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224 Cards in this Set
- Front
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1) represents a change in previous function.
2) symptoms cause distress/impaired social, occupation functioning 3) occur everyday: depressed mood, anhedonia, weight loss/gain, insomnia/hypersomnia, anergia, worthlessness, guilt, decreased concentration, suicidal ideation |
Major Depressive Disorder
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1) occur over 2 year period, depressed mood
2) symptoms cause distress in social, occupational functioning 3) decreased/increased appetite, insomnia/hypersomnia, low energy, decreased self esteem, poor concentrating, hopelessness, despair |
Dysthymic Disorder
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disorganized thinking, delusions, hallucinations
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psychotic features
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apathy, weight loss, guilt, symptoms are worse in the morning, suicidal ideation?
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melancholic features
(not attributable to environmental stressors) |
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dominant vegetative symptoms (overeating, oversleeping), younger onset, slowed psycho-motor activities, anxiety
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atypical features
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nonresponsiveness, extreme psychomotor retardation, seems paralyzed, withdrawal, negativity?
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catatonic features
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onset within 4 weeks after childbirth, psychotic features, delusional thoughts about the infant (risk for infant harm)
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post partum onset
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most episodes begin in winter months, reduced cerebral metabolic activity, anergia, hypersomnia, overeating, weight gain, carbohydrate craving
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seasonal features (seasonal affective disorder)
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premenstrual dysphoric disorder
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symptoms begin towards last week of luteal phase, absent the week following menses: depression, anxiety, affective lability,anger, irritability
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mixed anxiety-depression
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functional disability, 1 month of dysphoric mood, hypervigilence, difficulty concentrating, low self-esteem, irritability
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recurrent brief depression?
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episodes last 1 day to 1 week, must recur at least once every month for 1 year, high risk for suicide
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minor depression?
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sustained depressed mood w/o full depression, pessimistic attitude, self pity
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Dysthymic Disorder?
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chronic depressive syndrome, present most of the day, for 2 years, age of onset- early childhood, risk for MDD
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Difference in MDD and DD?
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duration
severity of symptoms |
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Dominant symptom of depression in children and adolescents?
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irritability
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subsyndromal depression?
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occurs in older adults; they experience many but not all symptoms of major depressive episode
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the incidence of depression greatly increases with the occurrence of ____?
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medical disorder
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biological risk factors for depression?
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*genetics (twins, but genetic predispostion must be affected by environmental factors)
*biochemical (neurotransmitters; serotonin, norepinephrine) *altered hormonal regulation (cortisol) *diathesis stress model-trigger |
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Psychological risk factors for depression?
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cognitive theory, learned helplessness
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Cognitive theory
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person's thoughts will result in emotions
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Learned helplessness?
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a person that thinks an event is his/her fault and that nothing can be done to change it is more prone to depression
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Beck's cognitive triad?
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1. negative view of self
2. pessimistic view of world 3. belief that negative reinforcement will continue in the future |
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assessment of suicide potential?
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tell me what being depressed is like for you, when you feel depressed what thoughts go on in your mind?, have you thought about taking your life?, do you have a plan?, do you have the means to carry out your plan?, is there anything that would prevent you from carrying out your plan?
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what are the 2 key features in depression?
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depressed mood
anhedonia |
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lack of energy?
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anergia
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constant pacing and wringing of hands?
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psycho-motor agitation
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slowed movements?
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psycho-motor retardation
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somatic complaints?
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headaches, malaise, back pain
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vegetative signs of depression?
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change in bowel movements, eating habits, sleep disturbances, sexual disinterest
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outward representation of a person's internal state of being; objective finding based on assessment?
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affect
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examples of assessing affect?
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poor posture, facial expression, weeping, no eye contact, monotone speech, frequent sighing
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assessing thought processes?
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poor judgment, indecisiveness, poor memory and concentration
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patient's subjective feelings/experience?
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mood
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hopelessness attributes
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negative future expectations, loss of control over outcomes, passive acceptance of plan to achieve goal, emotionally negative
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cardinal sign of depression?
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change in sleeping habits
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hallmark symptom for depression?
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waking at 3-4 am, staying awake
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self assessment
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recognizing unrealistic expectations, identify feelings that originate with the patient, understand the roles biology and genetics play in the precipitation and maintenance of a depressed mood
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depression assessment guidelines:
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1. risk for harm to self and others
2. determine if depression is primary or secondary- medical conditions, drugs, psychotic 3. past hx of depression 4. support systems |
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# 1 nursing dx
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risk for suicide
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effective approach for treating depression?
