practice nurs II 353 > depression > Flashcards

depression Flashcards

(59 cards)

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1
Q

depressive disorders are

A

disturbance in psychological, physiological, and social functioning

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2
Q

depression is a

A

wide range of symptoms with disturbance in daily patterns
sleep appetite ADLs weight attention memory libido
impoulse control suiocidal ideation social withdrawal
physical symptoms stomacheache muslce tension

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3
Q

transient depression

A

normal reaction to loss, sadness attributable to a situation or disaapointment - reactive or 2ndary depression

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4
Q

depressive disorder

A

sad mood r/t events or not
s/s from dissatisfaction w life to sudden and abrupt changes in function suppress or take away will to live

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5
Q

most common illness of any type is

A

major depression

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6
Q

major depression avg age

A

32 years old

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7
Q

depression in eldelry

A

major major issue
3.5 % community up to 15-20 in nurs homes
harder to diagnose
NOT a nL consequence of getting old

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8
Q

comorbid w depression

A

schizo, substance abuse, eating disorder, anxiety and personality disorders

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9
Q

depressive risk factors

A

higher in woman than men, past episodes of depression, family history, stressful life event, currrent substance abuse, medical illness, limited social supports

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10
Q

etiology of depression

A

combination or interaction of genetics (inc risk if first degree relatives suffered from depression) and envi

individual life hx development neurobio irregularities in thyroid nalso seen

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11
Q

thalamus

A

associated w changes in emotion and amygdala, inc levels of actiivty in depressed ppl

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12
Q

amygdala

A

overactive in depressed ppl

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13
Q

cingulate gyrus

A

increased activity - helos assiciate smells and sights w past emotions and react to pain or aggression

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14
Q

prefrontal cortexz

A

only one that actually decreased in acitivty - it regulates emotion

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15
Q

MDD

A

potential for pain and suffering in all acts of life, all ages, depressed mood or inability to feel pleasure from previously enjoyed activitiues

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16
Q

diagnosing MDD

A

4/7 symptoms must be present
suicidal ideations, sleep disruptions, appetire or weught disruptuions, concentration disruption, energy disruption, psychomotor agitation or retardation, or excessive guilt/worthlessness
over minumum 2 weeks, can include psychotic catatonic or melancholic features

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17
Q

PDD persistent

A

chronic depressed mood
over one year for children and adolescents
over 2 years for adults and elderly
poor appetite or overeatinng, insomnia or excessive sleep, low energy fatigue, low self esteem, poor concentration, dififclt making deicions, hopelessness

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18
Q

MDD clinical s/s

A

must have depressed mood or loss of interest, avg time 4-12 mo

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19
Q

PDD clin s/s

A

less severe than MDD, presents as lifelong struggle against depression, chronic negative and irritabele, more days than not w s/s at least 2 years

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20
Q

postpartum depression

A

more serious and persistent, lasting weeks or months after end of preg, can emergt anytime during 1st yr post childbirth

higher incidence w previous psych history, untreated can become dangerous for family and affected person, HCP need to screen for it, its treatable, obvious in some but not othetrs

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21
Q

assessment tools

A

beck depression inventory, hamilton depression scale, geriatric depression scale, zung scale

safety first, always assess suicidal risk ideation and intent

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22
Q

key s/s depression

A

depressed mood, anhedonia, anxiety, agitation or retardation, somatic compolaints, vegeative state

