bipolar, dep, anxiety Flashcards
1
Q
Sx of bipolar (7)
A
-sx during depressive episodes are consistent with those of major depression
-great risk for suicide
-sx during manic:
:grandiosity
:rapid thoughts, actions, and speech
:sleep disturbances
:spending sprees (reckless)
2
Q
incidence and prevalence (5)
A
- bipolar affects 1% in US 18 yo and older
- ave age of clients experiencing first manic episode is 18-20 yo
- earlier age of onset is associated with worse outcomes, including rapid cycling in adulthood
- lifetime prevalence of bipolar disorder is 3.9%
- rates of morbidity and mortality, particularly for bipolar dep are associated with cardio, cerebrovascular, and resp dz, and other psych illnesses, and substance-use disorders
- associated risk of completed suicide and bipolar illness is 15%
3
Q
etiology of bipolar (5)
A
- combo or interaction of genes
- neurobio
- environment
- life history
- development
4
Q
bio foundations of bipolar (6)
A
- genetic factors
- neuroanatomic
- neurotransmitters
- psych factors
- cog factors
- interpersonal and social rhythm model
5
Q
hypomania (3)
A
- slightly less severe subcategory of mania. differentiating points are that hypomania has no psychotic features and does not impair fn to a level that necessitates hospitilization. most hypomanic episodes in bipolar 2 occur immediately before or after a major depressive episode
- sx are not severe enough to cause marked social or occupational dysfn or to require hospitlilization
- families may collude, feel good, like can do anything in this state, more sexual, more noncompliance cus like it
6
Q
classifications of bipolar (3)
A
- bipolar 1: at least one clinical manic, alternating with major depressive episodes
- bipolar 2: major depressive episode, and at least one hypomanic episode
- cyclothymic disorders: sim to bipolar 1, sx are less severe
7
Q
rapid cycling (5)
A
- ct have 4 or more manic episodes for at least 2 weeks in a single yr
- episodes marked by either partial or full remission for at lesat 2 mo or a switch to an episode of opposite type
- associated with high risk of recurrence and resistance to conventional drug tx
- greater severity of illness and [prominent depressive sx
- part of bipolar 1, don’t do well, more ill, very depressed in that state
8
Q
tx settings for bipolar (5)
A
- acute care: for depression, suicidal, really manic because manic wont sleep or eat and really need physical care
- step-down programs: non-acute, hospital
- day tx programs
- community-based programs
- bipolar is one of the most treatable
9
Q
systematic tx enhancement program for bipolar (4)
A
- implement common clinical practice procedures across a network of clinicians treating large numbers of bipolar ct in diverse tx settings
- determine te most effective strategy for tx of bipolar
- determine which maintenance strategy most effectively prevent recurrences
- provide a systematic means for translation of novel tx and new findings into clinical practice
10
Q
common modalities of psychotherapy (6)
A
- psychoeducation: nurses teach pt about the drugs they will take
- cbt: change thinking and behavior
- family therapy: family very affected, people are very engaging when hypomanic and then switches
- interpersonal and social rhythm therapy (ipsrt)
- CBT, family-focused therapy, and psychoeducation as the most effective relapse prevention
- CBT and IPSRT have the most efficacy in treating residual dep
11
Q
drugs used to tx bipolar (5)
A
- lithium
- anticonvulsant meds: divalproex, carbamasepine, lamotrigine, topiramate
- antipsychotics: olansapine, risperidone, quetiapine, aripiprasole, and ziprasidone
- symbyax: combines olansapine and fluoxetine
- antipsychotics are controversial, but bc sedative and they have major sleep problems need them to sleep
12
Q
nonpharm somatic interventions for tx bipolar (3)
A
- sleep deprivation
- transcranial magnetic stimulation
- vagal nerve stimulation
13
Q
assessments for ct with bipolar (3)
A
-safety: suicide and violence
: physical care is very imp, manic need to be hydrated, fed, all is very fast
-mental statue: affect, thought processes, intellectual fn
: can be psychotic when manic
: affect is euphoric, mood is happy, intellectual fn not affected
-physiologic, psychomotor, behavioral, social activity
: when dep, physio systems all way down/slow
: get constipated from lack of movement and meds
: psychomotor retardation, lack of behavior
: manic become very social, dramatic and bizzare makeup, outlandish outfits
14
Q
Desired outcomes for ct with bipolar (6)
A
- impulse self-control
- aggression self-control
- self-care status: dont care for selves well