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cognitive, behavioral, interpersonal, psychopharmacology approach
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directed at reduction of depressive symptoms, restoration and function
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acute phase of depression
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directed at prevention of relapse
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continuation phase of depression
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directed at prevention of further depressive episodes
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maintenance phase
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when a patient is mute use which technique?
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making observations: "there are many new pictures on the wall," "you are wearing your new shoes."
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guidelines for mute/withdrawn patients:
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observations, concrete words, allow time for response, listen for covert messages, ask about suicide, avoid platitudes
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guidelines for counseling people with depression
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help them question underlying assumptions and consider alternate explanations to problems, help them identify cognitive distortions, encourage activities that raise self-esttem, exercise, support groups
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Overgeneralizations
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the patient takes one fact or event and makes a general rule out of it (he always.. i never)
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self blame
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the patient consistently blames self for everything negative
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mind reading
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the patient assumes others dont like him or her, without any real evidence
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examples of discounting positive attributes?
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the patient focuses on the negative
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illness management depends on what?
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understanding signs and symptoms of relapse, role of medication and side effects
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long term management is best assured if the patient undergoes _____?
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psychotherapy and medication
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Key to illness management?
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identifying and coping with stress of interpersonal relationships
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interventions related to nutrition?
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small, high calorie, high protein snacks and fluids frequently, encourage family to remain with patient during mealtimes, offer food choices, involve dietician, weight patient weekly, observe eating patterns
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interventions related to sleep?
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periods of rest, encourage pt to get up and dress and to stay out of bed in the daytime, encourage relaxation measures, reduce stimuli in evening
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interventions related to self care deficits?
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encourage use of toothbrush, washcloth, soap, etc., give step by step reminders when needed (wash the right side of your face, now the left)
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interventions related to constipation and elimination?
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monitor I&O, offer high fiber foods, exercise, fluids, laxatives, enemas when needed
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antidepressants target symptoms such as:
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sleep, appetite, fatigue, decreased sex drive, psychomotor retardation, agitation, impaired concentration
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activities that can raise self esteem?
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increasing social and work related skills
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what is a drawback to antidepressants?
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takes 1-3 weeks to work
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when would electroconvulsive therapy be appropriate?
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when a patient is acutely suicidal
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goal of antidepressant therapy?
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complete remission of symptoms
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adequate trial for treatment of depression using antidepressants?
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3 months
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first line therapy for most depression cases?
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SSRIs
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advantage of SSRI's?
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less side effects
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which antidepressant class has a high potential for lethal overdose?
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tricyclics
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common adverse reactions of SSRIs?
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negative effect on sexual performance, dry mouth, sweating, weight change, mild nausea, loose bowel movements
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life threatening event associated with SSRIs?
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serotonin syndrome
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symptoms of serotonin syndrome?
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abdominal pain
diarrhea sweating, fever, tachycardia, elevated blood pressure, altered mental status, muscle spasms, increased motor activity, mood change. severe symptoms= hyperpyrexia, cardiovascular shock, death |
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greatest risk for serotonin syndrome occurs when ____?
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an SSRI is administered in combination with a second serotonin enhancing agent such as, MONOAMINE OXIDASE INHIBITOR
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interventions for serotonin syndrome?
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remove offending agents, administer serotonin receptor blockade, cooling blankets, chlorpromazine for hyperthermia, dantrolene, diazepam, anticonvulsants, artificial ventilation
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when taking TCA's, _____ and _____ warrant immediate medical intervention?
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urinary retention
severe constipation |
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patients taking TCA's are at an increased risk for ______, due to postural hypotension?
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falls
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best time to take TCA's?
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night
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reasons to take TCAs at night?
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sedative, side effects occur while patient is sleeping which offers help in compliance
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the most serious effects of TCAs?
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cardiovascular: dysrhythmias, tachycardia, myocardial infarction, heart block
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TCA's contraindicated when?
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older adults, cardiac disease, glaucoma, pregnant, history of seizures
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SSRI examples?
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celexa, lexapro, prozac, luvox, zoloft
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side effects of SSRI?
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agitation, insomnia, headache, nausea, vomiting, sexual dysfunction, hyponatremia
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Warnings with SSRI use?
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discontinuation syndrome, taper slowly when quitting, contraindicated in people taking MAOIs
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Patient and family teaching with SSRIs?
