HESI MILESTONE 2 RETAKE 2023 LATEST GUIDE

HESI MILESTONE 2 RETAKE 2023 LATEST GUIDE I KNOW IT IS 18 PAGES BUT I ADDED EVERYTHING FROM TINSELY’S SESSION TODAY AND FROM THE ORIGINAL BLUEPRINT AND THE RETAKE BLUEPRINT. PLEASE FEEL FREE TO ADD MORE AND THEN PASS IT BACK TO ME. MENTAL HEALTH Managing Aggression Aggression response  RN has to protect other’s from pt’s behavior  Set limits on unacceptable behavior  Limit setting: (1) inform pt of rules (2) explain consequences (3) state expected behavior  Plans & Interventions: A. assess verbal/non-verbal ques for escalating behavior B. nonauthoritative approach C. “show of force” with a child who is out of control D. do not ask “why” questions E. use “quiet room”  Pt has verbal threats, pacing, raised voice  In a mental health floor, the RN will say in a calm, firm voice, not raising voice, “let’s go back to your room and take time out”  RN will not go into room  RN will go between the door  If pt is in day room threatening and pacing, scaring the staff and other pts  pt needs a time out  Free of injury and safe  Therapeutic communication Triggering phase - the nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client’s emotion and behavior Escalation phase - nurse should provide directions to the client in a calm, firm voice. The client should be directed to take a time-out for cooling off in a quiet area or his or her room Crisis phase – physically violent; staff must take charge of the situation for the safety of the client, staff, and other clients. Violence handling  Engage in dialogue to prevent escalation  Approach as non-threatening, calm manner