depression Flashcards
refers to the client’s pervasive and enduring emotional state (subjective)
mood
the outward expression of the client’s emotional state (objective)
affect
outward emotional expression is consistent with mood
congruent affect
outward emotional expression is incompatible with the situation
inappropriate affect
displays a facial expression that is incongruent with mood or situation
inappropriate affect
monimal outward expression is observed
blunted affect
little or slow to respond facial expression
blunted affect
absence of outward emotional expression
flat affect
no facial expression at all
flat affect
a mood disorder that causes a persistent feeling of sadness and loss of interest
depression
natural response to a loss
grief
painful feelings come in waves, often intermixed with positive memories associated with loss
grief
self ssteem is maintained
grief
intense sadness and withdrawal from usual activities
grief and depression
mood and/or interest are decreased
depression
feelings of worthlessness and self loathing are common
depression
how many weeks does a depressive episode last for it to be classified as major depressive disorder
2 weeks
what is the dsm v diagnostic criteria for major depressive disorder
- weeks of depressive episode
- with at least 4 of the following:
anhedonia
appetite disturbance
sleep disturbance
psychomotor agitation or retrdation
fatigue
feelings of worthlessness
recurrent suicidal thoughts
what is another name for persistent depressive disorder
dysthymia
how long should a depressive mood last for it to be categorized as persistent depressive disorder
2 years
what is the dsm v diagnostic criteria for persistent depressive disorder
- depressed mood for at least 2 years
- and at least two of the following
appetite disturbance
sleep disturbance
fatigue
feelings of worthlessness
feelings of hopelessness
poor concentration or difficulty making decision
this mood disturbance generally occurs in younger populations
atypical depression
this depression is more common in women
atypical depression
this depression causes increased appetite and/or weight gain
atypical depression
what are the characteristics of atypical depression
- increased appetite and/or weight gain
- hypersomnia
- leaden paralysis
- extreme sensitivity to interpersonal rejection
this depression occurs often in older adults
melancholic depression
what are the characteristics of melancholic depression
- inability to be cheered up
- anhedonia
- at least three of the following
- depression worse in the morning
- early morning awakening
- psychomotor retardation
- significant anorexia or weight loss
- excessive/inappropriate guilt
this depression has mood disturbance that occurs during the first 30 days postpartum
postpartum depression
what is the predisposing factor for postpartum depression
postpartum depression
what are the characteristics of postpartum depression
- consistent with those of depression
- anxious, irritable, or tearful but also having periods of normalcy
- overconcern or delusional thoughts about baby’s health
this type of depression occurs in conjunction with a seasonal change
seasonal affective disorder
which is more common onset of seasonal depression disorder
spring onset depression
what is the specific etiology for depressive disorders
unknown
what are the monoamine neurotransmitters
serotonin, dopamine, norepinephrine
this monoamine neurotransmitter controls food intake, sleep and wakefulness, regulation of emotions
serotonin
this monoamine neurotransmitter causes changes in attention, learning and memory, sleep and wakefulness mood
norepinephrine
this monoamine neurotransmitter controls motivation, cognition; regulates emotional responses
dopamine
what are the situations when monoamine neurotransmitters get dysregulated
- too few neurotransmitters are released
- neurotransmitters linger too briefly in synapses
- releasing presynaptic neurons reabsorb them too quickly
- conditions in the synapses do not support linkage with post synaptic receptors (monoamine oxidation)
- number of post synaptic receptors have decreased
how much concordance does major depression have between twins
40-50%
how many times are first degree relatives of depressed individuals likely to develop depression in comparison to the general population
3
how does the psychodynamic theory of depression work
it resolves from unresolved grieving in an early stage of the child-parent relationship. the person remains fixated in the anger stage and turns the anger inwards, resulting in a weak ego and punitive superego
people with low self-esteem ,who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience what
depression
this is the most commonly used instrument for assessing symptoms of depression
hamilton depression rating scale
the instrument is designed to be administered by clinicians after a structured or unstructured interview of the patient to determine their symptoms
hamilton depression rating scale
what does a score below generally represent for hamilton depression rating scale
the absence of remission of depression
what does a score between 7 to 17 represent in hamilton depression rating scale
mild depression
what does a score between 18 to 24 represent in hamilton depression rating scale
moderate depression
what does a score 25 and above represent in the hamilton depression rating scale
severe depression
what are the antidepressant types that are used in depression
- selective serotonin reuptake inhibitors
- tricyclic antidepressants
- atypical antidepressants
- monoamine oxidase inhibitors
this antidepressant blocks the reuptake of serotonin
selective serotonin reuptake inhibitors
this antidepressant has fewer sedating anticholinergic and cardiovascular side effects
selective serotonin reuptake inhibitors
how many days of selective serotonin reuptake inhibitor therapy does insomnia decrease
