Depression

Front 1

Define Secondary Depression.

Back 1

It occurs as part of a physical illness or medical regime, or other non-mood mental illness.

Front 2

Indicate some Neurological medical conditions that lead to secondary depression.

Back 2

Epilepsies,
Parkinson's Disease,
multiple sclerosis,
Alzheimer's disease.

Front 3

Indicate some Infectious or inflammatory medical conditions that lead to secondary depression.

Back 3

Neurosyphilis
AIDs

Front 4

Indicate some cardiac medical conditions that lead to secondary depression.

Back 4

Ischemic heart disease
Cardiac failure
Cardiomyopathies

Front 5

Indicate some Endocrine medical conditions that lead to secondary depression.

Back 5

Hypothyroidism
Diabetes melitus
Vitamin deficiencies
Parathyroid disorders

Front 6

Indicate some Inflammatory disorders that lead to secondary depression.

Back 6

Collagen-Vascular diseases
Irritable bowel syndrome
Chronic liver disorders

Front 7

Indicate some Neoplastic disorders that lead to secondary depression.

Back 7

Central nervous system tumors
Paraneoplastic syndromes

Front 8

Indicate some Centra nervous system depressants that lead to secondary depression.

Back 8

Alcohol
Barbiturates
Benzodiazepines
Clonidine

Front 9

Indicate some Central nervous system medications that lead to secondary depression.

Back 9

Amantadine Bromocriptine; Levodopa; Phenothiazines; Phenytoin

Front 10

Indicate some Psychostimulants that lead to secondary depression.

Back 10

Amphetamines

Front 11

Indicate some Systemic Medications that lead to secondary depression.

Back 11

Corticosteroids; Digoxin;
Ditiazem; Enalapril;
Isotretinoin; mefloquine;
Methyldopa; methoclopramide;
quinolones; reserpine;
statins; thiazides;
vincristine.

Front 12

Describe Primary Depression

Back 12

Depression which occurs that is not part of any other illness.

Front 13

What are the types of primary depressions?

Back 13

Major Depression
Dysthymia

Front 14

Describe Major Depression.

Back 14

characterized by emotional, cognitive, and behavioral symptoms which are markedly different from the person’s usual self. These symptoms interfere with the person’s life. The client may have one or more episodes of major depression, but when the symptoms subside the client usually experiences a complete remission.

Front 15

Describe Dysthymia

Back 15

in contrast with major depression, this disorder exhibits a mild to moderate degree of depression which is characterized by at least 2 years of duration. The depressive mood is chronic and doesn’t greatly impair the client’s functioning. These clients are at risk for developing major depression and/or other psychological diseases.

Front 16

What are the current Subtypes of depression?

Back 16

Psychotic features;
Melancholic features;
Atypical features;
Catatonic features;
Postpartum onset;
Seasonal affective disorder (SAD).

Front 17

What are the psychotic features of depression?

Back 17

Indicates the presence of disorganized thinking, delusions or hallucinations.

Front 18

What are the Melancholic features of depression?

Back 18

Indicates a severe form of endrogeinous depression characterized by severe apathy, weight loss, profound guilt, symptoms that are worse in the morning, early morning awakening, and often suicidal ideation.

Front 19

What are the Atypical features of depression?

Back 19

Refers to people who have dominant vegetative symptoms (overeating, oversleeping). Onset is younger, psychomotor activities are slow, and anxiety is often an accompaying problem which may cause misdiagnosis.

Front 20

What are the Catatonic features of depression?

Back 20

Marked by nonresponsiveness, extreme psychomotor retardation, withdrawal, and negativity.

Front 21

What are Psychodynamic influences?

Back 21

psychosocial stressors and interpersonal events trigger neurochemical and neurophysical changes in the brain

Front 22

Early trauma may sensitize the brain causing ...

Back 22

an exaggerated stress response and predispose genetically vulnerable people to depression.

Front 23

Within Cognitive theory, theorists state that...

Back 23

a triad of negative beliefs cause depression due to the reaction to the world. These beliefs cause
1. A negative view of self
2. A pessimistic view of the world
3. The belief that only bad things will happen in the future.
4. These beliefs seem to be true with depressed people regardless of the type of event.

Front 24

Learned helplessness indicates that

Back 24

a person who believes that negative events are his/her fault and that nothing can be done to change them is prone to depression.

Front 25

The signs of Learned helplessness are...

Back 25

Lack of social supports,
Lack of tension reduction skills,
Lack of self-confidence,
Lack of effective problem solving skills.

Front 26

Name the 5 Psychophysiological theories.

Back 26

1. Genetic: twin and family studies support genetic link
2. Biochemical: reduced levels of different neurotransmitters related to episodes of depression: norepinephrine, serotonin, dopamine, GABA, acetylcholine all some how involved.
3. Hyperactivity of the cortical-hypothalamic-pituitary-adrenal axis = hypersecretion of cortisol. Indicates over reaction of this system.
4. Sleep abnormalities: 90% of inpatients show electrocephalogram abnormalities during sleep.
5. Seems clear that the cause is multi-factor (biology + stressors) = diathesis – stress model.

