Several factors can account for obvious differences in how certain amounts of alcohol can affect one person more than another.

These factors also affect the particular signs and symptoms the person may exhibit to indicate alcohol intoxication. Major factors accounting for this variation in signs and symptoms:

Prior experience with alcohol: A longtime, heavy drinker may achieve blood alcohol concentration levels that would kill the average casual drinker. Conversely, a novice drinker may have severe symptoms with the ingestion of a moderate amount of alcohol. As a person's drinking increases, his/her liver will increase its capacity to metabolize alcohol. In addition, the brain of a heavy drinker becomes used to frequent, even constant, high blood alcohol concentrations. This habituation in a heavy drinker can backfire if this person suddenly stops drinking. The person may go into alcohol withdrawal and develop seizures or a condition called delirium tremens (DTs). Taking medications: The effects of alcohol are enhanced if a person is taking other prescription medications, especially those of the sedative class such as sleeping pills or anti-anxiety medications. A person who is not habituated to either alcohol or sedatives may experience serious harm, or even death, if taking prescribed doses. Together, they can be a deadly combination. A person may be taking medications prescribed by a doctor or over-the-counter medications, and may not know about these unintended consequences. Medical conditions: The presence of a wide variety of medical conditions may affect how a person reacts to alcohol. Smell of alcohol on the breath: There is a very poor correlation between the strength of the smell of alcohol on the breath and the blood alcohol concentration. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath. Scale of effects: In the average social drinker (defined as someone who drinks no more than two standard drinks per day), there is a rough correlation between blood alcohol concentration and how the person acts. Blood alcohol concentration. Blood alcohol concentration commonly is expressed in milligrams per deciliter (mg/dL). Using this measure, 100 mg/dL roughly is equal to one part alcohol in 1000 parts of water (or blood). Consequently, 100 mg/dL would be equal to a 0.1% concentration. In most states, 100 mg/dL represents the threshold concentration above which a person is legally intoxicated when operating a motor vehicle. o To find out more about blood alcohol concentration and how it affects a person, go to the Blood Alcohol Educator Web site of the Century Council and the University of Illinois. o TThe following scale details the expected effects of alcohol at various blood alcohol concentrations. There is a tremendous variation from person to person, and not all people exhibit all the effects. This scale would apply to a typical social drinker: 50 mg/dL: Loss of emotional restraint, vivaciousness, feeling of warmth, flushing of skin, mild impairment of judgment

100 mg/dL: Slight slurring of speech, loss of control of fine motor movements (such as writing), confusion when faced with tasks requiring thinking, emotionally unstable, inappropriate laughter 200 mg/dL: Very slurred speech, staggering gait, double vision, lethargic but able to be aroused by voice, difficulty sitting upright in a chair, memory loss 300 mg/dL: Stuporous, able to be aroused only briefly by strong physical stimulus (such as a face slap or deep pinch), deep snoring 400 mg/dL: Comatose, not able to be aroused, incontinent (wets self), low blood pressure, irregular breathing 500 mg/dL: Death possible, either from cessation of breathing, excessively low blood pressure, or vomit entering the lungs without the presence of the protective reflex to cough it out Other conditions that look like alcohol intoxication: It is important to recognize the symptoms of alcohol intoxication not only to confirm the presence and severity of the alcohol effect, but also to be able to differentiate the symptoms from other conditions that may coexist, mimic, or mask the symptoms of alcohol intoxication.

NTRODUCTION

Aggression arises from an innate drives or occurs as a defense mechanism and is manifested either by constructive or destructive acts directly towards self or others. Aggressive people ignore the rights of other people. They must fight for their own interests and they expect same from others. An aggressive approach to life may lead to physical or verbal violence. The aggressive behavior often covers a basic lack of self confidence. Aggressive people enhance to their self esteem by overpowering others and there by proving their superiority. They try to cover up their insecurities and vulnerabilities by acting aggressive. Meaning

Anger: Anger is defined as a strong uncomfortable emotional response to provocation that is unwanted and incongruent with ones values, beliefs or rights. Aggression: Aggression refers to behavior that is intended to cause harm or pain. Aggression can be either physical or verbal.

