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27 Cards in this Set
- Front
- Back
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5 psychosocial theories to depression
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psychoanalytic
learning (behavioral) object cognitive transactional |
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psychosocial theory that believes depression is the result of people being angry, and unable to express it appropriately so they turn anger inwards
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psychoanalytic theory of depression
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psychosocial theory of depression that believes its learn through reinforcement of helplessness, no ability to do anything about it and give up
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learning (behavioral) theory of depression
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psychosocial theory of depression that believes depression is caused by irrational beliefs & thoughts, in therapy look at thinking patterns and how that affects their moods
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cognitive theory of depression
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psychosocial theory of depression that is a combination of the other theories
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transactional theory of depression
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4 biological predisposing factors for depression
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Biological – familial connection, runs in families, more vulnerable but may not have
Biochemical – Norepinephrine, serotonin, dopamine Neuroendocrine – hormones Physiological – result of side effect of med, nutritional deficits, neurological disorders |
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what usually happens that causes an individual to be hospitalized for depression and give examples
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precipitating event
examples usually in form of a loss that calls for sadness and an appropriate emotional response and the person is unable to bounce back (death of loved one, divorce, layoff, perceived sense of failure, medical condition that affects person’s ability to function |
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difference between depression and bipolar disorder
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Depression is sustained down mood – can get so depressed that they become psychotic
Bi-polar – two extremes – has depressive episode but also have history of at least one episode of mania (mania is the opposite of depression) |
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3 affective signs that are considered the suicide trilogy
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hopelessness
helplessness loneliness |
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An occurrence of depressive episodes w/one or more elated mood episodes.
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bipolar disorder (mania)
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People who are bipolar are very sensitive to antidepressants. what might happen if they take one?
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they may go into manic episode.
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explain reaction formation in bipolar disorder
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people who are bipolar are thought to be so intolerant of feeling depressed that they end up acting the opposite, hypomania to manic
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signs & symptoms of bipolar disorder
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Lability of mood (up & down),
Can be psychotic Rapid, pressured speech, flight of ideas Speech & thinking become disorganized & incoherent Loose associations – topic to topic Highly distractible – like ADHD Hallucinations from sensory overload Delusions, usually grandiose & paranoid Excessive motor activity – can’t sit to eat, talk Poor impulse control Hypersexual Excessive spending Diminished to nonexistent need for sleep Bizarre appearance, dress, make-up Manipulative |
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some nursing diagnoses for bipolar disorder include
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Risk for injury r/t severe hyperactivity (exhaustion)
Risk for violence, self/other directed – poor impulse control, or become suicidal Disturbed thought processes Impaired social interactions – alienate family due to uncensored words Disturbed sleep pattern Imbalanced nutrition – give finger foods, plenty of calories & fluids due to hyperactivity |
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interventions for bipolar disorder include
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medications - primary-to help slow down
Use firm calm neutral voice set limits, let them know consequence of behavior matter-of-factly avoid long discussions, short & concise redirect back to what talking about if they have loose associations know self, know own weaknesses provide constructive outlets for energy (writing, punching bag) don’t put them in charge of group activities, non-competitive things only no special privileges, consistency may need to use quiet room to decr stimulation Nutrition – high calorie/protein Psychotherapy – aimed at improving self-esteem, decrease hostility, engage in problem solving teach about medicine to improve compliance & acceptance of illness |
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some developmental implications for childhood depression include
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Symptoms can vary w/age , kids will isolate themselves, have somatic complaints,
have problems at school, acting out behavior, eating/sleeping problems Genetic predisposition but can be precipitated by loss, parents separating, parent going to Afghanistan, Treatment can include meds but depends on age of child, will do good in play therapy to help child express their feelings and usually occurs in outpatient setting |
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some developmental implications for adolescent depression include
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harder to identify - mistaken for common adolescent angst
suicide - 3rd leading cause of death Most important to look for visible behavioral change that lasts more than a day or two (were social, now isolation) signs include isolation, somatic complaints, school problems, acting out behavior, eating/sleeping problems delinquency, running away, substance abuse, sexual acting out behavior, truancy, aggression Adolescents can become depressed by loss, parents separating, parent going to Afghanistan, plus breakup w/boyfriend/girlfriend, abandonment by parents or close peer relationship Tx can occur IP/OP, can use medications (Prozac, wellbutrin (helps also with ADHD), therapy done along with meds to develop coping behaviors, understand/name what they’re feeling |
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developmental implications for the elderly in depression
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Associated with aging process/dementia (sometimes diagnosed as dementia but truly depression)
Medications can produce depressive effects (beta blockers, diabetes meds) Depression can accompany other medical illnesses (ability to care for self, function) Tx in combination meds & therapy – caution because of age and usually on other meds, ECT is very safe & effective in elderly More likely to go to PCP w/somatic complaints, can be depression related |
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developmental implications in post partum depression
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Moderate baby blues to psychotic depression
Begin 3-4 days post delivery get worse up to a week and usually resolve w/in 2 weeks Symptoms – concerns of ability to care for baby all the way to lack of interest or rejection of baby, usually hormonal driven but family hx of depression will have increased vulnerability Risk of suicide/infantcide should not be overlooked Tx includes medications, support, hospitalization in severe incidences |
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developmental implications in childhood & adolescent bipolar
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Difficult to diagnose
Usually have ADHD Strong family connection Tx meds & therapy ADHD is most identified co-morbid condition Lithium, depokote, atypical antipsychotics approved to treat children Use melatonin for sleep Klonidine at night for sleep |
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normal grief vs. depression (normal grief on this slide)
No anhedonia Accept support from others Still hopeful May experience some degree of guilt over aspect of the loss Experience transient physical symptoms Self esteem intact May openly express anger Experience good/bad days Relates feelings of depression to specific loss experienced |
depression:
Anhedonia common Isolate self more hopeless Feels generalized guilt Express chronic physical complaints Disturbed self esteem Usually does not directly express anger Persistent state of dysphoria Does not relate feelings to particular experience |
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when is ECT contraindicated
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Increased ICP (pressure driven up due to seizure), recent CVA, brain tumor
High risk for problems – MI, CVA w/in 3 months, aortic/cerebral aneurysm or vascular malformation Severe underlying HTN or CHF Anesthetic risk |
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adverse side effects of ECT
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Most common – headache, nausea, temporary memory loss & confusion
Other SE arrhythmias, HTN, prolonged seizure, prolonged apnea, emergent mania |
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nursing role prior to ECT
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Medical clearance (MD)
Informed consent for ECT & anesthesia Baseline: MiniMentalStatusExam, orientation, memory, etc. assessment of mood, suicidal, homicidal, anxiety/fears r/t tx Review of past meds, allergies, VS Teaching |
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nursing diagnoses associated with ECT
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Knowledge deficit
Anxiety Risk for injury |
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planning implications for ECT
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NPO for surgery
Check informed consent Anesthesia assessment Labs, CBC, UA, EKG, X-rays (elderly to check for uinidentified fx) Normal pre-op (VS 1 hr before, void, no jewelry, etc) Atropine given to decrease secretions on floor Given short acting anesthesia & muscle relaxant in OR Will need oxygenated & ventilated BF cuff to one lower leg to prevent muscle relaxant getting to that one foot (usually see great toe seizing) |
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post ECT interventions
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Monitor VS at least q15 min x 1hr
Assess mental status Reorient/provide emotional support/education Assess for any side effects Always have headache (muscular) advil/ibuprofen Reintegrate into milieu activities |
