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Exam 4 > Depression > Flashcards

Depression Flashcards

1
Q

Depression is characterized by what?

A

A sad despondent mood

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2
Q

Many symptoms are associated with depression, but what are the four main ones?

A
  • Lack of energy
  • Abnormal eating
  • Sleep disturbances
  • Feelings of despair
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3
Q

What are the risk factors of depression?

A
  • Older than 65
  • Stressful life events
  • Poor social support; being unmarried
  • Dysfunctional family relationships
  • Family or previous personal history of mental illness
  • Substance abuse
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4
Q

What are the ways to help prevent depression?

A

No definitive way however these help:

  • Exercise
  • Proper diet and rest
  • Avoiding drugs and illicit drugs
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5
Q

What is MDD?

A

Major depressive disorder

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6
Q

What are the feelings that a patient may described if they have major depressive disorder?

A
  • Sadness
  • Discouragement
  • Hopelessness
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7
Q

What are the clinical manifestations of major depressive disorder?

A
  • Change in several aspects of individuals emotional state and function (2 week time period)
  • Report of somatic complaints or increased anger
  • May consist of a single episode or may reoccur
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8
Q

In order to be diagnosed with Major Depressive Disorder the patient must have 5 or more of these clinical manifestations.

A
  • Depressed mood
  • Sleep disturbance
  • Anhedonia
  • Weight increase or decrease
  • Increase or decrease in motor activity
  • Fatigue
  • Feelings of guilt, worthlessness, self-blame
  • Diminished ability to concentrate
  • Suicidal ideation
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9
Q

Persistent depressive disorder is also called what?

A

Dysthymic disorder

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10
Q

What are the clinical manifestations of Persistent depressive disorder?

A
  • Chronic depression for most days at least for 2 years.
  • Tends to be chronic
  • no more than 2 months symptom free
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11
Q

Are symptoms of persistent depressive disorder more severe than major depressive disorder?

A

No they are less severe

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12
Q

What age ranges tend to experience persistent depressive disorder?

A
  • Childhood
  • Adolescence
  • Early adulthood
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13
Q

When does Seasonal Affective Disorder usually occur?

A

In winder months

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14
Q

What may help modulate rhythms in patients with Seasonal Affective Disorder?

A

Natural light

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15
Q

What does SAD stand for?

A

Seasonal Affective Disorder

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16
Q

How is Seasonal Affective Disorder described?

A

Depressive disorder that relates to seasons

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17
Q

What medication is indicated for SAD?

A

Buproprion

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18
Q

What may Buproprion do for patient with SAD?

A

Prevent major depressive episodes

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19
Q

What may influence medication therapy in patients with depressive mood disorders?

A

Existing medical illnesses

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20
Q

There may not be a test to determine depressive mood disorders but what is available to help diagnose the patient?

A

Screening tools

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21
Q

A diagnosis of depressive mood disorders is done by whom?

A

A licensed mental health provider

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22
Q

A collaborative team to treat patients with depressive mood disorders consists of whom?

A
  • RN
  • MD
  • Pharmacist
  • Psychologist
  • Family
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23
Q

What is the most effective psychotherapy approach for depression?

A

Cognitive-behavioral therapy

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24
Q

Psychotherapy is usually used in addition to what?

A

Medication

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25
Q

Psychotherapy is used alone for patients who have what?

A

Mild depression

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26
Q

Psychotherapy helps clients do what?

A

Manage specific symptoms and promote coping skills

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27
Q

Through psychotherapy a patient can learn how to promote coping skills like what?

A

Postive, helpful patterns of thinking and behavior

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28
Q

What does CBT stand for?

A

Cognitive behavior therapy

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29
Q

What pharmacologic therapy is used to treat depressive disorders?

A

Antidepressant medications

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30
Q

Finding the correct antidepressant medications per patients is typically found through what?

A

Trial and error

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31
Q

How long should a patient be on an antidepressant medication?

A

Until they are symptom free and should slow discontinue the medication

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32
Q

What class does Imipramine belong to?

A

Tricyclic antidepressant

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33
Q

What class does Phenelzine belong to?

A

Monoamine oxidase

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34
Q

What class does Fluoxetine belong to?

A

Selective serotonin reuptake inhibitors

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35
Q

What are the indications of use of Imipramine?

A
  • Depression
  • Enuresis
  • Neuropathic pain
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36
Q

What is the method of action for Imipramine?

A

Inhibit reuptake: norepinephrine and serotonin

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37
Q

What are the contraindication/cautions used for Imipramine?