Characteristics of aggressive behavior

Aggressive behavior is communicated verbally or non verbally Aggressive people may invade the personal space of others They may speak loudly and with greater emphasis They usually maintain eye contact over a prolonged period of time so that the other person experiences it as an intrusive Gestures may be emphatic and often seem threatening. (For example they may point their figure, shake their fists, stamp their feet or make slashing motion with their hands) Posture is erect and often aggressive people lean forward slightly towards the other person. The overall impression is one of power and dominanc

Types of aggression

Instrumental aggression -- aggression aimed at obtaining an object, privilege or space with no deliberate intent to harm another person Hostile aggression -- Aggression intended to harm another person, such as hitting, kicking, or threatening to beat up someone. Relational aggression -- A form of hostile aggression that does damage to another's peer relationships, as in social exclusion or rumor spreading

Moyer Classification Moyer (1968) presented an early and influential classification of seven different forms of aggression, from a biological and evolutionary point of view.

Predatory aggression: Attack on prey by a predator. Inter-male aggression: Competition between males of the same species over access to resources such as females, dominance, status, etc. Fear-induced aggression: Aggression associated with attempts to flee from a threat. Irritable aggression: Aggression induced by frustration and directed against an available target. Territorial aggression: Defense of a fixed area against intruders, typically conflicts. Maternal aggression: A female's aggression to protect her offspring from a threat. Paternal aggression also exists. Instrumental aggression: Aggression directed towards obtaining some goal, considered to be a learned response to a situation.

THEORIES OF AGGRESSION

Aggressive and violent behavior can be viewed along a continuum with verbal aggression at one end and physical violence at other end. Specific reasons for aggressive behavior vary from person to person. Anger occurs in response to a perceived threat. This may be a threat of physical injury or more often a threat to the self concept. When the self is threatened, people may not be entirely aware of the source of their anger. A threat may be internal or external. Examples of external stressors are physical attack, loss of a significant relationship and criticism from others. Internal stressors might include a sense of might include a sense of failure at work, perceived loss of love and fear of physical illness.

Anger is the only one emotional response to these stressors. Some people might respond with depression or withdrawal. However, those reactions are usually accompanied by anger which may be difficult for the person to express directly. Depression is sometimes viewed as anger directed towards the self, and withdrawal may also be a passive expression of anger. A number of theories on the development of aggressive behavior have influenced the treatment of violent patients. They can be categorized as psychological, socio cultural and biological. 1. PSYCHOLOGICAL THEORY One psychological view of aggressive behavior suggests the importance of predisposing developmental or life experiences that limit the persons capacity to select nonviolent coping mechanisms. Some of these experiences may include:

Organic brain damage , mental retardation or learning disability, which impair the capacity to deal effectively with frustration. Severe emotional deprivation or overt rejection in childhood, or parental seduction, which may contribute to defects in trust and self esteem. Exposure to violence in formative years , either as a victim of child abuse or as an observer of family violence, which may instill a pattern of using violence as a way to cope

It has been also suggested that a disruption in the mother infant bonding process can lead to the development of poor interpersonal behavior that may increase the likelihood of violent behavior. When combined with neurological deficits, the risk of violent behavior is increased. Social learning theory proposes that aggressive behavior is learned through the socialization process as a result of internal and external learning. Internal learning occurs through the personal reinforcement received when enacting aggressive behavior. This may be the result of achieving a desired goal or experiencing feelings of importance, power and control. External learning process occurs through the observation of role models such as parents, peers, siblings and sports and entertainment figures. Sociocultural patterns that lead to the imitation of aggressive behavior suggest that violence is an acceptable social status.

Activities such as violent crime, aggressive sports, and war depicted through the media or witnessed, in person reinforce aggressive behavior. 2. SOCIOCULTURAL THEORY

Social and cultural factors also may influence aggressive behavior. Cultural norms help to define acceptable and unacceptable means of expressing aggressive behavior feelings. Sanctions are applied to violators of the norms through the legal systems. By this means, society controls violent behavior and attempts to maintain a safe existence of its members. A cultural norm that supports verbally assertive expressions of anger will help people deal with anger in a healthy manner. A norm that reinforces violent behavior will result in physical expression of anger in destructive ways. Social determinants of violence are:

Poverty and the inability to have basic necessities of life Disruption of marriages Production of single-parent families Unemployment Difficulty in maintaining interpersonal ties, family structure and social control.

3. BIOLOGICAL THEORY Current biological research ahs focused on three areas of the brain believed to be involved in aggression:

Limbic system Frontal lobes

Hypothalamus.

Neurotransmitters have also been suggested as having a role in the expression or expression of the aggressive behavior. I. Limbic system

t is associated with the mediation of basic drives and the expression of human emotions and behaviors such as eating, aggression and sexual response. It is also involved in the processing of information and memory. Alterations in the functioning of limbic system may result in an increase or decrease in the potential for aggressive behavior. In particular, the amygdala, part of the limbic system, mediates the expression of the rage and fear. II. Frontal lobe:

The frontal lobe plays an important role in mediating purposeful behavior and rational thinking. They are the part of the brain where reason and emotion interact. Damage to the frontal lobes can result in impaired judgment, personality changes, and problems in decision making, inappropriate conduct and aggressive outbursts.

