Depression

Question 1

what is major depression

Answer 1

symptoms that last longer than 2 weeks w/a chg. in fxn

Question 2

how do we classify major depression (MDD)

Answer 2

anhedonia and a depressed mood

5 of 9 symptoms

Question 3

mood symptoms of MDD

Answer 3

guilt, worthlessness, helplessness

Question 4

cognitive symptoms of MDD

Answer 4

can’t make decisions, diminished problem solving

Question 5

physical symptoms of MDD

Answer 5

vegetative (not sleeping/eating enough, eating too much decreased libido)

Question 6

decreased levels of NE are responsible for

Answer 6

anergia and anhedonia

Question 7

decreased levels of serotonin are responsible for

Answer 7

changes in mood

Question 8

2 neurotransmitters involved in MDD

Answer 8

decreased serotonin and norepinephrine

Question 9

**key priority for assessing someone with depression

Answer 9

identify suicide risk - anyone w/MDD is risk for suicide

Question 10

how do you determine risk for suicide on an assessment

Answer 10

ask directly - do you have thoughts of suicide

Question 11

if pt. states they are having thoughts of suicide what is the follow-up question

Answer 11

have you thought about how you would do that

Question 12

2 most lethal ways of suicide

Answer 12

gun and hanging

Question 13

common screening tools to assess depression

Answer 13

PHQ9, Beck inventory, and Hamilton screening tool

Question 14

assessment guidelines for depression

Answer 14

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

Question 15

pneumonic for assessing depression

Answer 15

SIGECAPS

Question 16

***what does SIGECAPS represent

Answer 16

sleep (increase/decrease)
interest (diminished)
guilt
energy (low)
concentration (poor)
appetite (increase/decrease)
psychomotor (agitation/retardation)
suicidal ideation

Question 17

communication guidelines for depression

Answer 17

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)

Question 18

red flag for suicide

Answer 18

give away possessions

Question 19

what is the model of care when incorporating client specific goals

Answer 19

recovery - we want to empower people to lead best possible life

Question 20

why not give a TCA to someone who is suicidal

Answer 20

due to cardio-toxicity

Question 21

what can happen if someone suddenly stops taking their SSRI abruptly

Answer 21

withdrawal - become very sick - teach s/s

Question 22

what is the intervention for safety

Answer 22

observation level

Question 23

is someone is actively suicidal what observation level will they be on

Answer 23

level 1 - 1:1 within arms length (accompany to shower, bathroom)

Question 24

what do we want to teach families about depression

Answer 24

s/s
trt. options
medications (alternative therapies)

Question 25

what do we want to focus on for discharge planning

Answer 25

relapse prevention - identify signs of relapse

Question 26

an important aspect of intervention for depression

Answer 26

structure - attend groups (milieu therapy)

Question 27

by engaging in the environment (milieu) they engage in

Answer 27

recovery

Question 28

those with social supports are less likely to relapse, t or f

Answer 28

true

Question 29

what is cognitive theory

Answer 29

thoughts influence feelings which influence behaviors | help pt. identify thoughts

Question 30

one of the last key interventions to work on

Answer 30

social skills therapy - socializing

Question 31

your active therapeutic agent

Answer 31

milieu (hospital environment) structured - locked units

Question 32

if pt. is suicidal what it a good tool to Implement

Answer 32

contract for safety (come to staff member)

Question 33

a contract for safety is a verbal or written contract

Answer 33

it can be either

Question 34

what will you not see in an inpatient setting

Answer 34

Freud - psychoanalytic therapy; too expensive too much time

Question 35

what is IPT

Answer 35

interpersonal therapy - focuses on interpersonal relationships (those around you feel better when you are treated for depression)

Question 36

principles of group therapy

Answer 36

every group has its own culture/values interaction in the group is for self need opportunity to learn about yourself

Question 37

group norms can be

Answer 37

overt - what time the group meets | covert - sit in same chair

Question 38

nurses role in leading groups

Answer 38

provide boundaries - set limits make everyone safe engage people who aren't motivated be direct - may need to ask someone to leave

Question 39

biological trt. for depression

Answer 39

ECT

Question 40

how often do pt. receive ECT

Answer 40

2-3 trts/week; for 6-12 treatments

Question 41

ECT is used for this type of dx

Answer 41

eating disorders those who haven't responded to meds major depression with psychosis bipolar disorders

Question 42

adverse reaction w/ECT

Answer 42

long-term memory deficits | difficulty remembering the day of treatment

Question 43

If pt experiences long-term memory deficits w/ECT what should be done

Answer 43

discontinue ECT

Question 44

1st line of trt for seasonal affective disorder

Answer 44

light therapy - sunlight for 30-60 min/day

Question 45

how does light therapy work

Answer 45

suppresses melatonin

Question 46

exercise is a good therapy for depression, t or f

Answer 46

true - increases mood and decreases depression

Question 47

**short-term evaluation of outcome for depression

Answer 47

reduction in suicidal thoughts state alternatives to suicide decrease in severity of symptoms (emotional, cognitive, physical) - sleeping, hydrated...

Question 48

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:

Answer 48

A.verbalize realistic positive characteristics about self by (date)

Question 49

long term goal for care of depression

Answer 49

``` taking meds (after yr can go off meds and try different strategies) functioning in the community re-establishing relationships ```

Question 50

A priority intervention for a patient with major depression is:

Answer 50

B.carefully and unobtrusively observing the patient around the clock.