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23
Q

anhedonia

A

without pleasure

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24
Q

areas to assess

Study These Flashcards
A

mood affect and thought process

25
mood assessment
subjective report of clients emotional state that impacts current life situation
26
affect assessment
emotional tone the client projects, physical appearance and posture, mood, eye contact, speech, withdrawn, blunted n flat
27
thought processes
insight and judgement, decision making, memory
28
nursing interventions ex
therapeutic communication, couynsel and encourage tx engagement, self care, therapetuic milleu
29
communication
just conveying info thru verbal and nonverbal send n recieve
30
therapeutic communication
nurse demonstrates empathy, effective communication skills, and responds to clients thoughts needs concenrs
31
nontherapeutic comm
nurse responds in ways that cause defensive feelings, misunderstoof controlled and alienated and discourages self expression
32
therapeutic comm ex
giving broad openings, paraphrasing, offering general leads, reflecting feedings, voicing doubts, clarifying, placing events time seq, giving info, encouraging plan formation
33
non therpaeutic comm
social respond, close ended q, changhe subject, belittle, steroytyping, offer false reassurance
34
listening
focus on all behaviors that the client express, watch for verbal and nonverbal, needs energy
35
confronting and setting limits
skill of pointing out in a caring way, discrepencies betwen what client does and says, describe behavior, offer feedback
35
self disclosure
personal info only if therpaeutic purpose - not rlly good idea use it to help client open up keep it brief do not imply you had same XP do not discuss painful situations needs to be appropriate n comfy monitor nonverbals
36
treatmnents
provide safety, both psychotherapy and meds work (most effective combo to treat depresive orders), group therapy or counseling, fam therapy or involvement, ECT CBT and social skills training and mileu therapy
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antidepressants
SSRIs (selective serotonin reuptake inhibitors) first line drugs for depression unless pt med history helps nausea, loss of libido, headache minimal anticholinergic or cardiotoxic effects
38
possible lethal rxn to ssri
serotonin syndrome, can be from ssris TCAs tryptophan dextromorphan or meperidine or MAOIs
39
herb to avoid for serotonin syndrome
st johns wort
39
s/s serotonin syndrome
confusion and disoriention mania n restless rigidity sweating tremors coma even
40
tx of serotonin syndrome
stop all serotogerngic drugs, give anticonvulsants if ordered or serotonin antagonist
41
atypical antidepressants
considered safwer than TCAs or MAOIs second line antidepressants ex trazodone or remeron
42
trycyclic antidepressants TCA
b4 ssris these were first line drugs not used anymore d/t cardiotixic effects and narrow therapeutic window, not used w suicidal pts current uses ae when pt unsuccesful on SSRI or past success w TCAs can be used for pt w GI isue ex elavil
43
MAOIS monoamine oxidase inhibitors
not used since ssris ex nardil may be used for atypical depression for pts who arent responding to others increase tyramine **must educate pt to not eat food hig in tyramine`
44
tyramine associaed w
MAOIs
45
high levels of tyramine lead to
hypertensive crisis
46
counseling
helps clients ID and questin cognitive disrotion encpurages acitivities to improve self esteem encourage exercise encourage supportive relationships probide referrals
47
family therapy
assessment interenton and evlauation of fam patterns of behavior examine parental and child interactions goal is to help fam members ID and change behaviors that maintain depression and dependence among families
48
ECT therapy
used if pharmacology and other tx ineffective seizure produced, modifies neurotransmissions few long term side effects can cause memory loss confusion lasting weeks or months short acting anesthesia and muslc eparalyzing agents no absolute contraindications high risk consent and skill required
49
ECT contraindications
MI CVA intracranial mass
50
ECT useful for
MD and bipolar - especially w psychotic features depression w psychomotor retardation and stupor rapid cycling bipolar disorder schizo especally catatonic pregnant psychotic clients parkinsons
51
ECT nurs care
routine pre and post anesthesia care may need to orient client after awakening provide supportive care for memory loss inform this is not a permanent cure watch for falls as pts are high fall risk after procedure
52
CBT
common tx for depressive disorders, group or individual, help clients identify and correct distrted negative catastrophic thinking, hope is to work actively w clients to change faulty thought paterns
53
milieu therapy
supportive group activities, suicide protection, assertiveness training, assist w groom and hygeine, brief and frequent interpersonal contacts, ensure adequate nutrition, prevent constipation, discourage daytime sleep
54
self assessment of nurse
unrealistic expectations for outcomes, understand of depression as a systemic illness, depressed clients can cause feelings of depression anger and hopelessness, nurses need to care for themselves as well as client
55
health teaching
teach client and family that depression is a legit illness, teach s/s, review meds, relax techniques, appropriate humor
56
outcome criteria
remains safe, reports hope for future, ID precursors of depression, reports improved mood, plans strategies to reduce effects of precusors of depression
57
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