De-Escalation Skills
How should you respectfully address an agitated patient when you first approach them?
Greet them using their full name.
What is one thing you should avoid doing when the person is explaining why they are upset?
To reduce overstimulation after a brain injury, the room should be kept like this:
quiet and calm
A patient is restless, pacing, and showing excessive movements. What do you do?
Identify external (environmental) and internal triggers (pain)
- Reduce stimulation and additional people
- Simplify instructions
- Validate emotions if patient is verbally communicating them to you.
A combined injury where damage occurs at the site of impact (coup) and on the opposite side (contrecoup) due to the brain rebounding inside the skull is called:
Coup-Contrecoup Injury
What type of setting helps reduce stimulation when speaking with someone who is upset/agitated?
A quiet environment with minimal distractions
What tone of voice should you avoid using when trying to calm someone down?
Raising your voice or sounding aggressive.
What environmental stimulation might need to be removed or turned off?
hallway noise
music
phones
TVs
Limitation of individuals in the room (should be 1-2 visitors at a time)
Your patient insists on being moved and you spend over 30 minutes trying to help the patient and when you attempt to leave, the indicate that you are incompetent. How do you react?
Do not engage in behavior responses - do not take comments/actions from the patient personally.
A collection of blood outside blood vessels, which can cause severe pressure on the brain is called:
Hematoma (TBI)
How should you speak to an agitated patient if they are yelling/raising their voice?
Speak in a normal, even tone, and do not raise your voice or shout.
If a patient is refusing to participate or respond to you, what should you NOT do?
Do not try to force the person to do what you want them to do.
How many individuals should be in the patients room at a time to avoid over stimulation?
1-2 individuals at a time.
You are trying to prodive meds and attempt to figure out the patient's pain level. The patient is focused on talking about what options they are choosing from the lunch menu. What do you do?
Consider reducing stimulation/distractions, simplify instructions/tasks, provide structure and memory/written aids, rest, and identify triggers.
Ex: If the patient is worrying about the lunch menu in front of them, try moving the distraction and ask them in a simpler way about their pain.
focal brain injuries occurring directly beneath the point of impact, often resulting in bruising (contusions), tearing of blood vessels, and swelling, frequently caused by blunt trauma or moving objects striking a stationary head is called a:
Coup traumatic brain injuries (TBIs)
Personal Space between the caregiver and patient.
If a patient uses poor verbal language towards you, how should you respond?
Do not take the personal actions or words of the patients personally.
Use de-escalation strategies to reduce agatation or walk away from the situation if needed.
What are activities we should encourage the patient to participate in?
All activities that are the least restrictive.
Ecourage the patient to participate in getting ready, using the bathroom, and eating meals around regular mealtimes.
The patient has 3 providers in the room with the lights on, the providers are speaking loud to the patient, and the patients phone is going off.
Turn the lights off/dim the lights
remove providers to only have 1-2 individuals in the room
ask the patient if they can mute/turn off their phone
Damage caused by lack of oxygen to the brain, which can occur as a result of a TBI.
Anoxic/Hypoxic Brain Injury
If the patient continues to escalate, what safety steps should you consider?
If a patient is taking too long to respond or is not responding at all, what should you NOT do?
What are signs and symptoms of agitation triggered by overstimulation?
clenched fist or jaw
decreased attention
enlarged eyes
fidgeting or pacing
flaring nostrils
flushed face
increased volume of voice
rapid respirations
Pt has family visiting (4 people), and the caregiver walks in to start treatment. The patient is highly agitated, frequently moving, looking at the TV that is on, and trying to respond to questions. What can you do to reduce the amount of overstimulation?
Ask the visitors to step out for a moment (limit to 1-2 individuals at a time) and explain why.
Look at agitating factors: turn off the TV
Figure out what factors are causing them to move and figure out any agitating factors (internal or external)
Widespread shearing and tearing of nerve fibers (axons) caused by rapid acceleration/deceleration, commonly leading to coma is called:
Diffuse Axonal Injury (DAI)