Depression Flashcards
what is major depression
symptoms that last longer than 2 weeks w/a chg. in fxn
how do we classify major depression (MDD)
anhedonia and a depressed mood
5 of 9 symptoms
mood symptoms of MDD
guilt, worthlessness, helplessness
cognitive symptoms of MDD
can’t make decisions, diminished problem solving
physical symptoms of MDD
vegetative (not sleeping/eating enough, eating too much decreased libido)
decreased levels of NE are responsible for
anergia and anhedonia
decreased levels of serotonin are responsible for
changes in mood
2 neurotransmitters involved in MDD
decreased serotonin and norepinephrine
**key priority for assessing someone with depression
identify suicide risk - anyone w/MDD is risk for suicide
how do you determine risk for suicide on an assessment
ask directly - do you have thoughts of suicide
if pt. states they are having thoughts of suicide what is the follow-up question
have you thought about how you would do that
2 most lethal ways of suicide
gun and hanging
common screening tools to assess depression
PHQ9, Beck inventory, and Hamilton screening tool
assessment guidelines for depression
are they suicidal do they have s/s (can vary from norm) is there a hx of depression determine presence of medical conditions (increase risk for depression) co-morbidities (substance use, anxiety) is there a triggering event (grief) determine cultural/spiritual beliefs
pneumonic for assessing depression
SIGECAPS
***what does SIGECAPS represent
sleep (increase/decrease) interest (diminished) guilt energy (low) concentration (poor) appetite (increase/decrease) psychomotor (agitation/retardation) suicidal ideation
communication guidelines for depression
establish rapport
establish clear times for interaction-set limits-follow through
pt. may need more time to reply - SILENCE IS OKAY
do not be EXCESSIVELY happy and cheery
observe environment (is pt. groomed? encourage a shower - don’t ignore)
never provide trite reassurance’s (this will pass)
red flag for suicide
give away possessions
what is the model of care when incorporating client specific goals
recovery - we want to empower people to lead best possible life
why not give a TCA to someone who is suicidal
due to cardio-toxicity
what can happen if someone suddenly stops taking their SSRI abruptly
withdrawal - become very sick - teach s/s
what is the intervention for safety
observation level
is someone is actively suicidal what observation level will they be on
level 1 - 1:1 within arms length (accompany to shower, bathroom)
what do we want to teach families about depression
s/s
trt. options
medications (alternative therapies)
what do we want to focus on for discharge planning
relapse prevention - identify signs of relapse
an important aspect of intervention for depression
structure - attend groups (milieu therapy)
by engaging in the environment (milieu) they engage in
recovery
those with social supports are less likely to relapse, t or f
true
what is cognitive theory
thoughts influence feelings which influence behaviors
help pt. identify thoughts
one of the last key interventions to work on
social skills therapy - socializing
your active therapeutic agent
milieu (hospital environment) structured - locked units
if pt. is suicidal what it a good tool to Implement
contract for safety (come to staff member)
a contract for safety is a verbal or written contract
it can be either
what will you not see in an inpatient setting
Freud - psychoanalytic therapy; too expensive too much time
what is IPT
interpersonal therapy - focuses on interpersonal relationships (those around you feel better when you are treated for depression)
principles of group therapy
every group has its own culture/values
interaction in the group is for self need
opportunity to learn about yourself
group norms can be
overt - what time the group meets
covert - sit in same chair
nurses role in leading groups
provide boundaries - set limits
make everyone safe
engage people who aren’t motivated
be direct - may need to ask someone to leave
biological trt. for depression
ECT
how often do pt. receive ECT
2-3 trts/week; for 6-12 treatments
ECT is used for this type of dx
eating disorders
those who haven’t responded to meds
major depression with psychosis
bipolar disorders
adverse reaction w/ECT
long-term memory deficits
difficulty remembering the day of treatment
If pt experiences long-term memory deficits w/ECT what should be done
discontinue ECT
1st line of trt for seasonal affective disorder
light therapy - sunlight for 30-60 min/day
how does light therapy work
suppresses melatonin
exercise is a good therapy for depression, t or f
true - increases mood and decreases depression
**short-term evaluation of outcome for depression
reduction in suicidal thoughts
state alternatives to suicide
decrease in severity of symptoms (emotional, cognitive, physical) - sleeping, hydrated…
A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, “No one cares about me anymore. I’m not worth anything.” Select an appropriate initial outcome for the nursing diagnosis Situational low self-esteem, related to feelings of abandonment. The patient will:
A.verbalize realistic positive characteristics about self by (date)
long term goal for care of depression
taking meds (after yr can go off meds and try different strategies) functioning in the community re-establishing relationships
A priority intervention for a patient with major depression is:
B.carefully and unobtrusively observing the patient around the clock.