- social interaction skills: need to dec social interaction for mania
- concentration: quiet, calm environment for mania
- compliance behavior: need them to stick to med compliance because can be treated, need to teach about meds
15
Q
Nursing interventions related to mania (14)
A
- active listening
- behavior management/overactivity: manage behaviors, slow down for mania, first sign noticed is sleep deprivation-fam should look out for this
- behavior management: sexual: dec sexuality, very sexual with mania
- cognitive restructuring
- coping enhancement: how manage mania
- guilt work facilitation: usually guilt is associated with actions done during mania
- limit setting: set limits, set isolation room for times
- mood management
- self-esteem enhancement
- simple guided imagery
- simple relaxation therapy
- socialization enhancement
- spiritual support
- teaching: disease process
16
Q
indicators that interventions are effective (7)
A
- ct refrains from acting aggressively toward others
- ct ingests adequate cal and fluids, maintains a balance btn rest and activity, and independently manages self-care
- ct participates appropriately in milieu activities and social interactions
- ct expresses a positive sense of self-worth w/o delusions of grandeur
- ct demonstrates logical thought processes
- ct reports reduced anxiety and agitation
- ct adheres to the therapeutic regimen and discusses the importance of doing so after discharge
17
Q
Incidence of depression (3)
A
- affects 14.8 million people 18 yo or older, 6.7% of popn/year
- can develp at any age, ave onset= 32
- dysthymia (chronic mild depression) affects 1.5% of us popn over 18 yo/yr
18
Q
prevalence of depressive disorders (3)
A
- more prevalent in women than in men
- genetics, sociocultural factors, hormones, and other elements may account for this disparity
- women may have more stress hormonal, issues, also seek treatment more than men, postpartum
19
Q
etiology of depressive disorders (5)
A
-genes
-environment
-individual life history
-development
-neurobiologic makeup: definitive exact causes have not yet been discovered
:dec activity in areas of brain that reg emotion
:sim to bipolar in terms of brain anatomy
20
Q
risk factors for depressive disorders (7)
A
- gender: higher in women
- prior episode of depression
- fam hx
- stressful live event
- current substance abuse: vicious cycle where one is always contributing to the other
- medical illness
- few social supports
21
Q
psychodynamic theory (4)
A
- postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others
- they cannot express this anger toward the person or people on whom they feel dependent so their anger turns inward
- anger begins in childhood when basic developmental needs are not met
- freud
22
Q
cognitive theory of depressive disorders (3)
A
-depression is a manifestation of errors in thinking and unrealistic attitudes about self and the world
-cognitive errors that precede mood changes involve thinking wrongly about self, having a negative views bout ability to achieve goals, and being unable to experience pleasure
:negative thinking occurs before depression, hopeless
-self-depreciation and unrealistic expectations cause recurrent dissatisfaction, which leads to depression
23
Q
common sx of depressive disorders (5)
A
-disturbances in daily patterns (sleep, appetite, wt, libido)
:people lay in bed all day, very tired, don’t eat
-disturbances in cognition (attention, memory, thinking)
:elderly dx is often confused with alzheimers
:need to provide written instructions because memory is affected
-disturbances in impulse control (suicide, homicide)
-disturbances in behavior (withdrawal, lack of pleasure, fatigability)
-physical sx such as HA, stomachache, and muscle tension
24
Q
sx of ct with dysthymia (7)
A
: feeling blue, not major depression, mild depression affects many, ongoing sx for 2 year period for dx
- poor appetite or overeating
- low energy
- fatigue
- low self-esteem
- poor concentration
- difficulty making decisions
25
settings of care for clients with depressive disorders (5)
-acute care settings: very depressed not moving, cant perform ADL, depression after suicide attempt
:very sick can't make the simplest of decisions
-step-down programs
-day treatment programs
-community-based programs
-outpatient clinics: for most people
26
beck's cognitive triad of depression (2)
- clients with depression see the future marked by continuing trouble, full of hardship, deprivations, and frustration. The client describes the world as negative, demanding, hostile, and full of obstacles. They view the self as deficient and inadequate and attribute unpleasant experiences to personal defects.