III. Hypothalamus

It is situated at the base of the brain, is the brains alarm system. Stress raises the level of steroids, the hormones secreted by the adrenal glands. Nerve receptors for these hormones become less sensitive in an attempt to compensate and hypothalamus tells the pituitary glands to release more steroids. After repeated stimulation, the system may respond more vigorously to all provocations. That may be one reason why traumatic stress in childhood may permanently enhance ones potential for violence. Neurotransmitters

Neurotransmitters are brain chemicals that are transmitted to and from neurons across synapses, resulting in communication between brain structures. An increase or decrease in this behavior can influence behavior. People who commit suicide and homicidal have lower than average levels of 5-HIAA, the breakdown product of the serotonin, in their spinal fluid. Other neurotransmitters often associated with aggressive behavior are dopamine nor epinephrine and acetylcholine and the amino acid GABA. Animal studies indicate that increasing in brain dopamine and nor epinephrine activity significantly enhances the likelihood that animal will respond to the environment in an impulsively violent manner. PREDISPOSING FACTORS

GENETIC FACTORS

a). Twin studies : concordance rate for monozygotic twins exceed the rates for dizygotic twins b). Pedigree studies: the persons with family histories of mental disorders are more susceptible to mental disorder and engage in more aggressive behavior than those without such histories. Those with low IQ scores appear to have frequency of delinquency and aggression than those with normal IQ scores. c) Chromosomal influences: XYY syndrome contributes to aggressive behavior. The person with this syndrome are tall, below average intelligence and likely to be apprehend and in prison for engaging in criminal behavior.

NEUROTRANSMITTERS Cholinergic and catecholaminergic mechanisms seem to be involved in the induction and enhancement of predatory aggression whereas seroteonergic system and GABA seem to inhibit such behavior. Dopamine seems to facilitate aggression, whereas nor epinephrine and serotonin appears to inhibit such behavior. Some human studies have indicated that 5-HIAA levels in CSF inversely correlates with the frequency of aggression, particularly among persons who commit suicide. NEUROPHYSIOLOGICAL DISORDERS

Epilepsy of temporal lobe and frontal lobe origin results in episodic aggression ad violent behavior .Tumors in the brain ,particularly in the areas of the limbic system and the temporal lobe ,trauma to the brain ,resulting in cerebral changes and the disease such as encephalitis have been implicated in the predisposition to aggression and violent behavior. PSYCHOLOGICAL FACTORS INTRINSIC BEHAVIOURS Freuds view:

According to Sigmund Freud held that all human behavior stems either directly or indirectly from two instincts. These are Eros and Thanatos. Eros -It is the life the life instinct whose energy or libido is directed towards the enhancement or reproduction of life. In this frame work, aggression was viewed simply as a reaction to blocking or thwarting of libidinal impulses and was neither an automatic nor an inevitable part of life. Thanatos: It is the death force-whose energy is directed towards the destruction or termination of life. According Freud , all human behavior stem from the complex interplay of Thanatos and Eros and the constant tension between them. Because the death instinct, if unrestrained, soon results in self-destruction. Freud hypothized that through the mechanism such as displacement, the energy of Thanatos is redirected towards and serve as the basis of aggression against others. Thus according to him, aggression primarily stems from the redirection of the self destructive death instinct away form the self and towards others.

Lorenzs view:

According to Konard Lorenz , aggression that causes physical harm to others springs from a fighting instinct that humans share with other organisms. The energy associated with this instinct is produced spontaneously in organisms at a more or less constant rate. Learned behavior