Front 27

Name the key components to assess when interviewing a patient with Depression.

Back 27

1. Suicidal thoughts
2. depressed mood, anhedonia, anergia, Anxiety.
3. Thinking
4. Feelings
5. Communication
6. Spirituality
7. Masked depression
8. Include all the above in a MSE report.

Front 28

What needs to be assessed for Suicidal thoughts?

Back 28

Explore
1. thoughts
2. plans
3. means to carry out the plan.

*** Be Direct. The most likely time for suicide is 6-9 months after initial episode (more energy).

Front 29

What type of thinking occurs in a patinet with depression?

Back 29

1. tends to be slowed,
2. problem solving is decreased,
3. insight and judgment poor.
4. The person is indecisive,
5. memory and concentration is poor.
6. The person may also be delusional: “God hates me,” or “I should die.”

Front 30

What types of feelings are expressed in a person with depression?

Back 30

anxiety,
worthlessness,
guilt,
hopelessness,
helplessness

Front 31

What type of physical behavior is seen in a person with depression?

Back 31

psychomotor retardation,
neglected grooming
hygiene.
Vegetative signs of depression:
changes in eating (anorexia),
early morning wakening
hypersomnia,
changes in elimination
sex patterns.

Front 32

How does communication alter in a person with depression?

Back 32

both expressive and receptive are slowed.

Front 33

Describe spirituality in a person with depression along with an intervention.

Back 33

1. Depression may affect beliefs causing doubt and a sense of separation
2. Encouraging a connection with spiritual practices can bring comfort.

Front 34

Describe masked depression in children.

Back 34

truancy,
underachievement,
learning disorders,
school phobias

Front 35

Describe masked depression in Adolescents:

Back 35

dropping out of school,
underachieveing,
compulsive use of drugs & sex,
delinquent behavior

Front 36

Describe masked depression in Adults.

Back 36

hypochondriasis,
drug addictions,
accident proneness,
drug addictions

Front 37

Describe why depression is missed in Older Adults:

Back 37

many suffer from depression, but due to ageism or inexperience assessing for depression it is often missed in older adults despite frequent visits to medical practioners. This leads to an increase in suicides in this age group as well as under treatment.

Front 38

Name some Nursing Diagnosises that could be used for depression.

Back 38

Risk for suicide
Impaired social interaction
Disturbed self esteem
Ineffective individual coping
Self care deficit

Front 39

What populations are at risk for suicide?

Back 39

elderly,
adolescents,
people with terminal illnesses,
crises

Front 40

Reasons for using Risk for Suicide as a Nursing Diagnosis.

Back 40

suicidal ideation, past attempts, and/or hopelessness

Front 41

Reasons for using Impaired Social Interaction for a Nusing Diagnosis.

Back 41

alienation from others secondary to depressed behavior AEB isolating self

Front 42

Reasons for using Disturbed self esteem for a Nusing Diagnosis.

Back 42

R/T (history of numerous failures, feelings of failure secondary to marital discord/financial problems/etc., or unrealistic expectations of self) AEB expressions of shame/guilt, or self-negating statements

Front 43

Reasons for using Ineffective individual coping for a Nusing Diagnosis.

Back 43

R/T inadequate psychological resources secondary to (choose one) poor self-esteem, helplessness, or negative role modeling AEB (choose correct behavior) verbalizations of inability to cope, inappropriate use of defense mechanisms, inability to meet role expectations,

Front 44

Reasons for using Self Care Deficit for a Nusing Diagnosis.

Back 44

R/T decreased motivation AEB not bathing, grooming, and/or eating

Front 45

Secondary gains =

Back 45

additional benefits the person experiences from being sick such as getting attention and being excused from responsibilities

Front 46

What needs to be considered when entering into a Psychotherapeutic relationship with the patient.

Back 46

spending time with a client who does not communicate well can be frustrating. Use short periods of time initially, set specific times and durations for meeting and stick to time, respect the difficulty the client has communicating by giving sufficient time to respond, use concrete words. Avoid tasks requiring concentration, instead use gross motor abilities.

Front 47

What are the considerations for Health teaching?

Back 47

educate the client and family about depression and validate it as a legitimate medical illness. Medication teaching vital. Patients need to know their personal S&S of depression and that long term management is best with both medication and therapy. Make sure the discharge planning involves the family and that they are aware of both the stresses on the family as well as coping mechanisms to deal with the depressed family member.

Front 48

What area's of ADLs should be considered when caring for a patient with depression?

Back 48

Nutrition-Anorexia
Sleep-Insomnia
Self-care Deficits
Elimination-Constipation

Front 49

What interventions regarding Nutrition/Anorexia should be taken when caring for a patient with depression?

Back 49

Offer small, high-calorie and high protein snacks/drinks frequently thoughout the day and evening. Encorage family to stay with patient while they eat. Offer choices of food the patient likes. Observe the pts. eating patterns and weigh weekly.

Front 50

What interventions regarding Sleep/Insomnia should be taken when caring for a patient with depression?

Back 50

Provid periods of rest. Encorage pt. to get up and stay out of bed for the day. Encourage relaxation measures in the evening. Refuce environmental and physical stimulants in the evening.