- common rating scale for depression
27
nursing assessment of ct with depressive disorders
-nursing assessment involves systematic, thorough consideration of the ct safety, mental status, and psychological functioning
-also necessitates careful review of physiologic and psychomotor activity, as well as behavioral and social activity
: need to be checking safety, suicide assess, check memory concentration bc affects teaching, mental status exam, check physical needs- constipation
:contract for suicidality, more to get them to talk as opposed to safety
28
factors increasing risk for suicide (7)
-expression of current thoughts, plans about suicide
-active mental illness
-substance abuse
-past hx of suicidal attempts or behaviors
-formulation of a plan
-availability of means for completing suicide
-disruption of important personal relationships
:we see them bc they stop taking their meds because on meds they do well
: depression can be harder to treat, hart to tell if its depression or bipolar in depressive state, self -care is really imp
29
nursing dx for clients with mood disorders (6)
- risk for suicide
- risk for violence toward others
- ineffective health maintenance
- impaired social interaction
- disturbed thought processes
- ineffective therapeutic regimen management
30
nursing outcomes for ct with mood disorders (6)
-suicide self-restraint
-aggression self-control
-self-care status
-social interaction skills: group therapy
-distorted thought self-control
-will to live
: can ask what is the worst that can happen
31
nursing interventions for ct with mood disorders (8)
-active listening
-cognitive restructuring
-coping enhancement
-hope instillation: they matter, give them a reason to live, they have value
-mood management
-self-esteem enhancement
-spiritual support: be careful but may be very helpful with suicide restraint bc of spiritual consequences
-suicide prevention
:pleasurable activities, journaling, relaxing, imagery, knitting,
:if it looked better now what would that look like to you, something to look forward to
:if another person felt like that what would you say to them?
:understanding personal moods go up and down
32
indicators of effective tx (6)
- reports fewer or no suicidal thoughts
- refrains from self-harm or aggression
- independently manages self-care
- participates appropriately in milieu activities
- expresses a pos sense of self-worth: i'm feeling better about myself
- adheres to the therapeutic regimen
33
about anxiety (4)
- we all have it at some point
- fear is a reaction to specific danger
- anxiety if apprehension in response to a real or perceived threat. the actual source may be unknown or unrecognized
- our body reacts the same way to fear and anxiety
34
levels of anxiety (4)
- mild: slightly nervous
- moderate
- severe
- panic
35
mild anxiety (2)
-slight discomfort
-problem solving and perception are improved
: performance is better, this is how anxiety serves us
36
moderate anxiety (3)
-perceptual field narrows
-problem solving ability is impaired
-physical sx-tension, increased pulse, and respirations
:take in less info, make worse decisions
37
severe anxiety (3)
-perceptual field greatly reduced
-unable to learn or problem solve
-intensified somatic complaints
:physically uncomfortable, can't fn, use our defense mech in order to not be in this place
: may be before surgery, upsetting dx, worry about fam member
38
panic level anxiety (4)
- cannot process information
- may lose touch with reality
- disturbed behavior
- automatic behaviors in order to manage
39
mild to moderate anxiety interventions (2)
-be calm and willing to listen
:nurse may feel anxiety but need to remain calm,
-help person to focus and problem solve: "what steps, who should I tell, what would you like to do next?"
40
severe to panic anxiety interventions (4)
-priority is safety: check the safety of the room, calm and quiet is imp
-meet physical needs: enough fluids is imp
-quiet environment
-client is unable to solve probs at this point
: talk very simply, 2 things at a time, written info, understand they can't process new things, be present with them
:need to be very directive, reassuring bc pt cant make own decisions
41
defenses against anxiety (5)
-manage conflict and affect
-unconscious: most are unconscious, deep breathing would be conscious
-discrete: each different from one another
-reversible: dont always stay that way, denial is temporary until pt accepts
-adaptive as well as maladaptive
:manage good feelings by defending against neg feelings
: people with anxiety use these mech over and over again to manage, often seen on medsurg
42
most healthy defense mech (4)
- altruism: makes you feel good/cope to help others
- sublimation: substitute something acceptable for something not acceptable ex: aggressive--play football
- humor: used often in nursing, appropriate but be respectful
- suppression: conscious decision to put feelings away ex at work and need to not focus on personal issues
43
intermediate healthy defense mech (6)