Aggression is primarily a learned form of social behavior. According to Albert Bandura, neither innate urges toward violence nor aggressive drives aroused by frustration are the roots of human aggression. He said that aggression is the learned behavior under voluntary control. The learning of aggressive behavior occurs by observation and modeling. For example, a child watches an angry parent strikes out another person. Learning aggressive behavior also takes place by direct experiences. The person feels anger and behaves aggressively. If behaving aggressively brings rewards, the behavior is encouraged. Moreno believed that anger is a natural by product of the learning process; it is signal that a person wants to learn something. The more inadequate a person feels, the more anger may be present. Moreno also believed that anger is spontaneous energy that propels an individual into new learning. SOCIAL FACTORS a). Frustration: The single most potent means of inciting human beings to aggression is frustration. Widespread acceptance of this view stems from John Dollards frustration, aggression hypothesis. This hypothesis indicated that frustration always leads to a form of aggression and that aggression always stem from frustration. Frustrated persons do not always respond with aggressive thoughts and words, or deeds. They may show a wide variety of reactions ranging from resignation, depression and despair to attempts to overcome the sources of frustration. Examination of the evidence indicates that whether frustration increases or fails to enhance covert aggression depends largely on two factors. First, frustration appears to increase aggression only when the frustration is intense. When it is mild or moderate, aggression may not be enhanced. Second frustration is likely to facilitate aggression when it is perceived as arbitrary or illegitimate, rather than when it is viewed s deserved or legitimate. b). Direct provocation: Evidence indicates that physical abuse and verbal taunts from others often elicit aggressive actions. Once aggression begins, it often shows an unsettling pattern of escalation; as a result even mild verbal slurs or glancing blows may initiate a process of in which a stronger and stronger provocation are exchanged. c). Television violence: A link between aggression and televised violence has been noted. The more televised violence children watch, the greater is their level of aggression against others. Mechanisms underlying the effects of televised and filmed violence on the behavior of the viewers

Mechanism Observational learning Disinhibition Desensitization

Effects Viewers acquire new means of harming others not previously present in their behavior Viewers restraints or inhibition against performing aggressive action are weakened as a result of observing others engaging in such behavior Viewers emotional responsivity to aggressive actions and their consequences signs of suffering on the part of victims is reduced. As result they show little, if any, emotional arousal in response to such stimuli.

d). Computer games: Similar concerns have been raised the bout computer game with violent themes. Some studies indicate that adolescents become desensitized to homicidal activities after repeated exposure, especially if the game involves killing the virtual opponents, which is common in many computer programs. ENVIRONMENTAL FACTORS

Air pollution: Exposure to noxious orders ,such as those produced by chemical plants and other industries ,may increase personal irritability and therefore aggression , although this effect appears to be truly up to a point. If the odors in question are truly foul , aggression appears to decrease perhaps because escaping from the unpleasant environment becomes a dominant goal for those involved.

Noise: several studies have reported that persons exposed to loud ,irritating noise direct stronger assaults against others than those not exposed to such environmental conditions. Crowding: some studies indicates that overcrowding may produce elevated levels of aggression, but other investigations have failed to obtain such evidence of such a link.

SITUATIONAL FACTORS

Heightened physiological arousal: Vigorous exercises ,exposure to provocative films enhances overt aggression. Sexual arousal: Exposure to photos of attractive nude , aggression is reduced. Aggression is enhanced by the exposure to films of couples engaged in various sex acts. Pain: Physical pain may arouse aggressive drive . this drive intern may find expression of against available targets including those not in any way responsible for the aggressors discomfort.

NURSING PROCESS IN AGGRESSION

Nurses provide care for patients with many types of problems; people who enter the health care system are often in great distress and exhibit many maladaptive coping responses. Nurses who work in the setting such as emergency rooms, critical care areas and trauma centre often care for people who respond to events with angry and aggressive behaviour that can pose a significant risk to themselves, other patients and health acre providers. Thus preventing and managing behaviour are important skills for all nurses to have.

General Principles of Management

The safety of patient, clinician , staff ,other patients and potential intended victims is of most importance while looking after aggressive patients The doors should be open outwards and not be lockable from inside or capable of being blocked from inside. while working with impulsively aggressive or violent patients in any setting one must take care to reduce accessibility to patients of movable objects as well as jewellery and other attire that might add to the risk of injury during an assault, including neckties, necklaces, earrings, eyeglasses, lamps and pens.

Adequate caregiver training and the availability of appropriate supervision are critical safeguards in the treatment of potentially dangerous patients. The caregiver may choose to present a few key observations in a calm and firm but respectful manner, putting space between self and patient; avoiding physical or verbal threats, false promises and build rapport with client.

For caregivers treating patients with a high risk for violence behaviour, training in basic self defence techniques and physical restraint techniques are useful.

Drug Treatment in Aggressive and Violent Behaviours

Careful diagnosis has to be made to avoid overuse and misuse of medication. Medications are used primarily for 2 purposes-

To use sedating medication in an acute situation to calm the client so that client will not harm self or others. To use medication to treat chronic aggressive behaviour.