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may cause sexual dysfunction, avoid alcohol, liver and renal tests performed periodically, should not discontinue suddenly (discontinuation syndrome)
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drugs that interact with MAOIs?
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ephedrine, tricyclics, narcotics, antihypertensives, sedatives, stimulants
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most serious reaction to MAOIs?
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high blood pressure- possible development of hemorrhage..routine monitoring of bp for first 6 weeks is necessary
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Foods that interact with MAOIs?
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vegetables, fruits (figs, bananas), meats, fish, sausage, milk products, cheese, yeast, beer, wine
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discontinuation syndrome?
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anxiety, dyphoria, flu like symptoms, dizziness, sweating
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electroconvulsive therapy indications
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depression, psychotic illnesses
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brief seizures are induced in what type of therapy?
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ECT
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noninvasive treatment that uses MRI strength magnetic pulses to stimulate focal areas of the cerebral cortex ?
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transcranial magnetic stimulation
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cognitive behavioral therapy?
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helps people change their negative thought patterns
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interpersonal therapy?
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focuses on working through personal relationships that may contribute to depression
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group therapy?
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offer patient an opportunity to socialize and share common feelings and concerns which decreases feelings of isolation, hopelessness, helplessness, and alienation
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" i hear voices of aliens trying to contact me"
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psychotic
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learned helplessness?
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its all my fault that my husband left me for another woman
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what should be the priority in teaching when planning discharge for a depressed patient?
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awareness of symptoms increasing depression
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st john's wort?
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not regulated by the FDA, potential for adverse reactions when taking with other medications
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Psychodynamic therapy?
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focuses on unresolved past relationships and core conflicts
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what is the role of the therapist in psychodynamic therapy?
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significant other
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What disorders are treated using psychdynamic therapy?
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anxiety, depression, personality
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what is the length of psychdynamic therapy?
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20 or more sessions
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what is the technique used in psychodynamic therapy?
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therapeutic alliance
free association understanding transference challenging defense mechanisms |
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Treatment focus for interpersonal therapy?
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current interpersonal relationships and social supports
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therapist role in interpersonal therapy?
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problem solver
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disorders treated with interpersonal therapy?
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depression
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length of treatment in interpersonal therapy?
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12-20 (short term)
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technique of interpersonal therapy?
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facilitate new patterns of communication and expectations for relationships
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treatment focus of cognitive behavioral therapy?
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thoughts and cognitions
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treatment focus of behavioral therapy?
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learned maladaptive behavior
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role of therapist in cognitive behavior therapy?
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active, challenging
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role of therapist in behavioral therapy?
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active, directive teacher
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CBT treats what disorders?
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depression, anxiety, eating disorders
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technique of behavioral therapy?
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relaxation, thought stopping, self-reassurance, seeking social support
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technique of cognitive behavioral therapy?
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evaluating thoughts and behaviors, modifying dysfunctional thoughts and behaviors
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characteristics of self-actualized persons?
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accurate perception of reality
self accepting spontaneous problem centered enjoyment of private detachment appreciative socially active not prejudice creative |
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situational depression
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more anxiety, life events can trigger depression
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sudden, unpredictable external events?
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situational loss
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change always involves ____ losses, which are a part of life
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necessary
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form of necessary loss and include all normally expected life changes across the life span?
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maturational losses
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examples of _____ loss are: child leaves for school
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maturational loss
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an automobile accident that involves a injury with physical changes that makes it impossible for a person to return to work/school is an example of what type of loss?
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situational loss
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occurs when a person can no longer feel, hear, or know a person
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actual loss
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loss of a body part, death of a family member, loss of a job?
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actual loss
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defined by the person experiencing the loss and are less obvious to other people?
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perceived loss
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losses that are internally and individually experienced?
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perceived losses
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____ and ____ influence the depth and duration of the grief response?
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type of loss and person's perception of the loss
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the ultimate loss?
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death
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the emotional response to a loss, manifested in ways unique to an individual, based on personal experiences, cultural expectations and spiritual beliefs?
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Grief
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includes the emotional responses and outward behaviors of a person experiencing a loss?
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bereavement
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process of coping with the death of a loved one?
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grieving
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most common reaction to death?
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normal (uncomplicated) grief
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the outward, social expressions of grief and the behavior associated with the loss?
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mourning
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complex response with emotional, cognitive, social, physical and spiritual concepts?
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normal grief
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longing or searching for the decreased person peaking around 2 months after death?
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yearning
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negative emotions peak around ___ months?