- repression: exclude something unpleasant from consciousness ex nervous for the dentist and forget the apt
- displacement: attributing feelings to something non-threatening ex mad that the dog peed and punishing them but really upset at bf
- reaction formation: out of awareness, by holding opposite opinion ex homophobic gay
- somatization: transfer anxiety to physical sx ex dad gets chest pain on daughters wedding
- undoing: make up for something bad ex brings home flowers after cheating
- rationalization: justifying for actions ex rapist said wouldn't have happened
44
immature defense mech (7)
- passive aggression: not direct, difficult to deal with
- acting out behaviors: lashing out ex rip up pics of ex
- dissociation: feeling unattached to your body ex didn't feel real, i was watching myself
- idealization: fixating on something that will be perfect ex this is the best nurse, she's gonna do the best job, and i will get better
- splitting: all good or all bad ex if the good nurse messes up, all the meds wont work, i wont get better
- projection: putting your emotions onto someone/thing else ex yelling and being upset while saying i don't know why you're getting so upset
- denial: escape from something unpleasant in life, acting like it didn't happen and emotions related aren't there
45
anxiety disorders (3)
- anxiety itself is a normal response. it becomes pathological when it causes intolerable distress or physical sx
- in anxiety disorders, rigid, repetitive and ineffective behaviors are used to control anxiety
- most common psychiatric disorder
- co-morbidity with depression, somatization, and other anxiety disorders
46
panic disorder (3)
- recurrent, unexplained attacks of panic
- physical sx related to sympathetic arousal, real sx of inc pulse, sob, etc
- limited perceptual field, disorganization
47
panic disorder with agoraphobia (2)
- agoraphobia: fear of being somewhere were escape would be difficult
- panic attacks with fear of being somewhere where escape may be difficult or help would not be available
48
phobia (2)
-persistant irrational fear or object, activity, or situation
-specific phobia: provoked by object, fairly common
: bees, insects, spider, snake, clown, flying
49
obsessive-compulsive disorder (2)
-obsession: persistent thought, image, or impulse
: continue to think it, afraid they will do something bad
-compulsion: ritualistic behavior
: can be good and/or pathologic, zoloft
50
GAD (2)
- excessive anxiety or worry for over 6 mo
| - sx: poor concentration, tension, sleep disturbances, restlessness
51
postraumatic stress disorder (5)
-re-experience traumatic event
-sx begin within 3 mo of event
-flashbacks and avoidance of stimuli associated with the trauma
-numbness, detachment
-increased arousal, hypervigilant
: people can id what the event was
: detached- feel part of a different world now, can't get back to normal life
52
acute stress disorder (2)
- 1 month after traumatic event
| - 3 dissociative sx during event : numbness, detachment, amnesia
53
anxiety due to medical conditions
-sx of anxiety are a direct physiological result of a medical condition
: check first if there is a medical reason why anxious
: check vitals, 02-first assess respiratory fn, check blood sugar, lytes, CA, K, NA
: if not an anxious person, and suddenly very anxious r/o medical
: all cardio probs make you feel anxious
54
Medical causes of anxiety (5)
- respiratory: COPD, PE, asthma, hypoxia, pulmonary edema
- cardio: angina, arrhythmia, CHF, hypertension, hypotension, mitral valve prolapse
- endocrine: hyperthyroidism, hypoglycemia, pheochromocytoma
- neuro: delirium, essential tremor, complex partial seizures, parkinson's, akathisia
- metabolic: hypercalcemia, hyperkalemia, hyponatremia
55
nursing process (4)
-assessment: caused by medical condition? is it an anxiety disorder?
-dx: anxiety, ineffective coping, disturbed thought process, social isolation, ineffective role performance
-outcome: what about their stat can you change with nursing interventions
: relax, suport group, deep breathing, monitor intensity (decide where your limit is and respect that)
-interventions: relaxation tech, coping strategies, monitor intensity
56
planning (2)
- mild to mod: encourage ct to be involved
| - severe: nurse may need to be directive
57
advanced practice (10)
- cognitive therapy: problem is an error in thinking so change thoughts ex im gonna fail, would you really fail?
- cognitive restructuring: identify negative beliefs and replace negative self-talk with supportive ideas
- behavioral therapy: relaxation training, modeling: being an example, systematic desensitization: for phobias that you need to be able to manage, thought stopping: use a rubber-band to snap during the neg thought, flooding: smoking, ton of the stimuli so you don't want it anymore, response prevention (OCD): what would happen if you only performed ritual 4x instead of 5x,
- CBT: cognitive behavioral therapy combines cognition with behavior: ex teaching self-monitoring of panic, think logically about the behavior