3 days
how many days does it take for selective serotonin reuptake inhibitor normalize appetite
5 to 7 days
how many days does it take for selective serotonin reuptake inhibitor to improve mood, concentration and interest in life
7 to 10 days
what time should you give fluoxetine (prozac) if the patient is nervous
fluoxetine (prozac)
what time should you give fluoxetine (prozac) if the patient is nervous
fluoxetine (prozac)
what time should you give fluoxetine (prozac) if the patient is nervous
fluoxetine (prozac)
what are the nursing implications for fluoxetine prozac
administer in am if patient is nervous
administer in pm if patient is drowsy
monitor for hyponatremia
encourage adequate fluids
report sexual difficulties to physician
when should you administer sertraline (zoloft) if patient is drowsy
pm
what are the nursing implications of sertraline (zoloft)
administer in PM if client is drowsy
encourage use of sugar free beverages or hard candy
drink adequate fluids
monitor hyponatremia
report sexual difficulties to physician
what are nursing implications for paroxetine (paxil)
administer with food
administer in PM if client is drowsy
encourage use of sugar-free hard candy or beverages
encourage adequate fluids
what are nursing implications for citalopram (celexa)
monitor for hyponatremia
administer with food
administer dose at 6 pm or later
promote balanced nutrition and exercise
what are nursing implications for escitalopram
check orthostatic blood pressure
assist client to rise slowly from sitting position
encourage use of sugar free beverages or hard candy
administer with food
what are the selective serotonin reuptake inhibitors for depression
fluoxetine (prozac)
sertraline (zoloft)
paroxetine (paxil)
citalopram (celexa)
escitalopram (lexapro)
this occurs when theres is an inadequate washout period between taking MAOIs and SSRIs or when MAOIs are combines with mepiridine
serotonin syndrome
what are symptoms of serotonin syndrome
change in mental state: confusion and agitation
neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse and muscle paralysis
autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and diaphoresis
this primarily blocks reuptake of norepinephrine and some degree of serotonin reuptake blockage
tricyclic antidepressants
what is the half-life of tricyclic antidepressants
15 - 30 hours
what is the half-life of tricyclic antidepressants
15 - 30 hours
what is the lag period of tricyclic antidepressants
1 to 4 weeks - only then will the symptoms begin to decrease
what is the lag period of tricyclic antidepressants
1 to 4 weeks - only then will the symptoms begin to decrease
what are the tricyclic antidepressants recommended for depression
amitriptyline (elavil)
amoxapine (asendin)
doxepin (sinequan)
imipramine (tofranil)
desipramine (norpramine)
nortriptyline (pamelor)
what are the nursing implications for imipramine (tofranil)
assist client to rise slowly from sitting or supine position
ensure adequate fluids and balanced nutrition
encourage use of sugar free beverages and hard candy
encourage exercise
what are the nursing implications for amitriptyline (elavil)?
assist client to rise slowly from sitting position
administer at bedtime
encourage use of sugar-free beverages and hard candy
ensure adequate fluids and balanced nutrition
encourage exercise
monitor cardiac function
what are the antidepressants given when there is inadequate response to or presence of side effects from SSRIs
atypical antidepressants
what are atypical antidepressants recommended for depression
venlaxafine (effexor)
duloxetine (cymbalta)
buproprion (wellbutrin)
nefazodone (serzone)
mirtazapine (rameron)
this interferes with enzyme metabolism (monoamine oxidase)
monoamine oxidase inhibitors (MAOI)
how long is the lag period of monoamine oxidase inhibitors
2 to 4 week lag period before reaching therapeutic level
how long is the washout period of monoamine oxidase inhibitors
5 to 6 weeks is recommended before changing into another regimen
what are the monoamine oxidase inhibitors
isocarboxazid (marplan)
phenelzine (nardil)
tranylcypromine (parnate)
what are nursing implications for monoamine oxidase inhibitors
assist client to rise slowly from sitting position
administer in AM
administer with food
ensure adequate fluids
perform essential teaching on importance of low tyramine diet
why do you need to have prescriptions and refills in limited amounts for MAOI and cyclic antidepressants
because both MAOI and cyclic depressants are potentially lethal when taken in overdose
what are the numerous drugs that interact with MAOIs
ampetamines
ephedrine
fenfluramine
isoproterenol
meperidine
phenylephrine
phenylpropanolamine
pseudoephedrine
what are the numerous drugs that interact with MAOIs
ampetamines
ephedrine
fenfluramine
isoproterenol
meperidine
phenylephrine
phenylpropanolamine
pseudoephedrine
SSRI antidepressants
tricyclic antidepressants
tyramine
this is a life threatening condition that can result when a client taking MAOIs ingests tyramine containing foods
hypertensive crisis
what is another name for hypertensive crisis
cheese reaction
this is a trace monoamine with indirect catecholamine releasing properties
tyramine
what degrades tyramine so it wont stimulate the sympathetic nervous system
monoamine oxidase
what are the clinical manifestations of hypertensive crisis
severe hypertension (BP>180 mmHg systolic)
hyperpyrexia (T>41C)
tachycardia
diaphoresis
tremors
cardiac dysrhythmias
what is the onset of hypertensive crisis
20-60 minutes after ingestion of tyramine containing foods
what is the drug of choice for hypertensive crisis
phentolamine
what is the management for hypertensive crisis
phentolamine and tyramine-free food (no aged, no cheese, no processed food
what are the cheeses that are not considered as aged cheeses?
