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27 Cards in this Set

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5 psychosocial theories to depression
psychoanalytic
learning (behavioral)
object
cognitive
transactional
psychosocial theory that believes depression is the result of people being angry, and unable to express it appropriately so they turn anger inwards
psychoanalytic theory of depression
psychosocial theory of depression that believes its learn through reinforcement of helplessness, no ability to do anything about it and give up
learning (behavioral) theory of depression
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
cognitive theory of depression
psychosocial theory of depression that is a combination of the other theories
transactional theory of depression
4 biological predisposing factors for depression
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
what usually happens that causes an individual to be hospitalized for depression and give examples
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
difference between depression and bipolar disorder
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)
3 affective signs that are considered the suicide trilogy
hopelessness
helplessness
loneliness
An occurrence of depressive episodes w/one or more elated mood episodes.
bipolar disorder (mania)
People who are bipolar are very sensitive to antidepressants. what might happen if they take one?
they may go into manic episode.
explain reaction formation in bipolar disorder
people who are bipolar are thought to be so intolerant of feeling depressed that they end up acting the opposite, hypomania to manic
signs & symptoms of bipolar disorder
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
some nursing diagnoses for bipolar disorder include
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
interventions for bipolar disorder include
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
some developmental implications for childhood depression include
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
some developmental implications for adolescent depression include
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
developmental implications for the elderly in depression
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
developmental implications in post partum depression
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
developmental implications in childhood & adolescent bipolar
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
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
when is ECT contraindicated
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
adverse side effects of ECT
Most common – headache, nausea, temporary memory loss & confusion
Other SE arrhythmias, HTN, prolonged seizure, prolonged apnea, emergent mania
nursing role prior to ECT
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
nursing diagnoses associated with ECT
Knowledge deficit
Anxiety
Risk for injury
planning implications for ECT
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)
post ECT interventions
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