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4
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when the grieving person has a prolonged difficult time moving foward after a loss?
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complicated grieving
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symptoms of complicated grief last at least ___ months and interrupt every dimension of a person's life?
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6
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trouble accepting the death, excessively bitter, uneasy about the future?
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complicated grieving
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the unconscious process of "letting go" before the actual loss or death occurs?
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anticipatory grieving
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marginal or unsupported grief?
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disenfranchised grief
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Kubler Ross- 5 stages of dying?
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Denial
Anger Bargaining Depression Acceptance |
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Bowlby attachment theory?
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numbing, yearning and searching, disorganization and despair, reorganization
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when a relationship to the deceased is not socially sanctioned, cannot be openly shared, seems of lesser significance?
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disenfranchised grief
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Worden tasks of mourning?
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accepting the reality of loss
working through the pain of grief adjusting to the environment emotionally relocating and moving on with life |
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Rando, the R process model?
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recognize the reality
react to, experience, express pain reminisce relinquish readjust reinvest |
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person acts as nothing happened?
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denial
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feelings of intense anger towards god?
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anger
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bargaining?
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postpones awareness of the loss by trying to prevent it from happening; make promises to self, god that they will live differently if...
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when a person realizes the full impact of the loss, _____ occurs?
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depression
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when the person incorporates the loss into life and finds ways to move forward?
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acceptance
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which theory describes the experience of mourning?
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bowlby's attachment theory
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feeling "stunned" or unreal?
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numbness
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protects the person from the full impact of the loss?
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numbing
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yearning and searching phase?
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emotional outbursts, tearful sobbing, acute distress
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tightness in the chest, throat, sob, lethargy, insomnia, loss of appetite?
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yearning and searching phase
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when a person endlessly examines how and why the loss occurred, expresses anger at anyone who seems responsible, retells the story over and over again?
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disorganization and despair phase
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phase when a person realizes the loss is permanent, begins to accept change, assume roles, builds new relationships?
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reorganization
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task I accept the reality of the loss?
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accepting the person is gone and will not return
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task II work through the pain of grief?
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using coping mechanisms most familiar and comfortable
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task III adjust to the environment in which the deceased is missing?
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take on roles formerly filled by the deceased
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task IV emotionally relocate the deceased and move on with life
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realizing it is possible to love other people without betraying the deceased
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The dual process model?
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describes the everyday life experiences of grief as moving back and forth between loss-oriented and restoration-oriented processes
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loss oriented behaviors?
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grief work, dwelling on the loss, breaking connections to the deceased, resisting activities to get past the grief
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restoration-oriented behaviors?
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attending to life changes, finding new roles, coping with finances, participating in distractions
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factors influencing loss and grief
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human development (age& tage)
personal relationships (meaning of the lost relationship) nature of the loss (meaning of loss) coping strategies socioeconomic status culture and ethnicity spiritual and religious beliefs hope |
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spiritual integration?
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occurs when one comes to terms with his or her life and puts life's pieces together in a way consistent with one's entire life (helps a person mend a broken relationship or unfinished business)
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assess client's expectations by asking...?
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"what is the most important thing I can do for you right now?"
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palliative care?
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the prevention, relief, reduction or soothing of symptoms of disease throughout the entire course of an illness
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how to promote dignity and self esteem?
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respecting him as a whole person with feelings, accomplishments, passion
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how to promote spiritual comfort and hope?
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patience, treating the family well, being friendly
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an emotional response to frustration of desires, a threat to one's needs?
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anger
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an action or behavior that results in verbal or physical attack?
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aggression
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involves the intentional use of force that results in, or has the potential to result in, injury to another person
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violence
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Nursing interventions for anger should begin when?
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when a person first experiences anxiety
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stages of anger and aggression?
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feeling of vulnerability--->uneasiness--->anxiety--->anger--->aggression--->violence
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intentional intimidation, abuse or neglect of children, adults, or elders by a family member?
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family violence
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5 types of maltreatment?
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1) physical
2)sexual 3)emotional 4)neglect 5)economic |
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a condition for violence requires: ____, ____, ____?
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1) perpetrator
2)victim 3)crisis situation or trigger |
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the most common form of child maltreatment?
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neglect
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characteristics of a vulnerable child?
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<3 years old
perceived as different product of unwanted pregnancy premature prolonged illness |
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characteristics of a vulnerable elder?
