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75 Cards in this Set
- Front
- Back
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What is the leading cause of disability in the U.S?
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Depression
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Major depressive disorder is more common in men or women?
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Women
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Depression is common among what age group?
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Older group
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Major depressive disorder is comorbid with what other health disorders?
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Anxiety disorders, schizophrenia, eating disorders, and substance abuse
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Major depressive disorder is comorbid with what other medical condition?
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Chronic pain, Alzheimers disease, multiple sclerosis, hypothyroidism
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Theory r/t depressive disorders: Genetics
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-Genetic linkage
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Theory r/t depressive disorders: Biochemical
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-Neurotransmitters abnormalities, reduction
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Theory r/t depressive disorders: Hormonal
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-Increased cortisol secretion
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Theory r/t depressive disorders: Diathesis-stress model
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-Combination of biological/psychosocial stressors
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Theory r/t depressive disorders: Cognitive
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-Negative thoughts from early life experiences
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Theory r/t Depressive Disorders: Learned helplessness
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-Sense of being helpless, no control. e.g. Elderly
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What are the 2 types of depression?
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-Major depressive disorder (MDD)
-Dysthymic disorder (DD) |
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What is Major depressive disorder?
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-Serious depression, impairment in functioning, accompanied by suicidal thoughts, requires hospitalization
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What is Dysthymic disorder?
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-Chronic depressive symptoms, social and occupational distress, usually do not warrant hospitalization, at risk for for MDD and other mental disorders.
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What is the onset of Dysthymic disorder?
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-Childhood to teenage
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Signs and symptoms of Major depressive disorder?
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-Depressed mood, Anhedonia, Weight loss/gain,
Insomnia/hypersomnia, Psychomotor retardation/agitation, feelings of worthlessness/guilt, anergia, Poor concentration, Recurrent thought of death |
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Subtypes of MDD:
-Psychotic features |
-disorganized thinking, hallucinations/delusions, MORE disabling, MORE intensive treatment
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Subtypes of MDD:
-Melancholic features -s/s |
-Endogenous (from within), severe apathy, symptoms are MORE pronounced during early morning w/ suicidal ideations.
-Anorexia/weight loss, and profound guilt |
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Subtypes of MDD:
-Atypical features -s/s |
-Vegetative symptoms.
-Overeating/ anorexia, hypersomnia/insomnia |
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Subtypes of MDD:
-Catatonic features |
-Mutism, extreme psychomotor retardation, echopraxia, echolalia, withdraw and negativity
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Subtypes of MDD:
-Postpartum onset -s/s |
-Develops w/in 4 wks post delivery, becomes problem if DANGEROUS to self or baby.
-Lack of interest in baby, lack of concentration. |
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Subtypes of MDD:
-Seasonal features -s/s |
-Occur fall/winter when shorter days; resolve in spring/summer.
-Anergia, hypersomnia, overeating, and weight gain |
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3 Phases in Major Depressive Disorder
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Acute phase, continuation phase, maintenance phase.
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What is the Acute phase in major depressive disorder? Goal?
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-(6-12 wks), possible hospitalization,
-Control the symptoms, assist client to returning to previous level of functioning. |
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What is the Continuation phase in major depressive disorder? Goal?
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-(4-9 mo.)
-Prevent relapse by medications, teaching, and psychotherapy |
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What is the Maintenance phase in MDD? Goal?
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-(1 or more years)
-Long-term to prevent further episodes of depression by medications, use of adaptive coping skills, and follow-up treatment w/ healthcare providers. |
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Assessment of Depressive disorders?
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1). Hx and physical= rule out s/s
2). Comorbid disorders 3). S/S 4). Lab tests 5).Sociocultural hx 6). Family hx of mood disorders 7). Support system |
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Self-Assesment for MDD:
-Nsg clarify expectations of themselves/clients UNMET |
- Feelings of anxiety, hurt, anger, and/or incompetence
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Self-Assesment for MDD:
-Personal feelings can be worked through with...? |
-Peers and more experienced clinicians
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What is countertransference?
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-Tendency to displace onto the client feelings that are a response to people in the nsg. past.
-Nx-pt |
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What is transference?