A
  • CV disease
  • Recent MI
  • Liver dysfunction
  • Angle closure glaucoma
  • Urinary retention
  • History of seizures
  • Pregnancy
  • Manic depression
38
Q

What are the adverse effects of Imipramine?

A
  • Orthostatic hypotension
  • Arrhythmias
  • Sedation
  • Bone marrow depression
  • Anticholinergic effects
39
Q

What are considered anticholinergic effects?

A
  • Constipation
  • Blurred vision
  • Urinary retention
  • Dry mouth
40
Q

What are the drug to drug interactions of Imipramine?

A
  • MAOIs
  • SSRIs
  • St. John’s wort
  • CNS depressants
  • Antihypertensives
  • Sympathomimetics
  • Oral anticoagulants
41
Q

How long does it take for a patient to have a therapeutic effect when taking Imipramine?

A

2-6 weeks

42
Q

True or False:

It is perfectly okay to take any type of drugs without notifying your provider is you are prescribed imipramine?

A

False:

Notify provider before taking other drugs

43
Q

What should you avoid if you are taking Imipramine?

A

Alcohol and other CNS depressants

44
Q

What should you teach a patient if they are prescribed Imipramine?

A
  • Change positions slowly
  • Do not drive until sedative effect known
  • Take at bedtime if sedation occurs
45
Q

What drug would you give a patient experiencing depression related to alcohol and cocaine withdrawal?

A

Imipramine

46
Q

What is the peak of imipramine?

A

2-4 hours

47
Q

What is the mechanism of action for Fluoxetine?

A

Inhibits CNS neuronal reuptake of serotonin with little effect on norepinephrine

48
Q

What are the indications for use for Fluoxetine?

A
  • Depression
  • OCD
  • Panic attacjs
  • Bulimia
  • PMDD
  • Posttraumatic stress disorder
  • Social phobias or anxiety
49
Q

What are the contrraindicaitons/cautions for Fluoxetine?

A
  • Pregnancy
  • Lactation
  • Impaired renal or hepatic function
  • Cardiac disease
  • Diabetes
  • Severely depressed or suicidal patients
50
Q

What are the adverse effects for Fluoxetine?

A
  • Headache
  • Drowsiness
  • Dizziness
  • Insomina
  • Anxiety
  • Tremor
  • Chest pain
  • Agitation
  • Sexual dysfunction
  • Palpitations
  • Increased appetite
  • Hyponatremia
51
Q

What are the drug to drug interactions for Fluoxetine?

A
  • MAOIs
  • TCAs
  • St. Johns Wort
52
Q

How long until the patient will have full benefit from Fluoxetine?

A

Several weeks

53
Q

What is important to monitor for in a patient who is taking Fluoxetine?

A

Changes in behavior and therapy effectiveness

54
Q

What should you get baselines of and monitor for patients who are taking Fluoxetine?

A

LFT
Weight
Electrolytes

55
Q

What should you educate your patients on if they are taking Fluoxetine?

A
  • Notify provider before taking other drugs
  • Report side effects; may increase seizures in those with a history
  • Do not stop drug suddenly
  • Take with food in morning
  • Exercise, restrict caloric intake to avoid weight gain.
56
Q

What are the two considerations when prescribing a patient Fluoxetine ?

A

Serotonin syndrome and Discontinuation Syndrome

57
Q

What is Serotonin syndrome?

A

Overstimulation with serotonin caused by giving other drugs that increase serotonin

58
Q

What are the signs and symptoms of serotonin syndrome?

A
  • Elevated heart rate and blood pressure
  • Agitation
  • Sweating
  • Hyperthermia
  • CV collapse
  • Coma
  • Seizures
59
Q

What is discontinuation syndrome?

A

From abrupt d/c of drug

-Flu like symptoms

60
Q

How can you avoid discontinuation syndrome?

A

Taper over weeks before d/c

61
Q

What is the onset for fluoxetine?

A

Slow

62
Q

What is the peak for fluoxetine?

A

6-8 h

63
Q

What class does Phenelzine belong to?

A

Monoamine oxidase inhibitors (MAOIs)

64
Q

What is the mechanism of action for Phenelzine?

A

Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft

65
Q

What is the indication for use of Phenelzine?

A

Depression- for those unresponsive to or unable to take other anti depressive agents

66
Q

What are the adverse reactions for Phenelzine?

A
  • Dizziness
  • Nervousness
  • Mania
  • Hyperreflexia
  • Tremors
  • Confusion
  • Insomnia
  • Agitation
  • Liver toxicity
  • Nausea/vomiting
  • Constimation
  • Anorexia
  • Weight gain
  • Dry mouth
  • Orthostatic hypotension
  • Hypertension
67
Q

How long until the patient will have a therapeutic effect for Phenelzine?