cottage cheese, cream cheese, ricotta cheese, processed cheese slices
this involves delivering enough electric impulses to the brain to cause a seizure
electroconvulsive therapy
what are the indications for electroconvulsive therapy
pregnant women
patients with intolerable side effects a therapeutic doses
actively suicidal patients
patients who are unresponsive to pharmacologic antidepressants
what is the mechanism of action of electroconvulsive therapy
electric shocks corrects chemical imbalance in brain by stimulating brain chemistry
what are the pre procedure preparation for electroconvulsive therapy
remove nail polish
npo post midnight
starv iv line
instruct to void before procedure
what are the drugs given prior to the electroconvulsive therapy?
atropine
methohexital (brevital) iv
succinylcholine (anectine) iv
why is atropine given prior to ect?
to reduce secretions during seizure
why is methohexital given prior to ect
to make the procedure painless
why is succinylcholine (anectine) given prior to ect
to relax muscle so it doesnt contract and break bones
what are the criteria of good, induced seizure?
- motor convulsions for at least 20 seconds
- increased heart rate for 30 to 50 seconds
- brain seizure for 30 to 150 seconds
what are the side effects of electroconvulsive therapy
- mild confusion/brief disorientation
- fatigue
- headache
- short term memory loss
what are post procedure care for electroconvulsive therapy
- oxygenate patient with 100% concentration until able to breathe unassisted
- monitor for any respiratory problems
- reorient patient as they return from a groggy state
- administer benzodiazepines if patient is agitated
this psychotherapy focuses on difficulties in relationships such as grieving, role disputes and role assumption
interpersonal therapy
this psychotherapy aims to increase frequency of positive interactions while decreasing negative interactions
behavioral therapy
this psychotherapy focuses on how the patient perceives the future, themselves, their experiences and other people
cognitive therapy
this is the tendency to think only between two polar opposites (e.g., all or none, black or white, etc.)
absolute, dichotomous thinking
this is drawing a conclusion despite the lack of evidence
arbitrary inference
this is when the person concentrate on small detail (mostly negative) while ignoring other more significant details
specific abstraction
this is jumping into conclusions despite having little to no experience about something
overgeneralization
this is undervaluing or overvaluing something (like overvaluing the negative experience while undervaluing the positive experience)
magnification and minimization
this is self-inferencing external events despite having no evidence
personalization
what are general appearance and motor behavior of someone with depression
- looks sad
- slouched with head looking down
- psychomotor retardation
- (+) latency of response
- psychomotor agitation
this is when the patient takes 30 seconds to react to something
latency of responce
this is when patient has slow body movements, slow cognitive processing, and slow verbal interaction
psychomotor retardation
this is when there is increased body movements and thoughts
psychomotor agitation
this means losing any sense of pleasure from any activity
anhedonia
this is when the patient does not care about anyone or anything
apathy
this means negative thinking
pessimism
this means going repeatedly over the same things
rumination
these psychotic hallucinations tell the patient to commit suicide
command hallucination
this is when a patient cannot use cognitive abilities to solve problems or to make decisions due to apathy or pessimism
impaired judgement
what is the number one nursing diagnosis for depression
risk for suicide
how do you provide safety for a depressed patient
- determine suicidal tendencies
- institute suicide precautions by removing harmful items and increasing supervision
t/f:
you should begin patient interaction with several shorter visits
true
t/f:
you should sit with client for a few minutes at interval throughout the day
true
t/f:
you should do try to always converse with the client the entire time
false
It is not necessary for the nurse to talk to clients the
entire time; rather, silence can convey that clients are
worthwhile even if they are not interacting
t/f:
you should always be cheerful around patients and try to cheer them up
Avoid being overly cheerful or trying to “cheer up”
clients
t/f:
you shouldnt ask patients to perform global tasks since its harmful to them
false
how do u build competency for slightly more complex tasks
use the patient’s success in small, concrete steps as basis to increase self esteem
what should u do if the patient is unable to choose between articles of clothing
the nurse selects clothing and directs patient to put them on
what should you do when patient is unable to put on clothing
assist the patient