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-Pt-nx
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Antidepressant drugs:
-Selective Serotonin re-uptake Inhibitors (SSRI's) -s/s |
-First line, prevents uptake of serotonin, regulates moods
-Sleep disturbance, H/A, Tremor, N/V, insomnia, agitation, sexual dysfunction, hyponatremia, |
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Central Serotonin syndrome:
s/s: |
-Possible fatal, resulting from too much serotonin or combination with other drugs such as MAOI's.
-Abd. pain, diarrhea, diaphoresis, elevated vs, delirium, muscle spasms, psychomotor agitation, hostility, seizure |
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Interventions for Central serotonin syndrome
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-remove offending agents
-serotonin blockade -cooling blankets= hypothermia -anti muscle rigidity -anticonvulsants -o2 |
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What could happen in severe cases for central serotonin syndrome?
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Hyperpyrexia, cardiovascular shock, and death may occur
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How long does it take for SSRI's to take effect?
SSRI's may be prescribed for? |
-2-4 wks
-Anxiety, OCD, and panic disorder |
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What is discontinuation syndrome?
s/s? |
-Stopping SSRI's imm.
-Dizziness, insomnia, nervousness, irritability, nause, and agitation |
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What are examples of SSRI's?
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-Celexa, Prozac, Paxil, Zoloft
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New/Novel atypical antidepressants e.g.?
Safer than what in terms of s/e? |
-SNRI: serotonin-norep
-NDRI: norep-dopamine =Tricyclics, and MAOI |
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Tricyclic antidepressants action?
Onset? Effects not seen till? What kinda effect? Smilar s/e to what? |
-Stop uptake in serotonin
-10-14 days -4-8days -Sedative/ more drowsy -Antipsychotics |
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Tricyclic Antidepressants s/e?
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-postural hypotension, dry mouth, blurred vision, urinary retention, tachycardia, constipation, esophageal reflux, weight gain, sedation
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What is the most adverse reactions of TCA's?
e.g.? |
-Cardiovascular system
-Dysrythmias, Tachycardia, myocardial infarction, heart block |
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Examples of TCA's medications
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-Elavil, Norpramin, Tofranil
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MOAI?
s/e? |
Monamine Oxidase Inhibitors, break down of brain amines.
-Orthostatic hyptension, weight gain, edema, constipation, muscle twitching, fatigue, insomnia, manic behavior, vertigo, urinary hesitation, sexual dysfunction |
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When on MOAI what kinda chemical do you have to be aware of? What do you watch out for? What foods do you avoid?
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-Tyramine
-Pickled, smoked, aged, fermented, overriped -Soy sauce, chocolates, caffeine, avocados, beer, wine, fermented bean, figs, bananas |
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What are signs of hypertensive crisis due to OD of MOAI?
What is needed during a crisis? How many weeks should you wait to start MAOI after stopping meds.? |
-H/A, stiff neck, palpations, n/v, chest pain, and pyrexia
-antihypertensive meds., hypothermic blanket. -5 weeks |
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What are examples of MAOI's?
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parnate, Nardil, Marplan
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What does ECT induce?
What does ECT help with? When used? |
-Grand mal seizure
-Increase circulating levels of neurotransmitters -Treatment resistant, last alternative, for major depression/ bipolar and useful for manic clients resistant to lithium and neuroleptic meds. |
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ECT contraindicated when?
ECT dosing? |
-CVA, history of MI, or intracranial mass lesions
-2-3x week, with total of 2-12 treatments |
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How is ECT done?
How do you know current going? s/e of ECT? Is ECT permanent cure? |
-Pt. under general anesthesia with muscle relaxant
-Dorsiflex and toe -Memory loss, confusion, h/a, muscle soreness, nausea -no |
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Transcranial Magnetic Stimulation?
Treatment time? s/e? |
-NONINVASIVE passing of magnetic pulses in brain-stimulate charges- flow, activate neurons
-30 min. 5days/wk for 4-6 wks -h/a and lightheadedness |
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Nsg. important interventions for Major depressive disorder?
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Matter of fact approach, encourage motivation, reinforcing positive behavior
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What is Cognitive behavioral therapy?
Individual psychotherapy Social skills training? |
-change thinking- change behavior
-exploration -assertiveness training (express/feeling appropriately) |
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What is the recovery model?