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poor mental, physical health
dependent on perpetrator female >75 white, living with relative daughter caring for father who was abusive elder woman cared for by husband who abused previously |
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intimate partner abuse, characteristics of perpetrator:
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history of violence
needs are more important jealousy controls finances alcohol, drugs poor social skills enmeshed and codependent |
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greatest risk of intimate abuse?
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when partner attempts to leave and makes a move toward independence
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cycle of violence
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1) tension building phase-pushing
2) acute battering (beatings, injury) 3)honey moon phase (kind,loving) |
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when you should suspect child abuse?
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bruises, burns, fractures, malnutrition, failure to thrive, pain on urination, school absences, impaired behavior/social interaction
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goals of violence?
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no more violence, protection from abuse, abuse recovery, improved coping, self esteem, social support, pain control
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primary prevention for abuse?
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prevent re-occurrence, education, identify high risk, stressors
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secondary prevention for abuse?
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early intervention in abuse
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tertiary prevention for abuse?
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healing, rehabilitation, providing support
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interventions for abuse?
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safety plan: place to go, how to get there, way to get there, key word, referral's number hotline
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evaluating outcomes of interventions regarding violence?
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acknowledge of abuse
accept interventions perpetrator removed |
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rape trauma syndrome?
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consists of an acute phase and a long term reorganization process that occurs after an actual or attempted sexual assault
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acute phase of RTS?
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occurs immediately after rape, lasts for 2-3 weeks, usually seen by medical provider, somatic symptoms are present, emotional reactions
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expressed style of reaction in the acute phase?
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overt behavior: crying, laughing, restlessness, hysteria, anger, confusion, tenseness
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controlled style of reaction in the acute phase?
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confusion, incoherence, masked facies, calm, shock, numbess, difficulty making decisions
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somatic reaction?
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evidenced within the first several weeks after rape: physical trauma, muscle tension, gi symptoms, gu symptoms
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long term reorganization phase
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occurs 2 or more weeks after the rape consists of intrusive thoughts, increased activity, increased emotional lability and fears and phobias
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assault
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intentional threat that produces fear or a reasonable concern of harm
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sexual assault
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any type of sexual activity without consent
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rape
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nonconsensual anal, vaginal or rectal penetration by force or threat
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stages of assault cycle?
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trigger
escalation crisis recovery depression |
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6 causes of death in minority groups
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cancer
heart disease, stroke chemical dependence diabetes homicides, accidents infant mortality |
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advocacy in healthcare includes:
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protecting rights of patient, promoting whats best, ensuring needs are met, assuring safe staffing
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what principles guide the nursing code of ethics?
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responsibility
advocacy accountability confidentiality |
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owning up to one's actions?
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accountability
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confidentiality
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hippa
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how to decide to take an assignment?
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what is the assignment, characteristics of patient, do i have the expertise, experience, knowledge, geography of assignment, is this temporary? is this a crisis or ongoing pattern? can i take the assignment in good faith?
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nurses have an obligation to report what statutes?
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child abuse, elder abuse, communicable diseases
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most states offer ____ for reporters who report suspected abuse in good faith?
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legal immunity
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workforce advocacy?
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promoting and protecting the occupational safety and health of nurses, using nurse practice acts, political process to influence, providing education regarding employment rights and responsibilities
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workforce advocacy ecosystem model?
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staffing
workflow design personal and social factors physical environment organizational factors |
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how to avoid hospital related deaths?
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rapid response at first sign of decline, care of MI, prevent adverse drug events, prevent central line infections, prevent surgical site infections, prevent VAP
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how to file an incident report?
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address immediate nurse manager, describe all events objectively, never document a report was filed in the medical chart
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tracks accidents and injuries that occur in the facility.
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risk manager
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how to reduce legal liability?
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risk management systems
incident reports |
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defines scope and limitations of practice
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nurse practice act
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when to file an incident report?
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client injury, unanticipated death, malfunction of equipment, adverse reaction, witnessed incompetent practice, refusal of DNR
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taking action to help?
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beneficence
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do no harm
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nonmalfescience
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freedom to make choices?
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autonomy
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faithfulness, loyalty
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fidelity
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trust, open communication
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veracity
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deontology?
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defines actions as right and wrong
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utilitarianism?
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greatest good for the most amount of people
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ethics of care?
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focuses on the nature of relationships, "empathy"
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solving an ethical dilemma?
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is it an ethical dilemma? gather information, clarify values, verbalize problem, ID possible course of action, negotiate a plan, evaluate a plan
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