A

4-8 weeks

68
Q

What are the contraindications/ cautions for use of Phenelzine?

A
  • Pheochromocytoma
  • CV disease
  • HTN
  • Glaucoma
  • Increased intracranial pressure
  • Renal or hepatic impairement
69
Q

What are the drug to drug interactions with Phenelzine?

A
  • Antidepressants
  • Sympathomimetics
  • Insulin or oral anti diabetic agents
  • CNS depressants
  • Opioid analgesics
  • General anesthetics
70
Q

What foods interact with Phenelzine and what happens?

A

Tyramine containing foods cause a hypertensive crisis

71
Q

What is the onset for Phenelzine?

A

Slow

72
Q

What is the duration for Phenelzine?

A

48-96 h

73
Q

What are the other types of therapies that can treat depression?

A
  • Electoconvulsive therapy (ECT)
  • Transcranial magnetic stimulation
  • Alternative or Complementary therapies like St. Johns Wort.
74
Q

What should the nurse focus her process on in patients with depression?

A
  • Safety
  • Therapeutic communication
  • Meeting functional needs like daily hygiene, sleep, nutrition
75
Q

What should you assess for in a patient suspected to have depression?

A

-Symptoms of depression, and a history of manic episodes

76
Q

What are the symptoms of depression?

A
  • Feelings of sadness, tearful, emotional
  • Fatigue
  • Anhedonia
  • Feelings of worthlessness
  • Impaired concentration
  • Excessive sleep
  • Impaired concentration, decision-making ability
  • Appetite changes or GI complaints
  • Somatic concerns
77
Q

Other than symptoms of depression what else should the nurse assess for in a patient suspected to have depression?

A

Comorbities

78
Q

Why should you assess for comorbidities in a patient with depression?

A

To rule out possibility of underlying medical condition like a chronic illness or life-threatening illness

79
Q

What can complicate depression?

A

Use of certain legal and illegal drugs

80
Q

When assessing a child for depression What should you do?

A
  • Rule out physical illness

- Question parents and caregivers

81
Q

Who carries out the initial diagnostic evaluation on a child with depression?

A

Child psychologist or psychiatrist

82
Q

What are useful tools for diagnosis of a child with depression?

A
  • Children’s depression inventory 2
  • Reynolds Child Depression scale
  • Beck depression inventory
83
Q

What should you include in your assessment for an older adult with depression?

A
  • Realize it may be challenging due to polypharmacy

- Use the geriatric depression scale or cornell depression scale

84
Q

Who is the Geriatric Depression Scale used for?

A

Older adults with cognitive impairements

85
Q

Who is the Cornell Depression Scale used for?

A

Adults with severe cognitive impairments

86
Q

What are the diagnoses associated with a patient who has depression?

A
  • Risk for self-directed violence
  • Situational Low Self-Esteem or Chronic Low Self-Esteem
  • Hopelessness
  • Social Isolation
  • Ineffective Health Maintenance
87
Q

What are the client goals for a patient with depression?

A
  • Remain free of injury
  • Refrain from attempts to injury self and others
  • Participate in recreational activities
  • Comply with treatment regimen
  • Articulate steps to feeling better, before beginning to feel better
88
Q

In order for the patient with depression to reach the goal you have set out for them- what must you implement?

A
  • Adopt emotionally neutral attitude while maintaining confidence that client will feel better
  • Be aware of personal feelings and moods
89
Q

Why must you be aware of your own personal feelings or moods when dealing with a patient who has depression?

A

Because you could be at risk for emotional contagion

90
Q

When adopting an emotionally neutral attitude with a patient with depression what should you also be doing?

A
  • Not trivializing the patients feelings
  • Instill hope
  • Improve self-esteem
91
Q

Upon evaluation of a patient with depression- what should you be able to document?

A
  • Client meets daily functional needs appropriately
  • Client does not demonstrate or express suicidal ideation
  • Client describes hopefulness for future
  • Client is able to resume normal activity patterns such as returning to work or school
92
Q

The nurse is caring for a client who is experiencing a major depressive episode. The nurse monitors the client for signs of urinary retention and constipation, knowing that these problems are possible due to which of the following:

  1. Inadequate dietary and fluid intake
  2. Psychomotor retardation and medication
  3. Lack of exercise
  4. Poor dietary choices
A
  1. Inadequate dietary and fluid intake

Exam 4 (13 decks)

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