Emphasis? |
-healing is possible among individuals with mental disorders with healthcare and providers
-Clients needs, values, and interventions that are evidence based. |
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Bipolar?
Onset? 3 types of bipolar, what are they? |
-chronic disorder, characterized by mania and depression.
-18 and 30 -bipolar I, bipolar II, and cyclothymia |
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What is bipolar 1?
What is bipolar 2? Cyclothymia? |
-1 episode of manic alternating w/ depression and psychosis may occur
-Hypomanic epi. alternating w/ depression. NO psychosis.(Adolescence) -hypomanic episodes alternating w/minor depressive episodes |
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s/s of bipolar disorder?
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-Inflated self-esteem/grandiose, decreased need for sleep, hyper verbal w/ pressured speech, flight of ideas, distractibility, psychomotor agitation, excessive involvement in pleasurable activities, poor judgment, agitation, attention seeking behavior, NEGLET of adl's, including nutrition, and hydration.
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Cycle of mania in bipolar?
Hypomania? |
-normal-manic-normal-depressed-normal
-fun, part time, sexually preoccupied, decrease need for sleep, grandiose |
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Acute mania?
What level do you have to watch out for in bipolar pt? |
-Erratic, abile mood, angry outbursts, restlessness, manipulative, profane.
-Lithium level, depakote level, urine toxicology |
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Nutrition for bipolar?
Activity for bipolar? Limit setting for bipolar? |
-finger food, protein= hamburger, cheeseburger
-nothing competitive -verbalize, PRN, restraints, seclusion |
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Legal requirements for restraints?
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-MD signature 24 hrs.. relative notified, no use of weapons, discontinuation as soon as possible
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True or False four sided rail for seizure patient is NOT a restraint?
T/F seclusion/restraint can be PRN? |
-True
-False |
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Tucking sheets tightly is a restraint?
What is the release procedure for restraint patient? |
-True
-Pt. must be able to follow commands and stay in control, termination of restraints, debrief with patient |
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Documentation for restraints?
T/F can charge nurse place pt. under restraint/seclusion? |
-Time, type, PRN's, describe event that lead to decision of restraints, toileting, range of motion, skin assessment.
-True |
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How many fingers for wrist restraints?
T/F bipolar pt.s undergo ECT? Drug of choice for Bipolar? What is it? |
-2 fingers
-True -Lithium carbonate -Natural occurring salt |
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What is the therapeutic blood levels for Lithium?
How long does it take for lithium levels to be reached? |
-0.8-1.4 mEq/L
-7-14 days |
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What level should not be exceeded while on lithium?
What level is lithium life threatening? |
-Should not exceed 1.5 mEq/L
-2 mEq/L or above. |
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How is lithium monitored, time wise?
Lithium levels drawn when? What's contraindicated while on lithium? |
-weekly-biweekly, usually every month, and then reduced to 3 mo.
-8-12 hrs after last dose -Diuretics, (salt) |
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Long term use of Lithium can lead to?
s/e of lithium? |
-hypothyroidism, and renal impairment
-hand tremor, polyuria, thirst, mild nausea, weight gain, general discomfort |
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What do you do if you suspect lithium toxicity?
s/s of lithium toxicity? |
-HOLD MEDICATION
-coarse hand tremor, n/v, diarrhea, slurred speech, muscle weakness, confusion, ataxia (unsteady gait), blurred vison, severe hypotension, cardiac arrhythmia, seizure, coma, |
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What do you give if there is lithium toxicity?
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-Drug is discontinued, emetic is admin., gastric lavage, hemodyalis
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Anticonvulsants stabilize what?
Examples of anticonvulsants? |
-Mood
-Lamotrigine (Lamictal), valproate (depakote), carbamazepine (tegretol) |
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Lamictal?
Depakote levels? Tegretol levels? |
-First line, usually well tolerated, one serious but rare derm. reaction
-50-125 mcg/ml -8-12g/ml |
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Common s/e of anticonvulsants?
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-GI distress such as N/V, anorexia
-Neurologic symptoms such as sedation, h/a and dizziness |
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What drug class is used for managing psychomotor agitation? e.g?
What drug class is used for sedative effects, and mood stabilizing properties? e.g.? |
-anxiolytics, klonopin and ativan
-Antipsychotics, zyprexa and risperdal |