Factors influencing choice of drug availability of an IM injection, speed of onset and previous history of response. Acute agitation and aggression Antipsychotic often it is the sedating property of antipsychotic that produce the calming effect for the client. Atypical antipsychotic are also commonly used. But only Ziprasidone is available in intramuscular form. Haloperidol-1 mg or 0.5 mg IM Risperidone o.5mg-1mg- In dementia and schizophrenia. Trazodone 50-100mg . In older clients with sun downing syndrome and aggression. Benzodiazepines- used due to the sedative effect and rapid action. Most commonly lorazepam, oral or injection. Other sedating agents used include Valproate, chloral hydrate and diphenhydramine. Chronic aggression

When client continues to exhibit aggression more than several weeks choice of medication is based on underlying condition. I.e., if related to schizophrenia-antipsychotic.

Antipsychotic Anxiolytics- Buspirone Carbamazepine and valproate to treat bipolar associated aggressive behaviour. Antidepressants trazodone in aggression associated with organic mental disorder. Antihypersensitive medication Propanolol to treat aggression related to organic brain syndrome.

NURSING PROCESS

Nursing Assessment

A violence assessment tool can help the nurse. Establish a therapeutic alliance with the patient. Assess patients potential for violence. Develop a plan of care. Implement the plan of care. Prevent aggression and violence in the milieu. Following the assessment , if the patient is believed to be potentially violent, the nurse should: Implement the appropriate clinical protocol to provide for the patient and staff safety Notify co-workers Obtain additional security if needed Assess the environment and make necessary changes. Notify the physician and assess the need for prn medications.

Nursing Interventions Nursing interventions can be thought of existing in a continuum . They range from preventive strategies such as self awareness, patient education and assertiveness training to anticipatory strategies such as verbal and nonverbal communications, and the use of medications. If the patients aggressive behaviour escalates despite these actio ns the nurse may need to implement crisis management techniques and containment strategies such as seclusion or restraints. Self awareness The most valuable resource of a nurse is the ability to assess ones self to help others .to ensure the most effectiv e use of self , its important to know about personal stress that can interfere in ones ability to communicate with patients. Anxiety, angry, tiredness, apathy, personal work problems etc... from the part of nurse can affect the patient. Negative countertransferance reactions may lead to non therapeutic responses on the part of the staff. Ongoing self

awareness and supervision can assist the nurse in ensuring that patient needs rather than personal needs are satisfied. Patient education

Teaching patients about communication and the appropriate way to express anger can be one of the most successful interventions in preventing aggressive behaviour. Teaching patients that feelings are not right or wrong or good or bad can allow them to explore feelings that may have been bottled up, ignored or repressed. The nurse can then work with patients on ways to express their feelings and evaluate whether the responses they select are adaptive or mal adaptive.

Overview Poisons

are substances that cause injury, illness or death These events are caused by a chemical activity in the cells Poisons can be injected, inhaled or swallowed Poisoning should be suspected if a person is sick for unknown reason Poor ventilation can aggravate Inhalation poisoning First aid is critical in saving the life of victims

Causes Medications

Symptoms Blue lips

Drug overdose Occupational exposure Cleaning detergents/paints Carbon mono oxide gas from furnace, heaters Insecticides Certain cosmetics Certain household plants, animals Food poisoning (Botulism) Skin Rashes Difficulty in breathing Diarrhea Vomiting/Nausea Fever Headache Giddiness/drowsiness Double vision Abdominal/chest pain Palpitations/Irritability

Treatment Seek immediate medical help Meanwhile, Try and identify the poison if

Loss of appetite/bladder control Numbness Muscle twitching Seizures Weakness Loss of consciousness

For inhalation poisoning Seek immediate emergency

possible Check for signs like burns around mouth, breathing difficulty or vomiting Induce vomiting if poisonswallowed In case of convulsions, protect the person from selfinjury If the vomit falls on the skin, wash it thoroughly Position the victim on the left till medical help arrives help Get help before you attempt to rescue others Hold a wet cloth to cover your nose and mouth Open all the doors and windows Take deep breaths before you begin the rescue Avoid lighting a match Check the patient's breathing Do a CPR, if necessary If the patient vomits, take steps to prevent choking

Steps to Avoid Avoid giving

Prevention Store medicines,

an unconscious victim anything orally Do not induce vomiting unless told by a medical personnel Do not give any medication to the victim unless directed by a doctor Do not neutralize the poison withlimejuice/honey carefully Keep all potentially poisonous substances out of children's reach Label the poisons in your house Avoid keeping poisonous plants in or around house Take care while eating products such as berries, roots ormushrooms Teach children the need to exercise caution cleaning detergents,mosquito repellantsand paints

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