Radiography of Difficult Patients

What are the 3 stages of the anger model?

1) trigger

2) escalation

3) crisis

What happens to your quality of judgment/ability to communicate and reason during an anger episode?

it tanks

List a few factors that may CAUSE aggression (3)

- frustration

- feeling threatened

- feeling powerless

- in pain

- expects to be confronted/treated with hostility

- feels justified in being angry

List a few cues of agitation in BODY LANGUAGE (5)

- clenched teeth/jaw

- muscle tension

- clenched fists

- rapid breathing or sharp inhalation

- staring

- flushed face and/or neck

- rise in pitch or volume of voice

- pointing or extreme hand gestures when talking

List a few reasons WHY someone may be agitated (3)

- they are in an unfamiliar place

- may be experiencing distress, upset or uncertain about a medical outcome

- may be experiencing dissatisfaction or frustration with the process

- may expect to have to "fight" in order to have their needs met or worries considered

List a few ways you can monitor and control your OWN emotions (3)

- use an open, non-threatening stance

- keep eye contact & non-threatening facial expressions

- move slowly & deliberately

- respect personal space

List a few ways to allow the patient to EXPRESS themseles fully, then support those feelings (3)

- ask what has happened to upset them

- listen to their answer

- demonstrate respect & empathy for the situation

- reassure them that you are there to help

List a few things that you do NOT do (5)

DO NOT

- use expressions that convey power

- stand over/directly in front of the agitated patient

- ignore what they are saying

- continue with the exam without addressing their concerns

- turn your back to them

- criticize or blame them for becoming angry

- trivialize their anger

- become angry yourself

What are 5 reasons you can look out for to EXPECT uncooperative behavior?

1) age (elderly & kids)

2) mental health issues

3) dementia

4) alcohol abuse

5) drug use

What is something to keep in MIND when imaging kids?

toddlers & preschoolers will want to deomonstrate independence, so allow them as much as possible (offer them choices)

What are some things you can DO when imaging kids? (5)

- may hang on to an animal or toy if possible

- make sure parents understand that you may have to restrain them

- if they scream, do not shout over them. talk quietly so they have to listen to hear you

- don't use the words "hurt" or "pain"

- muscular activity like kicking, wiggling & screaming is their bodies reactions to stress and uncontrolled emotion

Name a diagnostic imaging restraining device for children

- Piggo-stat

- Pedi-poster

- Papoose restrainer

List a few SYMPTOMS of mental health issues (3)

- paranoia

- delusion

- apprehension & fear

- rapid emphatic speech

- accentuated hand gestures

List a few TIPS for imaging a patient with mental health issues (3)

- stay calm, don't raise your voice

- step back & allow the patient space

- keep your hands in front of you with palms open

- use a non-aggressive stance

- ask them what they are upset about

- listen & offer assistance

- if they have been given medication, ask if the exam can wait

- may require restraints

What does dementia mean?

loss of memory & other mental abilities severe enough to interfere with daily life

What are one of the CAUSES of dementia?

- Alzheimer's Disease

- Vascular Dementia (stroke)

What are a few SYMPTOMS of dementia? (3)

- difficulty remembering recent conversations, names or events

- apathy and depression

- impaired communication

- impaired judgment

- inability to make decisions

- disorientation and confusion

- behavior changes

- difficulty speaking, swallowing & walking

What does lucid or lucidity mean?

periods of time when patient looks & talks normal (unaffected by dementia)

What does sundowning mean?

period of time in which symptoms are severe, typically in the late afternoon

What are a few ways to UNDERSTAND and REASSURE DEMENTIA patients? (3)

- allow the person to take their time

- be friendly and smile

- consider their feelings & respond to the emotions they are expressing

- if they experience difficulty or appear distressed, ask direct (simple) questions

What are a few things to do with BODY LANGUAGE & PHYSICAL CONTACT when imaging patients with DEMENTIA? (3)

- make eye contact

- make sure your body language & facial expressions match what you are saying

- never stand too close or stand over someone to communicate

- don't cover your mouth; they should see your face clearly

- touching should be done to comfort & reassure; don't grab or force

What are a few things to do with VERBAL COMMUNICATION when imaging patients with DEMENTIA? (3)

- speak clearly & calmly

- use short, simple sentences

- speak at a slightly slower pace

- avoid speaking sharply or raising your voice

- address the patient directly

What ways can you offer PRACTICAL SUPPORT when imaging patients with DEMENTIA? (3)

- if someone can't remember how to do something, offer to show them

- try not to put them under pressure: break down tasks into smaller tasks, supporting them along the way

- if a patient forgets what you said, repeat your sentence patiently like you have not said it before

- be aware of noisy and dark environments, and if you can, provide a quiet place where it's easier to offer 1:1 assistance

- if they get agitated, ask specific questions on how you can help, allow them to calm down, don't rush them

Name ways you can communicate with an AGGRESSIVE INTOXICATED patient (3)

- make eye contact and use simple wording and phrases

- stay professional & appropriate

- don't use terms that convey power, say, "I need" NOT "You need"

- stay calm & don't take anything the patient says personally

- watch your non-verbal, don't convey judgement, frustration or hostility

- keep a safe distance & keep your eye on the patient

- get help if you think the patient may become violent

Name the 5 tips for imaging someone under drug influence

1) keep your eye on the patient at all times

2) stay professional, don't convey judgment

3) keep the patient talking

4) don't be manipulated by the patient

5) get help if the patient becomes aggressive or agitated

What are the FOUR things to remember with an aggressive patient?

1) keep your cool

2) get help

3) look for an escape route

4) try to calm the patient until help arrives