Front 51

What interventions regarding Self-care deficits should be taken when caring for a patient with depression?

Back 51

Encourage the use of toothbrush, washcloth, soap, makeup, shaving, ect... Give step by step reminders of how to do hygene acts.

Front 52

What interventions regarding Elimination/Constipation should be taken when caring for a patient with depression?

Back 52

Monitor intake and output. Offer foods high in fiber, and provide periods of exercise. Encourage the intake of fluids. Evaluate the need for laxatives and enemas.

Front 53

What type of health teaching interventions should the nurse do?

Back 53

1. educate the client and family about depression and validate it as a legitimate medical illness.
2. Medication teaching vital.
3. Patients need to know their personal S&S of depression and that long term management is best with both medication and therapy.
4. Make sure the discharge planning involves the family and that they are aware of both the stresses on the family as well as coping mechanisms to deal with the depressed family member.

Front 54

What Psychopharmacology interventions whould be done by the nurse?

Back 54

1. the nurse needs to know how to safely administer these drugs while the client is in the hospital
2. teach the client or support system how to administer them safely at home.
3. Inform pt. that Medication therapy may take 1-3 weeks to show effect and 2-3 months for full effect.
4. Inform pt Only 50% of patients respond to the first medication tried.

Front 55

What is the first line of treatment and why?

Back 55

SSRIs
a. lower anticholinergic side effects
b. faster onset than TCA’s
c. lower cardiotoxcity
d. compliance better than TCA’s
e. common side effects: sexual disturbances (25%) headache/dizziness/fine tremor (10%), nausea

Front 56

What are the serious side effects of SSRI's?

Back 56

central serotonin syndrome: hyperactivity, tachycardia, hyperpyrexia, hypertension lead to delirium, then seizures, then possibly death.

Front 57

What interventions should be taken if Serotonin Syndrome occurs?

Back 57

Remove offending agent
Initiate symptomatic treatment:
*serotonin-receptor blockade with cyproheptadine, methysergide, propranolol
*Cooling blankets, chlorpromazine for hyperthermia
*Dantrolene, diazepam for muscle rigidity or rigors
*Anticonvulsants
*artificial ventilation
*paralysis

Front 58

Name the 6 SSRI's we need to know.

Back 58

Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft

Front 59

Name the 4 atypical antidepressents and their action.

Back 59

*Effexor- Blocks reuptake of Serotonin & NE; Monitor BP
*Cymbalta- Blocks reuptake of Serotonin & NE; Decreases neuropathic pain.
*Wellbutrin- Blocks reuptake of NE & DA; also used to quit smoking.
*Remeron- Blocks alpha1 receptors that normally inhibit NE and Serotonin; May work faster than SSRI

Front 60

What are the common S.E. of TCA's?

Back 60

sedation, anticholinergic, tachycardia, postural hypotension

Front 61

What are the serious S.E. of TCA's?

Back 61

dysrthymias, MI, heart block

Front 62

The patient and family should be taught that it takes how long for mood elevation and full theraputic effects?

Back 62

7-28 days for mood elevation
6-8 weeks for full thereputic effects.

Front 63

The patient should be taught what about the common S.E.?

Back 63

drowsiness, dizziness, & hypotension usually subside after the first few weeks.

Front 64

What time of the day should the nurse teach the patient to take the medication?

Back 64

Night time.

Front 65

What effect should the nurse warn about Alcohol & how it effects TCA's?

Back 65

Blocks the effects of antidepressants.

Front 66

Teach the pt that suddenly stopping the medication...

Back 66

can cause nausea, altered heartbeat, nightmares and cold sweats in 2-4 days. The pt should call the primary care provider or take one dose of TCA until the PCP can be contacted.

Front 67

What should the nurse teach about a forgotten dose?

Back 67

the patient should take the dose within 3 hours; otherwise the patient should wait until the usual medication time the next day. The pt should not double the dose.

Front 68

Name the two TCA's to know.

Back 68

Elavil
Tofranil

Front 69

If a MAOI is used with an antidepressant which ones may it be.

Back 69

Parnate, Nardil

Front 70

Name the Vegetables that can not be taken with MAOI's.

Back 70

Avocados, espeially if overripe; fermented bean curd; fermented soybean; soybean paste.

Front 71

Nave the fruits that should not be eaten with MAOI's

Back 71

figs, bananas

Front 72

Name the meats that should not be eaten with MAOI's

Back 72

fermented, smoked or aged meat; spoiled meat; liver; Sausages

Front 73

What type of fish should be avoided by a patient taking a MAOI

Back 73

dried, cured, fermented, smoked or aged fish; spoiled fish.

Front 74

What dairy products should be avoided by pt if taking a MAOI.

Back 74

Cheese

Front 75

Name some foods that don't fall into a catagory.

Back 75

Foods with yeast extract (eg Marmite, bovril); imported beers, chianti wines; Protein supplements, soups, shrimp paste; soy sauce;

Dangerous w/out thyramine are chocolate; fava beans; ginseng' caffeinated beverages.